The Interdisciplinary Hospice “Healing the Healer Group”: A Qualitative Study of the Effects of a One-Year Pilot Educational Program (S717)

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

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Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i1.27070 ◽

2019 ◽

Vol 6 (1) ◽

pp. 8-13

Author(s):

Birendra Kumar Yadav ◽

Robin Bahadur Basnet ◽

Anil Shrestha ◽

Parish Mani Shrestha

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Urine Culture ◽

Operation Time ◽

Group A ◽

One Year ◽

Group B ◽

Stone Characteristics ◽

Negative Urine Culture ◽

Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

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Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740925 ◽

2021 ◽

Author(s):

Beniamino Brunetti ◽

Rosa Salzillo ◽

Stefania Tenna ◽

Bruno Brunetti ◽

Mario Alessandri Bonetti ◽

...

Keyword(s):

Functional Outcomes ◽

Locoregional Recurrence ◽

Demographic Data ◽

Exact Test ◽

Significant Difference ◽

Chi Squared ◽

Group A ◽

The Aesthetic ◽

One Year ◽

Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

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Immunity to Diphtheria, Pertussis, Tetanus, and Poliomyelitis in Children with Acute Lymphocytic Leukemia After Cessation of Chemotherapy

PEDIATRICS ◽

10.1542/peds.67.2.222 ◽

1981 ◽

Vol 67 (2) ◽

pp. 222-229 ◽

Cited By ~ 1

Author(s):

A. van der Does-van den Berg ◽

J. Hermans ◽

J. Nagel ◽

G. van Steenis

Keyword(s):

Acute Lymphocytic Leukemia ◽

Lymphocytic Leukemia ◽

First Year ◽

Healthy Children ◽

Healthy Control ◽

Antibody Titers ◽

Group A ◽

One Year ◽

Group B ◽

Antibody Levels

Antibody titers to diphtheria, pertussis, tetanus, and poliomyelitis (types I to III) were measured in previously vaccinated children with acute lymphocytic leukemia in remission after cessation of therapy. The response to revaccination one year after therapy was stopped was also studied. The patients' antibody titers were compared with those of healthy children, matched for age and sex. Two groups of patients were studied: one group (group A, N = 30) was given two drugs (6-mercaptopurine, methotrexate); the other group (group B, N= 19) was given three drugs (6-mercaptopurine, methotrexate, and cyclophosphamide) for maintenance treatment. In general, the patients' antibody titers were lower than those of healthy children, but in most patients they were still at levels considered to be protective. No significant differences in antibody levels between the two patient groups were found. A spontaneous rise in antibody titers in the first year after termination of therapy was not observed. After revaccination the rise in antibody titers was correlated with preexisting antibody titers in the same way in patients as in healthy children, and the antibody titers in patients and in healthy control subjects were on roughly the same level.

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Changing on Patient-Centred Attitudes on Same Students Group; A Qualitative Study

Journal of General Practice ◽

10.4172/2329-9126.1000350 ◽

2018 ◽

Vol 06 (01) ◽

Author(s):

Tontus HO ◽

Nebioglu S

Keyword(s):

Qualitative Study ◽

Group A

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In congenital hypothyroidism bone maturation at birth may be a predictive factor of psychomotor development during the first Year of life irrespective of other variables related to treatment

Acta Endocrinologica ◽

10.1530/eje.0.1490001 ◽

2003 ◽

pp. 1-6 ◽

Cited By ~ 42

Author(s):

M Wasniewska ◽

F De Luca ◽

A Cassio ◽

N Oggiaro ◽

P Gianino ◽

...

Keyword(s):

