Diminishing returns or appropriate treatment strategy? – an analysis of short-term outcomes after pain clinic treatment

Pain ◽  
1997 ◽  
Vol 70 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Huw Talfryn Oakley Davies ◽  
Iain Kinloch Crombie ◽  
John Hallam Brown ◽  
Charles Martin
Keyword(s):  
Treatment Strategy ◽  
Pain Clinic ◽  
Short Term ◽  
Appropriate Treatment ◽  
Diminishing Returns

The Preoperative Prognostic Nutritional Index Predicts Short-Term and Long-Term Outcomes of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-Institution Dataset

2019 ◽  
Vol 37 (2) ◽  
pp. 135-144 ◽  
Author(s):  
Masahiro Sasahara ◽  
Mitsuro Kanda ◽  
Seiji Ito ◽  
Yoshinari Mochizuki ◽  
Hitoshi Teramoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Area Under The Curve ◽  
Prognostic Nutritional Index ◽  
Stage Ii ◽  
Long Term Outcomes ◽  
Short Term ◽  
Nutritional Index ◽  
Appropriate Treatment ◽  
Disease Free

Background/Aims: Identification of nutritional indicators to predict short-term and long-term outcomes is necessary to provide appropriate treatment to patients with gastric cancer. Methods: We designed an analysis of a multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014. We enrolled 842 eligible patients who had stage II/III gastric cancer. The area under the curve (AUC) values were compared among prognostic nutritional index (PNI), calculated as 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3, and its constituents, and the predictive value of preoperative PNI for postoperative short-term and long-term outcomes was evaluated. Results: Preoperative PNI exhibited higher AUC values (0.719) for 1-year survival than its constituents, and the optimal cutoff value was 47. The disease-free and overall survival of patients in the PNI-low group were significantly shorter compared with those in the PNI-high group. The prognostic difference between the PNI-high and PNI-low groups was significantly greater in the subgroup of patients who underwent total gastrectomy. Clinically relevant postoperative complications were more frequently observed in the PNI-low group. Conclusions: The preoperative PNI is a useful predictor reflecting the incidence of complications after gastrectomy and the prognosis of patients with stage II/III gastric cancer.

scholarly journals Effectiveness of a Short-Term Treatment of Oxygen-Ozone Therapy into Healing in a Posttraumatic Wound

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Irene Degli Agosti ◽  
Elena Ginelli ◽  
Bruno Mazzacane ◽  
Gabriella Peroni ◽  
Sandra Bianco ◽  
...  
Keyword(s):  
Oxygen Free Radicals ◽  
Antibacterial Properties ◽  
Term Treatment ◽  
Ozone Therapy ◽  
Short Term ◽  
Short Term Treatment ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
The Right ◽  
Free Radicals Scavenging

Introduction. A number of studies suggest that oxygen-ozone therapy may have a role in the treatment of chronic, nonhealing, or ischemic wounds for its disinfectant and antibacterial properties. Nonhealing wounds are a significant cause of morbidity. Here we present a case of subcutaneous oxygen-ozone therapy used to treat a nonhealing postoperative wound in a young man during a period of 5 weeks.Case Presentation. A 46-year-old man had a motorcycle accident and underwent amputation of the right tibia and fibula. At the discharge he came to our attention to start rehabilitation treatment. At that time the wound was ulcerated but it was afebrile with no signs of inflammation and negativity to blood tests. At 2 months from the trauma despite appropriate treatment and dressing, the wound was slowly improving and the patient complained of pain. For this reason in addition to standard dressing he underwent oxygen-ozone therapy. After 5 weeks of treatment the wound had healed.Conclusion. In patients with nonhealing wounds, oxygen-ozone therapy could be helpful in speeding the healing and reducing the pain thanks to its disinfectant property and by the increase of endogenous oxygen free radicals’ scavenging properties. Compared to standard dressing and other treatments reported in the literature it showed a shorter time of action.

scholarly journals Pediatric Orbital Fractures

2013 ◽  
Vol 6 (1) ◽  
pp. 9-20 ◽  
Author(s):  
Adam J. Oppenheimer ◽  
Laura A. Monson ◽  
Steven R. Buchman
Keyword(s):  
Treatment Strategy ◽  
Orbital Fractures ◽  
Craniofacial Skeleton ◽  
Appropriate Treatment

It is wise to recall the dictum “children are not small adults” when managing pediatric orbital fractures. In a child, the craniofacial skeleton undergoes significant changes in size, shape, and proportion as it grows into maturity. Accordingly, the craniomaxillofacial surgeon must select an appropriate treatment strategy that considers both the nature of the injury and the child's stage of growth. The following review will discuss the management of pediatric orbital fractures, with an emphasis on clinically oriented anatomy and development.

scholarly journals The Role of the Emergency Department in Protecting the Hospital as a Critical Infrastructure in the Corona Pandemic Strategies and Experiences of a Rural Sole Acute-Care Clinic

2020 ◽  
Author(s):  
Stefan O. Kortuem ◽  
Dirk Becker ◽  
Hans-Juergen Ott ◽  
Hans-Peter Schlaudt
Keyword(s):  
Emergency Department ◽  
Critical Infrastructure ◽  
Early Stage ◽  
Short Term ◽  
Care Clinic ◽  
Appropriate Treatment ◽  
Patient Pathways ◽  
Strategic Element ◽  
First Contact

