scholarly journals Implementation of a multidisciplinary infections conference improves the treatment of spondylodiscitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
D. Ntalos ◽  
B. Schoof ◽  
D. M. Thiesen ◽  
L. Viezens ◽  
H. Kleinertz ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Treatment Strategies ◽  
Autologous Bone Graft ◽  
Treatment Modalities ◽  
Post Intervention ◽  
Operative Revision ◽  
Significant Difference ◽  
Spinal Segments ◽  
Patient Groups ◽  
Single Discipline

AbstractEstablishing a multidisciplinary approach regarding the treatment of spondylodiscitis and analyzing its effect compared to a single discipline approach. 361 patients diagnosed with spondylodiscitis were included in this retrospective pre-post intervention study. The treatment strategy was either established by a single discipline approach (n = 149, year 2003–2011) or by a weekly multidisciplinary infections conference (n = 212, year 2013–2018) consisting of at least an orthopedic surgeon, medical microbiologist, infectious disease specialist and pathologist. Recorded data included the surgical and antibiotic strategy, complications leading to operative revision, recovered microorganisms, as well as the total length of hospital and intensive care unit stay. Compared to a single discipline approach, performing the multidisciplinary infections conference led to significant changes in anti-infective and surgical treatment strategies. Patients discussed in the conference showed significantly reduced days of total antibiotic treatment (66 ± 31 vs 104 ± 31, p < 0.001). Moreover, one stage procedures and open transpedicular screw placement were more frequently performed following multidisciplinary discussions, while there were less involved spinal segments in terms of internal fixation as well as an increased use of intervertebral cages instead of autologous bone graft (p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most frequently recovered organisms in both patient groups. No significant difference was found comparing inpatient complications between the two groups or the total in-hospital stay. Implementation of a weekly infections conference is an effective approach to introduce multidisciplinarity into spondylodiscitis management. These conferences significantly altered the treatment plan compared to a single discipline approach. Therefore, we highly recommend the implementation to optimize treatment modalities for patients.

Craniopharyngioma: a comparison of tumor control with various treatment strategies

2010 ◽  
Vol 28 (4) ◽  
pp. E5 ◽  
Author(s):  
Isaac Yang ◽  
Michael E. Sughrue ◽  
Martin J. Rutkowski ◽  
Rajwant Kaur ◽  
Michael E. Ivan ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Treatment Strategies ◽  
Group Versus ◽  
Outcome Data ◽  
Treatment Modalities ◽  
Rank Test ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Log Rank Test ◽  
Significant Difference

Object Craniopharyngiomas have a propensity to recur after resection, potentially causing death through their aggressive local behavior in their critical site of origin. Recent data suggest that subtotal resection (STR) followed by adjuvant radiotherapy (XRT) may be an appealing substitute for gross-total resection (GTR), providing similar rates of tumor control without the morbidity associated with aggressive resection. Here, the authors summarize the published literature regarding rates of tumor control with various treatment modalities for craniopharyngiomas. Methods The authors performed a comprehensive search of the English language literature to identify studies publishing outcome data on patients undergoing surgery for craniopharyngioma. Rates of progression-free survival (PFS) and overall survival (OS) were determined through Kaplan-Meier analysis. Results There were 442 patients who underwent tumor resection. Among these patients, GTR was achieved in 256 cases (58%), STR in 101 cases (23%), and STR+XRT in 85 cases (19%). The 2- and 5-year PFS rates for the GTR group versus the STR+XRT group were 88 versus 91%, and 67 versus 69%, respectively. The 5- and 10-year OS rates for the GTR group versus the STR+XRT group were 98 versus 99%, and 98 versus 95%, respectively. There was no significant difference in PFS (log-rank test) or OS with GTR (log-rank test). Conclusions Given the relative rarity of craniopharyngioma, this study provides estimates of outcome for a variety of treatment combinations, as not all treatments are an option for all patients with these tumors.

