scholarly journals The Promise and Neglect of Follow-up Care in Obstetric Fistula Treatment in Uganda

2022 ◽  
pp. 37-55
Author(s):  
Bonnie Ruder ◽  
Alice Emasu
Keyword(s):  
International Development ◽  
Participant Observation ◽  
Obstetric Fistula ◽  
Treatment Options ◽  
Success Rates ◽  
Psychosocial Consequences ◽  
Follow Up Care ◽  
Fistula Treatment ◽  
Poor Outcomes

AbstractConsidered the most severe of maternal morbidities, obstetric fistula is a debilitating childbirth injury that results in complete incontinence with severe physical and psychosocial consequences.The primary intervention for women with obstetric fistula is surgical repair, and success rates for repair are reported between 80% and 97%. However, successful treatment is commonly defined solely by the closure of the fistula defect and often fails to capture women who continue to experience urinary incontinence after repair. Residual incontinence post-fistula repair is both underreported and under-examined in the literature. Through a novel mixed-method study that examined clinical, quantitative, and qualitative aspects of residual incontinence post-repair, this chapter draws on in-depth interviews with women suffering with residual incontinence and fistula surgeons, participant observation, and a desk review of fistula policies and guidelines to argue that an inadequate model of fistula treatment that neglects follow-up care exists. We found that obstetric fistula policy has been determined in large part over the years by international development agencies and funding organizations, such as international nongovernmental organizations (INGOs). We argue that the neglect in follow-up care is evident in fistula policy and can be traced to a donor-funded treatment model that fails to prioritize and fund follow-up care as an essential component of fistula treatment, instead focusing on a “narrative of success” in fistula treatment. As a result, poor outcomes are underreported and women who experience poor outcomes are largely erased from the fistula narrative. This erasure has limited the attention, resources, research, and dedicated to residual incontinence, leaving out women suffering from residual incontinence largely without alternative treatment options.

scholarly journals Peri-Implant Bone Loss and Peri-Implantitis: A Report of Three Cases and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Vanchit John ◽  
Daniel Shin ◽  
Allison Marlow ◽  
Yusuke Hamada
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Dental Implant ◽  
Patient Selection ◽  
Treatment Options ◽  
Prevalence Rates ◽  
Review Of The Literature ◽  
Follow Up Care ◽  
Nonsurgical Therapy

Dental implant supported restorations have been added substantially to the clinical treatment options presented to patients. However, complications with these treatment options also arise due to improper patient selection and inadequate treatment planning combined with poor follow-up care. The complications related to the presence of inflammation include perimucositis, peri-implant bone loss, and peri-implantitis. Prevalence rates of these complications have been reported to be as high as 56%. Treatment options that have been reported include nonsurgical therapy, the use of locally delivered and systemically delivered antibiotics, and surgical protocols aimed at regenerating the lost bone and soft tissue around the implants. The aim of this article is to report on three cases and review some of the treatment options used in their management.

Dental Implants and Incisor Bridge Placement in a Dog

2016 ◽  
Vol 33 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Rocco E. Mele ◽  
Anthony Caiafa ◽  
Gregori M. Kurtzman
Keyword(s):  
Dental Implants ◽  
Case Reports ◽  
Treatment Options ◽  
Success Rates ◽  
Endosseous Implants ◽  
Pet Owners ◽  
Endosseous Implant ◽  
Bone To Implant Contact ◽  
Very High

Veterinary dentistry has tended to follow the trends and advancements in the human dental field. As for any procedure performed on a patient, whether human or animal, an informed decision is based on the available evidence regarding treatment options. This is certainly true for the more involved treatments in veterinary dentistry which can include the disciplines of endodontics and dental implantology. A number of published case reports have been accepted by the specialty that endodontic therapy is indeed a predictable and a valuable service that can be offered to pet owners. Oral implantology has become an accepted and predictable procedure in the human dental field and can now be offered to pet owners if performed by suitable trained veterinary clinicians. The success rate for endosseous implant osseointegration is very high in humans. Success rates are also very high in animals used for implantology research. Canine studies have shown good bone-to-implant contact of around 73% in osseointegrated endosseous implants based on histological sections. Radiographic and histological findings demonstrate stable alveolar crestal bone levels after loading endosseous implants for up to 12 months in a dog model. This article discusses use of dental implants in the rostral mandible of a companion dog to replace periodontally diseased incisors, their restoration, to return the animal to full dental function and 3-year follow-up.

