scholarly journals Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience

2022 ◽  
Author(s):  
Apratim Chatterjee ◽  
Anshu Mahajan ◽  
Vinit Banga ◽  
Piyush Ojha ◽  
Gaurav Goel
Keyword(s):  
Cost Effective ◽  
Stent Migration ◽  
Hematoma Expansion ◽  
Technical Aspects ◽  
Single Center Experience ◽  
Level Of Consciousness ◽  
Resource Poor ◽  
Wide Availability ◽  
Cost Effective Alternative

AbstractStent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.

scholarly journals Robotic hepatectomy is a safe and cost-effective alternative to conventional open hepatectomy: A single center experience

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S186-S187
Author(s):  
J. Hawksworth ◽  
N.P. Llore ◽  
M.L. Holzner ◽  
P. Radkani ◽  
E. Mesler ◽  
...  
Keyword(s):  
Cost Effective ◽  
Effective Alternative ◽  
Single Center ◽  
Robotic Hepatectomy ◽  
Single Center Experience ◽  
Open Hepatectomy ◽  
Cost Effective Alternative

Effective Pharmacist led interventional strategies to improve outcomes in hypertensive patients: a narrative review

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Samra Bashir ◽  
Akash Syed
Keyword(s):  
Pharmaceutical Care ◽  
Cost Effective ◽  
Pharmacist Intervention ◽  
Care Plan ◽  
Hypertensive Patients ◽  
Disease Outcomes ◽  
Cost Effective Alternative ◽  
The Impact

The role of pharmacist intervention as a cost-effective alternative to physician in disease management is increasingly been recognized. Studies have demonstrated that pharmaceutical care can improve drug therapy as well as patient satisfaction in chronic health conditions including cardiovascular diseases. This study is aimed to review and outline a comprehensive pharmaceutical care plan from the randomized controlled trials previously conducted to assess the impact of pharmacist-managed care on disease outcomes in hypertensive patients. Compared with usual care, the pharmaceutical intervention involved patient evaluation, patient education and counselling, medication review and management, patient monitoring and follow-up, and feedback to the primary physician as major strategies.

Monetary Incentives to Improve Follow-up Data Collection

1986 ◽  
Vol 58 (3) ◽  
pp. 739-742 ◽  
Author(s):  
F. Matthew Kramer ◽  
Robert W. Jeffery ◽  
Mary Kaye Snell
Keyword(s):  
Data Collection ◽  
Statistical Power ◽  
Cost Effective ◽  
Monetary Incentives ◽  
Size Estimation ◽  
Causal Inferences ◽  
Effect Size Estimation ◽  
Power Effect ◽  
Cost Effective Alternative

Loss of subjects during follow-up is a frequent occurrence in outcome research on habit disorders. This attrition may have undesirable effects on statistical power, effect-size estimation, and causal inferences. The present study investigated the effects of offering subjects a monetary incentive of $0.00, $5.00, or $15.00 as a cost effective alternative to normal follow-up procedures for attending a scheduled follow-up meeting. The results indicate that these modest incentives did not significantly enhance attendance at the follow-up visit. Suggestions for future applications of monetary incentives in follow-up data collection are provided.

Application of covered stent graft in the treatment of complex carotid artery lesions: A single center experience

Vascular ◽  
2021 ◽  
pp. 170853812110409
Author(s):  
Changya Liu ◽  
Yin Shen ◽  
Kang Qian ◽  
Yueyun Hu ◽  
Xuebin Hu ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Perioperative Complications ◽  
Stent Migration ◽  
Covered Stent ◽  
Parent Artery ◽  
Imaging Features ◽  
Stent Grafts ◽  
Single Center Experience ◽  
Carotid Artery Lesions

Purpose To assess the clinical efficiency and imaging outcome of applying covered stent grafts for the treatment of complex carotid artery lesions. Method A total of 39 consecutive patients with carotid artery lesions treated with covered stent grafts at our institution from December 2016 to December 2019 were reviewed. Two kinds of stent including self-expandable covered stent (Viabahn; W. L. Gore & Associates) and balloon-expandable covered stent (Willis; Microport) were applied. The angiograms immediately after the procedure, perioperative complications, and follow-up outcomes were recorded. Result Based on imaging features, 11 patients exhibited pseudoaneurysms, 23 patients had blood blister-like aneurysms (BBAs), and five patients were carotid cavernous fistulas. A total of 40 stent implantations were performed, including nine Viabahn stents and 31 Willis stents. Two patients received double implants of Willis stents. Stent failed to perform for one patient due to tortuous parent artery. The angiography reports immediately after the procedure showed that the lesions in 36 patients were completely occluded, whereas two patients had minimal endoleaks. With respect to the occurrence of procedural complications, an aneurysm ruptured during the procedure in one case, which resulted in CCF, and acute in-stent thrombosis occurred in another case. Clinical and angiographic follow-up (11.2±2.4 months) sessions were conducted for 38 patients and a complete lesion exclusion was achieved in 36 patients. The minimal endoleak persisted in one patient and another patient experienced recurrence with stent migration, leading to ipsilateral blepharoptosis. However, none of the patients developed hemorrhage or ischemia and in-stent stenosis was not observed. Conclusion Covered stent grafts appear to be a safe and feasible for the treatment of complex carotid artery lesions. Despite the potential for stent delivery failure as well as endoleak and procedure-related complications, covered stent grafts should be considered when selecting the optimal treatment strategy.