scholarly journals GCT-23. MULTI-INSTITUTIONAL ANALYSIS OF TREATMENT MODALITIES IN BASAL GANGLIA AND THALAMIC GERMINOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii332-iii332
Author(s):  
Richard T Graham ◽  
Mohammad H Abu-Arja ◽  
Joseph Stanek ◽  
Ute Bartels ◽  
Andrea Cappellano ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Institutional Analysis ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Event Free Survival ◽  
Free Survival ◽  
Combine Chemotherapy ◽  
Imaging Characteristics ◽  
Significant Difference

Abstract BACKGROUND Central nervous system (CNS) germinomas are radiotherapy (RT)-sensitive tumors with excellent survival. Current treatment strategies combine chemotherapy with RT to reduce the field and dose of RT. There is no standard treatment for germinomas originating in the basal ganglia/thalami (BGTG) given their rarity and poorly-defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have been previously utilized; however, the optimal strategy remains unclear. METHODS Retrospective multi-institutional analysis was conducted across 18 institutions in four countries. RESULTS For 46 cases with non-metastatic BGTG, the event-free survival (EFS) was 86.9% at both 5 and 10 years, while overall survival (OS) was 100%, and 95.7% respectively at 5 and 10 years. Median RT dose and range for the various treatment volumes were as follows: CSI (n=10): 2340 cGy (1980–3060 cGy), WBI (n=8): 2340 (1800–3000 cGy), WVI (n=14): 2340 cGy (1800–2550 cGy), focal (n=9): 3600 cGy (3060–5400 cGy). There was no statistically significant difference in the EFS based on RT modality (p=0.57), but EFS for subjects with CSI and WBI were both 100%. The three subjects who received chemotherapy alone had significantly lower EFS than those who received chemotherapy and RT (p=0.001), but were salvageable with RT. CONCLUSION In the largest study to date for BGTG, there were no significant differences in outcomes between patients who received CSI, WBI, WVI or focal RT. This group of patients should be included in future prospective clinical trials, and a more limited RT field may be considered.

scholarly journals Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

2022 ◽  
Vol 1 (1) ◽  
pp. 1-14
Author(s):  
Oluseun Olufade
Keyword(s):  
Corticosteroid Injection ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Post Intervention ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Operative Strategies ◽  
Greater Trochanter Pain Syndrome ◽  
Clinically Significant

Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.

scholarly journals Clinical Evaluation of Preoperative Embolization, Vertebroplasty, and Decompression in the Treatment of Aggressive Vertebral Hemangiomas

2020 ◽  
Author(s):  
Derong Xu ◽  
Yongming Xi ◽  
Chuanli Zhou ◽  
Kai Zhu ◽  
Xuexiao Ma
Keyword(s):  
Treatment Plan ◽  
Treatment Strategies ◽  
Preoperative Embolization ◽  
Efficacy And Safety ◽  
Operative Blood Loss ◽  
Operative Duration ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Vertebral Hemangiomas

Abstract Background: Symptomatic aggressive vertebral hemangioma often requires clinical treatment; however, there is great controversy over the treatment plan. We aimed to evaluate the efficacy and safety of different methods including preoperative emobilization, vertebroplasty, decompression and internal fixation in the treatment of aggressive hemangioma.Methods: A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to 3 groups according to the treatment strategies: patients in Group A underwent embolization before decompression, patients in Group B underwent decompression with vertebroplasty, patients in Group C received all three treatments. Clinical indexes were compared within 3 groups.Results: There were 6 patients received embolization and decompression (Group A), 9 patients underwent decompression with vertebroplasty (Group B) and 6 patients in Group C. The operative duration of patients in group A (198.33±38.43 min) were less than another two groups (P=0.001). The intra-operative blood loss of patients in group C was 713.33±165.13ml, which was significantly less than group A and group B (P=0.045). Patients in group C exhibited the lowest volume of drainage on POD 1 (178.33±66.76ml), which showed significant difference compared with group A (368.33±191.15ml, P=0.01). There was no significant difference of pre-operative and post-operative VAS and JOA score among 3 groups, as well as drainage on POD 2, total volume and hospital duration.Conclusion: The treatment strategy of combined embolization, vertebroplasty and decompression fixation is efficient and safe. For special patients, if such a strategy cannot be adopted, simple embolization plus decompression or vertebroplasty plus decompression is also competent.