Congenital Hypothyroidism ◽

Psychomotor Development ◽

First Year ◽

X Rays ◽

Bone Maturation ◽

Gestation Age ◽

Group A ◽

One Year ◽

First Year Of Life ◽

Tsh Levels

OBJECTIVE: To evaluate in a cohort of infants with congenital hypothyroidism (CH): (a) the frequency of bone maturation (BM) retardation at birth and (b) whether BM delay at birth may be considered as a tool to make a prognosis of psychomotor status at the age of 1 Year, irrespective of other variables related to treatment. DESIGN: BM at birth, CH severity and developmental quotient (DQ) at the age of 1 Year were retrospectively evaluated in 192 CH infants selected by the following inclusion criteria: (a) gestation age ranging between 38 and 42 weeks; (b) onset of therapy within the first Month of life; (c) initial thyroxine (l-T(4)) dosage ranging from 10 to 12 microg/kg/day; (d) normalization of serum thyrotropin (TSH) levels before the age of 3 Months; (e) Monthly adjustments of l-T(4) dose during the first Year of life with serum TSH levels ranging from 0.5 to 4 mIU/l; (f) no major diseases and/or physical handicaps associated with CH; (g) availability of both thyroid scanning and knee X-rays at the time of treatment initiation; (h) availability of DQ assessment at an average age of 12 Months. METHODS: BM was considered normal if the distal femur bony nucleus diameter exceeded 3 mm (group A) or retarded if either this nucleus was absent (subgroup B1) or its diameter was <3 mm (subgroup B2). DQ was evaluated with the Brunet-Lezine test. RESULTS: In 44.3% of cases BM was either delayed (23.5%) or severely delayed (20.8%). The risk of BM retardation was higher in the patients with athyreosis than in the remaining patients (41/57 vs 44/135, chi(2)=25.13, P<0.005). BM-retarded infants showed a more severe biochemical picture of CH at birth and a lower DQ at the age of one Year compared with the group A patients. If compared with infants of subgroup B2 those of subgroup B1 exhibited significantly lower T(4) levels at birth and a more frequent association with athyreosis (70.0 vs 30.0%; chi(2)=7.49, P<0.01), whereas DQ was superimposable in both subgroups. CONCLUSIONS: (a) BM at birth is delayed in almost half of CH patients and (b) CH severity per se can affect DQ at the age of 1 Year irrespective of other variables related to therapy.

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Third phase of cardiac rehabilitation: a nurse-based “home-control” model

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2011.173 ◽

2015 ◽

Vol 76 (4) ◽

Author(s):

Sara Albertini ◽

Antonella Ciocca ◽

Cristina Opasich ◽

Gian Domenico Pinna ◽

Franco Cobelli

Keyword(s):

Secondary Prevention ◽

Cardiac Rehabilitation ◽

Cardiac Disease ◽

Educational Program ◽

Control Program ◽

Pharmacological Therapy ◽

Phase 3 ◽

Phone Calls ◽

Third Phase ◽

One Year

Background. Phase 3 is a critical point for cardiac rehabilitation: many problems don’t allow achieving a correct secondary prevention, in particular regarding the relationship between patient and cardiologist. Aiming at ensuring continuity of care of phase 3 cardiac rehabilitation patients, we have developed a telemetric educational program to stimulate in them the will and capacity to become active co-managers of their disease. Methods. Nurses specialized in cardiac rehabilitation, with the collaboration of the general practitioners, contact the patients by scheduled phone calls to collect questionnaires about their health status and the result of biochemistry. All the results are analyzed by the nurses and discussed with each patient (educational reinforcement). The effects of this program of co-management of cardiac disease and secondary prevention are analyzed comparing each patient data at the discharge with data after one year and those coming from our archive (retrospective analysis). Results. The patients enrolled in this study pay much more attention to the amount of food they eat; they tend not to gain weight, and they restart smoking in a reduced proportion compared to patients not enrolled in the study. However, despite having received better information on their cardiac disease, their compliance to physical training, consumption of healthy food, and pharmacological therapy is not improved. Conclusions. This study focuses on the role of a continuous educational program of a cardiac rehabilitation unit after the patient’s discharge. This home control program conducted by nurses specialized in cardiac rehabilitation, with the assistance of cardiologists, psychologists and physiotherapists, and in collaboration with the general practitioner, was quite cheap, and helped maximizing the knowledge of the disease and reinforcing correct life style in the patients. The results are not as good as expected, probably because one year does not represent a sufficient time, or because the educational intervention needs to be improved.

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Amino acid infusion in oligohydromnios and increase in AFI and impact on perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190294 ◽

2019 ◽

Vol 8 (2) ◽

pp. 617

Author(s):

Isha Sunil ◽

Chejerla Sunitha ◽

Harkirat Kaur

Keyword(s):

Amino Acid ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Apgar Scores ◽

Acid Infusion ◽

Amino Acid Infusion ◽

Vaginal Deliveries ◽

Group A ◽

One Year ◽

Group B

Background: Decreased amniotic fluid is related to adverse maternal and perinatal outcomes. The purpose of this study was to evaluate the role of amino acid infusion in patients of oligohydromnios and compare the perinatal outcome in the two groups.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, ASCOMS Hospital, Jammu for a period of one year from October 2017 to September 2018. A total of 50 women with AFI <8 cm were enrolled in the study . They were divided into two groups of 25 each. Group A were given amino acid infusion and Group B were not given any intervention. These were compared for increase in AFI and perinatal outcome.Results: In the present study, the gain in AFI in Group A was 2.32 ± 0.67 and in group B was 1.32 ± 1.03 which was statistically significant. The perinatal outcome was better Group A compared to Group B with decreased incidence of meconium stained liquor, low birth weight, low APGAR scores and NICU admissions and increase in vaginal deliveries as compared to caesarean sections.Conclusions: The present study suggests that parentral transfusion of amino acid in cases of oligohydromnios significantly increases the AFI of the patient and decreases the incidence of caesarean sections, meconium stained liquor, low APGAR scores and NICU admissions.