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

2021 ◽  
pp. 112067212110128
Author(s):  
Néstor Ventura-Abreu ◽  
Marina Dotti-Boada ◽  
María Jesús Muniesa-Royo ◽  
Jordi Izquierdo-Serra ◽  
Andrea González-Ventosa ◽  
...  
Keyword(s):  
Cox Regression ◽  
Real Life ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Life Outcomes ◽  
Kaplan Meier ◽  
Real Life Setting ◽  
Complete Failure ◽  
Poor Outcomes

Purpose: To evaluate real-life outcomes of XEN45 stent surgery including bleb needling (BN) and surgical bleb revision (SBR). Methods: Retrospective analysis of all XEN45 gel stents implanted in a tertiary glaucoma center with a minimum follow-up of 6 months. The main outcomes were intraocular pressure (IOP), the number of glaucoma medications, postoperative maneuvers like BN, and subsequent SBR. Success was defined as IOP ⩽ 18 and 20% reduction (criterion A), ⩽15 and 25% reduction (criterion B), and ⩽12 mmHg and 30% reduction (criterion C) reached with (qualified) or without (complete) medications at the last visit. Complete failure was defined as additional glaucoma surgery, loss of light perception, or sight-threatening complications. Multivariable Cox regression and Kaplan-Meier survival estimates tests were performed. Results: Fifty-eight eyes with either stand-alone or combined Phaco-XEN surgery were included. Complete success by the different definitions was 50.0% (95% confidence interval, 5.8%–84.5%) (A), 50.0% (5.8%–84.5%) (B), and 25% (0.9%–66.5%) (C) whereas qualified success was 38.3% (1.6%–80.1%), 31.7% (2.0%–71.4%), and 0%, respectively, at the 24-months visit. 30% of cases underwent BN with 5-Fluorouracil, and SBR was performed in 17.5% of eyes. Low IOP levels at 1-month and early BN were significantly associated with success. The highest chance of failure was achieved in the combined Phaco-XEN group undergoing SBR. Conclusions: In our real-life setting, the first month IOP was associated with greater success rates. Although BN obtained improved IOP values, SBR was associated with a greater bleb survival in the stand-alone XEN group. Both BN and SBR had poor outcomes in the combined Phaco-XEN group.

scholarly journals Patient predictors of poor drug sensitive tuberculosis treatment outcomes in Kyiv Oblast, Ukraine

F1000Research ◽  
2019 ◽  
Vol 6 ◽  
pp. 1873 ◽  
Author(s):  
Omowunmi Aibana ◽  
Andrej Slavuckij ◽  
Mariya Bachmaha ◽  
Viatcheslav Krasiuk ◽  
Natasha Rybak ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Good Treatment ◽  
Success Rates ◽  
Patient Factors ◽  
Increased Risk ◽  
Poor Treatment ◽  
Poor Outcomes ◽  
Lost To Follow Up

Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high.     We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default (lost to follow up) or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) were lost to follow up. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 – 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 – 12.43; p 0.01) were at increased risk of poor outcomes. Smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) was also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.

scholarly journals Patient predictors of poor drug sensitive tuberculosis treatment outcomes in Kyiv Oblast, Ukraine

F1000Research ◽  
2018 ◽  
Vol 6 ◽  
pp. 1873
Author(s):  
Omowunmi Aibana ◽  
Andrej Slavuckij ◽  
Mariya Bachmaha ◽  
Viatcheslav Krasiuk ◽  
Natasha Rybak ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Good Treatment ◽  
Success Rates ◽  
Patient Factors ◽  
Increased Risk ◽  
Poor Treatment ◽  
Poor Outcomes ◽  
Lost To Follow Up

Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high.     We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default (lost to follow up) or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) were lost to follow up. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 – 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 – 12.43; p 0.01) were at increased risk of poor outcomes. Frequent alcohol use (OR 1.81; 95% CI 0.93 - 3.55; p 0.08) and smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) were also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.

scholarly journals Long-term outcome following bilateral lateral rectus recession for intermittent exotropia

2014 ◽  
Vol 8 (4) ◽  
pp. 565-568
Author(s):  
Jutima Patlidanon ◽  
Parnchat Pukrushpan ◽  
Supharat Jariyakosol ◽  
Pokpong Praneeprachachon
Keyword(s):  
Lateral Rectus ◽  
Success Rates ◽  
Intermittent Exotropia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Motor Outcome ◽  
Ocular Deviation ◽  
Poor Outcomes

Abstract Background: Bilateral lateral rectus recession is the most common surgical treatment of intermittent exotropia in children. Success rates in previous studies differ because longer follow-up periods may change success rate as the eyes drift out with time. Initial overcorrection was thought to be appropriate management, but the preferred initial postoperative deviation has not been well quantified. Objective: To study long-term outcomes (≥3 years) of bilateral lateral rectus recession for intermittent exotropia and to evaluate factors influencing long-term success. Methods: This retrospective descriptive study reviews patients with intermittent exotropia who underwent bilateral lateral rectus recession with a minimum follow up of 3 years. Long-term motor outcome was classified as good (within 8 prism diopters (PD) of esodeviation and 10 PD of exodeviation), acceptable (exodeviation 11-20 PD), and poor (esotropia >8 PD or exotropia >20 PD). Stereoacuity testing pre- and postoperatively was used to evaluate sensory outcome. Correlation between long-term outcome and various pre- and postoperative factors were analyzed. Results: A total of 59 patients met the selective inclusion criteria. The mean age at time of surgery was 7.1 years with a mean follow-up time of 4.5 years. At the time of the last visit, 69% (41 patients) had good outcomes, 24% (14 patients) had acceptable outcomes, and 7% (4 patients) had poor outcomes. Initial postoperative ocular deviation significantly correlated with long-term outcome (P < 0.05). Mean initial postoperative ocular deviation of patients with good outcome was esodeviation 12.7 PD (range ortho to esodeviation 25 PD). In 45 patients whose stereoacuity could be assessed, 58% (26 patients) had stereoacuity improvement. Conclusion: Good long-term motor outcome can be achieved in 69% of patients following bilateral lateral rectus recession for intermittent exotropia. Initial postoperative ocular deviation correlated with long-term motor success.