scholarly journals Molar Incisor Hypomineralization from Inception to Intervention–Evidence Based Review

2021 ◽  
pp. 113-125
Author(s):  
Rana A. Alamoudi
Keyword(s):  
Oral Health ◽  
Wide Spectrum ◽  
Treatment Plan ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Tailored Treatment ◽  
Dental Practitioners ◽  
Molar Incisor Hypomineralization

Background: Molar Incisor Hypomineralization (MIH) is considered a highly prevalent clinical problem worldwide. The etiology of MIH involves a complex interaction between systemic and environmental insults with possible genetic contribution. Early diagnosis is facilitated by collaboration between clinicians responsible for oral health management of the patient and is the key for enhancing the long-term prognosis and quality of life of affected children. MIH management is a formidable oral health challenge due to the wide spectrum of clinical presentation with the need for tailored treatment for the child affected by MIH condition. Objective: To provide dental practitioners with an updated and evidence-based overview of MIH etiology, diagnosis, and treatments modalities available for its management. Conclusion: In this review, recent clinical evidence on MIH etiology, diagnosis and treatment is presented. Given recent availability of sophisticated technologies there is an increasing number of treatment modalities now at the fingertips of all oral health clinicians alike, ranging from preventive measures, management of hypersensitivity to advanced restorative techniques. The tailored treatment plan should encompass a short and long-term approach requiring more frequent dental check-ups in order to achieve better outcomes and prognosis. Future translational clinical research to best practice that will enhance our understanding of the exact causes of MIH and allow development of standardized diagnostic criteria as well as optimal treatment strategies are warranted.

scholarly journals Mandibular Coronoid Fractures, How Rare?

2015 ◽  
Vol 16 (3) ◽  
pp. 222-226 ◽  
Author(s):  
Tejraj Pundalik Kale ◽  
SM Kotrashetti ◽  
JB Lingaraj ◽  
Vipin Aggarwal
Keyword(s):  
Treatment Strategies ◽  
Mouth Opening ◽  
Objective Evaluation ◽  
Coronoid Process ◽  
Treatment Modalities ◽  
Mandibular Fractures ◽  
Lower Face ◽  
Limited Mouth Opening ◽  
Significant Difference ◽  
Coronoid Fractures

ABSTRACT Background To study the rarity of mandibular coronoid process fractures and treatment strategies based on the displacement of these fractures. Materials and methods A retrospective study of 11 cases of coronoid process fractures among 307 treated cases from 2008 to 2013 was conducted. Six patients were treated conservatively and 5 underwent ORIF with associated fractures. A statistical analysis of the data obtained after subjective and objective evaluation was done. Results The incidence of coronoid process fractures was 3.58% of all mandibular fractures analyzed. There was no statistically significant difference found between two treatment modalities, but differences in maximum interincisal opening (MIO) and pain in the postoperative period were significant. Conclusion We recommend that linear coronoid fractures with minimal displacement can be managed with conservative treatment. For patients with significant displacement of coronoid process, limited mouth opening or concomitant mid-face or lower-face fractures, rigid internal fixation is recommended. How to cite this article Kale TP, Aggarwal V, Kotrashetti SM, Lingaraj JB, Singh A. Mandibular Coronoid Fractures, How Rare? J Contemp Dent Pract 2015;16(3):222-226.

New Trends and Developments in Patients with Severe Aortic Stenosis – Towards Optimal Treatment?