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Persistence of Antibody Following Immunization of Children With Groups A and C Meningococcal Polysaccharide Vaccines

PEDIATRICS ◽

10.1542/peds.60.5.673 ◽

1977 ◽

Vol 60 (5) ◽

pp. 673-680 ◽

Cited By ~ 1

Author(s):

Martha L. Lepow ◽

Irving Goldschneider ◽

Ronald Gold ◽

Martin Randolph ◽

Emil C. Gotschlich

Keyword(s):

Meningococcal Disease ◽

Geometric Mean ◽

Routine Immunization ◽

Antibody Concentration ◽

Primary Immunization ◽

Booster Immunization ◽

Young Infants ◽

Group A ◽

One Year ◽

Control Of Epidemics

Persistence of antibody following immunization with groups A and C meningococcal polysaccharides was studied in two groups of children. Cohort 1 (20 children, 2 to 11 years of age) received two doses of A vaccine three years apart; cohort 2 (1,345 children, 6 to 8 years of age) received A or C vaccine initially and the heterologous vaccine one year later. No significant reactions were observed. Geometric mean anti-A concentrations one month after primary and booster immunizations in cohort 1 were 8.77 and 13.08 µg/ml, respectively. Mean anti-A concentration declined 32% one year after booster immunization, but then stabilized. Mean anti-A and anti-C concentrations in cohort 2 were 9.35 and 9.12 µg/ml, respectively, one month after primary immunization. Mean anti-A concentration declined to 5.54 and 3.62 µg/ml while anti-C levels fell to 2.35 and 1.47 µg/ml one and four years after immunization. The proportion of children in cohort 2 with ≥ 2.0 µg/ml of anti-A and anti-C four years after immunization were 80% and 40%, respectively. An antibody concentration ≥2.0 µg/ml has been associated with protection against meningococcal disease. The results suggest that routine immunization of young infants with group A vaccine may result in long-lasting immunity. The usefulness of the presently available group C vaccine appears to be limited to the control of epidemics.

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Single-choice or multiple true false questions (Kprime):Direct comparison of online tests in pharmacology over one year (Preprint)

10.2196/preprints.27179 ◽

2021 ◽

Author(s):

Joachim Neumann ◽

Stephanie Simmrodt ◽

Beatrice Bader ◽

Bertram Opitz ◽

Ulrich Gergs

Keyword(s):

Medical Students ◽

Multiple Choice ◽

Test Group ◽

Learning Objectives ◽

Multiple Choice Questions ◽

Online Test ◽

True Answer ◽

Group A ◽

One Year ◽

Group B

BACKGROUND There remain doubts about whether multiple choice answer formats (single choice) offer the best option to encourage deep learning or whether SC formats simply lead to superficial learning or cramming. Moreover, cueing is always a drawback in the SC format. Another way to assess knowledge is true multiple-choice questions in which one or more answers can be true and the student is not aware of how many true answers are to be anticipated (K´ or Kprime question format). OBJECTIVE Here, we compared both single-choice answers (one true answer, SC) with Kprime answers (one to four true answers out of four answers, Kprime) for the very same learning objectives in a study of pharmacology in medical students. METHODS Two groups of medical students were randomly subjected to a formative online test: group A) was first given 15 SC (#1-15) followed by 15 different Kprime questions (#16-30). The opposite design was used for group B. RESULTS The mean number of right answers was higher for SC than for Kprime questions in group A (10.02 vs. 8.63, p < 0.05) and group B (9.98 vs. 6.66, p < 0.05). The number of right answers was higher for nine questions of SC compared to Kprime in group A and for eight questions in group B (pairwise T-Test, p < 0.05). Thus, SC is easier to answer than the same learning objectives in pharmacology given as Kprime questions. One year later, four groups were formed from the previous two groups and were again given the same online test but in a different order: the main result was that all students fared better in the second test than in the initial test; however, the gain in points was highest if initially mode B was given. CONCLUSIONS Kprime is less popular with students being more demanding, but could improve memory of subject matter and thus might be more often used by meidcal educators.

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