scholarly journals Utility of modified Rankin Scale for brain vascular malformations in hereditary hemorrhagic telangiectasia

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
K. P. Thompson ◽  
J. Nelson ◽  
H. Kim ◽  
S. M. Weinsheimer ◽  
D. A. Marchuk ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Modified Rankin Scale ◽  
Gi Bleeding ◽  
History Of ◽  
Measuring Outcomes ◽  
Poor Outcomes

Abstract Background Approximately 10% of hereditary hemorrhagic telangiectasia (HHT) patients harbour brain vascular malformations (VMs). Intracranial hemorrhage (ICH) from brain VMs can lead to death or morbidity, while treatment options for brain VMs also have associated morbidity. The modified Rankin Scale (mRS) may provide an approach to identifying HHT-brain VM patients with poor outcomes, and their predictors. We aimed to measure the relationship between mRS score and brain VM, brain VM number, as well as other aspects of HHT, at enrollment and during prospective follow-up. Methods 1637 HHT patients (342 with brain VMs) were recruited from 14 HHT centres of the Brain Vascular Malformation Consortium since 2010 and followed prospectively (mean = 3.4 years). We tested whether the presence of brain VM, other HHT organ involvement, and HHT mutation genotype were associated with worse mRS scores at baseline and during follow-up, using linear mixed models, adjusting for age, sex, and year of visit. Results Presence of brain VMs was not associated with worse mRS score at baseline and there was no significant worsening of mRS with prospective follow-up in these patients; 92% had baseline mRS of 0–2. HHT-related gastrointestinal (GI) bleeding was associated with worse mRS scores at baseline (0.37, 95% CI 0.26–0.47, p < 0.001), as were history of anemia (0.35, 95% CI 0.27–0.43, p < 0.001) and liver VMs (0.19, 95% CI 0.09–0.30, p < 0.001). Presence of pulmonary arteriovenous malformations (AVMs) was not associated with worse mRS scores at baseline. mRS score was not associated with either HHT genotype (Endoglin vs ACVRL1). Only GI bleeding was associated with a significantly worsening mRS during prospective follow-up (0.64, 95% CI 0.21–1.08, p = 0.004). Conclusion Most HHT-brain VM patients had good functional capacity (mRS scores 0–2) at baseline that did not change significantly over 3.4 mean years of follow-up, suggesting that mRS may not be useful for predicting or measuring outcomes in these patients. However, HHT patients with GI bleeding, anemia history or liver VMs had worse mRS scores, suggesting significant impact of these manifestations on functional capacity. Our study demonstrates the insensitivity of the mRS as an outcomes measure in HHT brain VM patients and reinforces the continued need to develop outcomes measures, and their predictors, in this group.

scholarly journals Active septic arthritis of the hip in adults: what’s new in the treatment? A systematic review

2021 ◽  
Vol 6 (3) ◽  
pp. 164-172
Author(s):  
Fabio D’Angelo ◽  
Luca Monestier ◽  
Luigi Zagra
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Success Rate ◽  
Treatment Options ◽  
Success Rates ◽  
Two Stage ◽  
Search Terms ◽  
Timely Treatment

Treatment of bacterial septic arthritis in the native adult hip joint can be challenging. Prompt diagnosis and treatment decisions can reduce the associated morbidity and mortality. For this systematic review of the literature, we asked: (1) What are the treatment options? (2) What are the success rates and the outcomes after treatment? (3) Which antibiotic and duration of therapy are optimal? We searched the electronic databases PubMed, Scopus, and Embase using the search terms “hip” or “native hip” and “septic arthritis” or “coxitis”. Studies were included if they reported on: (1) bacterial infection of the hip, (2) treatment, (3) success rate/outcomes, (4) follow-up. The final review included 19 studies. The quality of study reporting was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire. Three treatment options are: arthroscopy, single open surgery, and two-stage total hip arthroplasty (THA). A high success rate in infection eradication was reported for all three. Intravenous antibiotic therapy should be promptly initiated to eradicate septic arthritis and minimize potential sequelae and complications. Arthroscopy, single open or two-stage THA were reported to be effective in treating bacterial septic arthritis of the native hip. The key to optimal outcome is early diagnosis and timely treatment. Cite this article: EFORT Open Rev 2021;6:164-172. DOI: 10.1302/2058-5241.6.200082

Urban Study Uses Follow-Up Care to Prevent RSV

2007 ◽  
Vol 41 (1) ◽  
pp. 23
Author(s):  
BRUCE K. DIXON
Keyword(s):  
Urban Study ◽  
Follow Up Care
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