2009 ◽  
Vol 5 (2) ◽  
pp. 81 ◽  
Author(s):  
Martijn WA van Geldorp ◽  
Johanna JM Takkenberg ◽  
Ad JJC Bogers ◽  
A Pieter Kappetein ◽  
◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Tissue Doppler ◽  
Doppler Imaging ◽  
Treatment Modalities ◽  
Diagnostic Tools ◽  
Number Of Patients ◽  
Transcatheter Valve

Over the next few decades the number of patients diagnosed with aortic stenosis is expected to rise as the population ages and the use of several diagnostic tools expands. This will result in a growing need for both medical and surgical treatment and stimulate the development of new diagnostic and surgical techniques. This article briefly describes the prevalence, pathogenesis and clinical presentation of patients with aortic stenosis and focuses on developments in diagnostic tools, treatment strategies and treatment modalities: the use of echocardiography, tissue Doppler imaging, stress testing and biomarkers is discussed, as well as timing of surgery and the role microsimulation can play in prosthesis selection. Furthermore, newly developed transcatheter valve implantation techniques and their possible role in treating ‘inoperable’ or ‘elderly’ patients are discussed.

scholarly journals Using the Life Story Book With Mentally Alert Residents of Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 487-487
Author(s):  
Theresa Chrisman
Keyword(s):  
Depressive Symptoms ◽  
Nursing Homes ◽  
Meaning In Life ◽  
Life Story ◽  
Well Being ◽  
Post Intervention ◽  
Significant Difference ◽  
Wilks Lambda ◽  
Potential Benefits ◽  
Hispanic White

Abstract Depression and lack of meaning in life (MIL) are common among residents of nursing homes (NHs) and contribute to a reduction in overall health and well-being. Life Story Book (LSB), a reminiscence intervention, is designed to provide a person with the opportunity to review their past and capture their life stories and photographs into a book. LSB has demonstrated positive outcomes for residents of NHs with dementia, yet little is known for residents without dementia. A switching replication design was used to examine the effects of LSB among 21 mentally alert residents from two NHs (NH-A and NH-B) in Houston, Texas. Participants in NH-A received three weeks of the LSB intervention, while NH-B received three weeks of care-as-usual; the intervention was then switched. The GDS-12R and the MIL questionnaire (MLQ) were used to measure depressive symptoms and MIL respectively. Participants from NH-A (n =11) and NH-B (n = 10) had a mean age of 75 years (SD =11.34); 81% female; 52% non-Hispanic white and 33% African American. Results from a one-way MANCOVA found no statistically significant difference on the GDS-12R and MLQ (F(3, 14) = 2.50, p = .102; Wilks’ Lambda = .652; η2 = .35). Further analyses comparing the pre-intervention and post-intervention scores for the entire sample (N =21) found a significant reduction in depressive symptoms (M = 2.67; SD = 2.52) and (M =1.67, SD = 2.29); (t (20) = 2.21, p = 0.039). The potential benefits of LSB for mentally alert residents of NHs warrants further research.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Effect of “Spatially Separated Speech in Noise Training” on speech perception in noise in children with bimodal fitting

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Younes Lotfi ◽  
Mahdieh Hasanalifard ◽  
Abdollah Moossavi ◽  
Enayatollah Bakhshi ◽  
Mohammad Ajalloueyan
Keyword(s):  
Speech Perception ◽  
Intervention Group ◽  
Auditory Training ◽  
Control Group ◽  
Interventional Study ◽  
Post Intervention ◽  
Speech Perception In Noise ◽  
Speech In Noise ◽  
Significant Difference ◽  
Recognition Ability

Abstract Background The objective of this study was to evaluate the effect of “Spatially separated speech in noise” auditory training on the ability of speech perception in noise among bimodal fitting users. The assumption was that the rehabilitation can enhance spatial hearing and hence speech in noise perception. This study was an interventional study, with a pre/post-design. Speech recognition ability was assessed with the specific tests. After performing the rehabilitation stages in the intervention group, the speech tests were again implemented, and by comparing the pre- and post-intervention data, the effect of auditory training on the speech abilities was assessed. Twenty-four children of 8–12 years who had undergone cochlear implantation and continuously used bimodal fitting were investigated in two groups of control and intervention. Results The results showed a significant difference between the groups in different speech tests after the intervention, which indicated that the intervention group have improved more than the control group. Conclusion It can be concluded that “Spatially separated speech in noise” auditory training can improve the speech perception in noise in bimodal fitting users. In general, this rehabilitation method is useful for enhancing the speech in noise perception ability.

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