Background. The Klinikum Hochrhein is responsible as a regional sole provider for the acute and emergency medical treatment of more than 170.000 people. Against the background of the pandemic spread of SARS-CoV-2 with expected high patient inflows and at the same time endangering one's own infrastructure due to intraclinical transmissions, the hospital management defined the maintenance of one's functionality as a priority protection objective in the pandemic. An essential strategic element was a very short-term restructuring of the Emergency Department with the objectives of reducing the number of cases within the clinic, detecting COVID-19 cases as sensitively as possible and separating the patient pathways at an early stage. Methods. The present work is a retrospective analysis of the processes and structures established in the Emergency Department between 27 March 2020 and 20 May 2020. In addition, a retrospective descriptive evaluation of the epidemiological and clinical data of the patients is carried out at the time of first contact during the period mentioned above. Results. After establishing a pre-triage with structured algorithms, all confirmed COVID-19 cases were identified before entering the clinic and assigned to an appropriate treatment pathway. Unprotected entry into hospital structures or nosocomial infections were not observed, although almost 35% of patients with confirmed infection were admitted due to other symptom complexes or injuries. 201 inpatient patients were initially isolated without COVID-19 being confirmed. The number of cases in the Emergency Department was 39% lower than the previous year's period, thus avoiding crowding. Discussion. The reduction in the number of cases was strategically intended and is primarily the result of a restrictive indication of in-clinical treatment but supported by a decline in emergency consultations that can be noticed anyway. The proportion of false positive triage results is probably dependent on epidemiological activity and was accepted for safety reasons as sufficient resources were available for isolation. Conclusion. Short-term organizational, spatial and procedural restructuring of the Emergency Department has enabled the clinic to achieve its goal of managing the pandemic. The algorithms we developed are particularly well suited to guarantee the desired level of safety in the case of a high pre-test probability.

scholarly journals The Role of Operation in the Treatment of Boerhaave’s Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Dingpei Han ◽  
Zhuoqiong Huang ◽  
Jie Xiang ◽  
Hecheng Li ◽  
Junbiao Hang
Keyword(s):  
Surgical Treatment ◽  
Length Of Stay ◽  
Treatment Strategy ◽  
Time Interval ◽  
Esophageal Rupture ◽  
Spontaneous Esophageal Rupture ◽  
Appropriate Treatment ◽  
Age Range ◽  
Primary Healing

Purpose. This study aims to discuss the appropriate treatment strategy for spontaneous esophageal rupture. Methods. Clinical data from twenty-one cases were retrospectively analyzed. The parameters included etiology, time interval between onset and treatment, therapy methods, prognosis, and length of stay. Results. The ratio of males/females was 17/4, age range was 32–82 years (mean = 43.1), and the time interval between onset and treatment was as follows: <24 h: nine cases (42.8%); 24–48 h: six cases (28.6%); and >72 h: six cases (28.6%). All patients underwent operative treatment, and the following primary healing rates were achieved: <24 h: 88.9%, 24–48 h: 66.7%, and >72 h: 0. No patients died in this study. All patients were discharged with recovery, and the average hospitalization times were 18.1 days (<24 h), 27.8 days (24–48 h), and 51.2 days (>72 h). Conclusions. Surgical treatment remains an effective method for treating spontaneous esophageal rupture, and the shorter the time interval between onset and treatment, possibly the better the prognosis.

scholarly journals Disordered eating among adolescents with chronic pain: the experience of a pediatric rheumatology subspecialty pain clinic

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Pianucci ◽  
Maitry Sonagra ◽  
Brooke A. Greenberg ◽  
Diana R. Priestley ◽  
Sabrina Gmuca
Keyword(s):  
Chronic Pain ◽  
Logistic Regression ◽  
Disordered Eating ◽  
Pediatric Rheumatology ◽  
Functional Disability ◽  
Patient Characteristics ◽  
Regression Modeling ◽  
Pain Clinic ◽  
Logistic Regression Modeling ◽  
Appropriate Treatment

Abstract Background Disordered eating and chronic pain often co-occur in adolescents, but the relationship between these conditions is not well understood. We aimed to determine the prevalence of and to identify the clinical characteristics associated with the presence of disordered eating among adolescents with chronic musculoskeletal pain (CMP) presenting to a pediatric rheumatology subspecialty pain clinic. Methods This was a retrospective cohort study of pediatric patients presenting to a pediatric rheumatology subspecialty pain clinic for an initial consultation from March 2018 to March 2019. We complemented data from an existing patient registry with secondary chart review for patients identified with disordered eating. We compared patient characteristics based on the presence or absence of disordered eating among adolescents with CMP. Logistic regression modeling was used to determine factors associated with disordered eating. Results Of the 228 patients who were seen for an initial consultation in the pain clinic in 1 year, 51 (22.4%) had disordered eating. Only eight (15.7%) of the 51 patients identified with disordered eating had a previously documented formal eating disorder diagnosis. Through multivariate logistic regression modeling, we found that disordered eating was associated with older age, higher functional disability, presence of abdominal pain, presence of gastrointestinal comorbidities, and presence of anxiety (all p < 0.05). Conclusions Adolescents with chronic pain, especially those who experience gastrointestinal issues, anxiety, and greater functional disability, should be evaluated for disordered eating by the treating clinician in order to ensure timely and appropriate treatment.

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