Outcomes of infants undergoing laparoscopic pyeloplasty: A single-center experience

2018 ◽  
Vol 86 (1) ◽  
pp. 27-31 ◽  
Author(s):  
İbrahim Erol ◽  
Kaan Karamık ◽  
Mahmut Ekrem İslamoğlu ◽  
Mutlu Ateş ◽  
Murat Savaş
Keyword(s):  
Operation Time ◽  
Significant Degree ◽  
Stent Migration ◽  
Mean Value ◽  
Laparoscopic Pyeloplasty ◽  
Mean Values ◽  
Single Center Experience ◽  
The Mean ◽  
Split Function

Purpose: The aim of this study was to evaluate the outcomes of laparoscopic pyeloplasty in children less than 12 months of age. Materials and methods: The records of 20 infants, who had pelviureteric junction obstruction and subsequently underwent LP from January 2013 to November 2016 with at least 1 year of follow-up, were retrospectively reviewed. Patients demographics, the results of preoperative and postoperative imaging studies, perioperative details, complications, and results were noted. Results: The mean age of 20 infants was 4.75 months. The gender of cases was 5 females (25%) and 15 males (75%). Of that, 13 (65%) laparoscopic pyeloplasties were in left side and 7 (35%) were in right side. No cases needed open conversation. Aberrant crossing vessel was observed in three patients (15%). The mean operation time was 79.35 min (45–128 min). The mean hospital stay was 2.9 ± 0.308 days (2–3 days). There were complications in three children (15%); two patients developed stent migration and one child had fever over 38°. Three children with complications did not require a second intervention. In one child, the kidney was non-functioning in follow-up and nephrectomy was performed. The anteroposterior diameter significantly reduced. Preoperative mean value was 24.305 ± 5.6157 and postoperative mean value was 15.40 ± 6.030 (p = 0.000, p < 0.05). There was a significant degree of improvement in renal split function for all patients. Preoperative mean values were 45.53 ± 11.512, while postoperative values were 47.850 ± 13.347 (p = 0.029, p < 0.05). Conclusion: Although there are doubts about the reliability and efficacy of results for pyeloplasty in children less 12 months, many studies including this study show that laparoscopic pyeloplasty is an effective and reliable method for infants.

scholarly journals STEENBEEK FOOT ABDUCTION BRACE FOR CLUBFOOT: COST EFFECTIVE BUT IS IT EFFECTIVE? A PROSPECTIVE STUDY

2017 ◽  
Vol 10 (5) ◽  
pp. 99 ◽  
Author(s):  
Thatikonda Sai Dinesh ◽  
Prem Kotian
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Exact Test ◽  
Pirani Score ◽  
Proven Efficacy ◽  
The Status ◽  
Cost Effective Alternative ◽  
A Prospective Study ◽  
Fischer Exact Test

Introduction: Foot Abduction Brace is recommended to prevent recurrence after casting phase in Ponseti method. Various types of braces are described, most current braces with proven efficacy are costly(100-300$) and difficult to acquire especially for the common man in India. Steenbeek brace can be made with locally available materials and is very simple to make and is cost effective(10$). Its efficacy is largely untested.Aim: To evaluate effectiveness of Steenbeek foot abduction brace to maintain correction achieved and to study the reasons for failure and complications associated with the brace.Materials and Methods: In KMC Mangalore and allied hospitals between Jun’2014-Aug’2016 25patients (38feet) who were treated by Ponseti method of cast application were given the Steenbeek foot abduction brace and followed up for a minimum duration of 1 year. The Status of foot was assessed using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and Compliance defined as brace application for 23 hours/day for the first three months, and nap time brace application for rest of the duration of study.Results: In 36 of 38 feet on the brace the correction was maintained(94.7% effective). In two patients(feet) there was worsening of the Pirani score after brace application and recurrence was seen. The reason for failure was found to be non compliance. The correlation between noncompliance and recurrence was significant(p <0.001) using Fischer Exact Test. Pirani score improved significantly in compliant group with significant worsening noted in noncompliant group. There were no other brace related complications.Conclusions: The significant correlation between noncompliance and recurrence shows that Steenbeek FAB is effective in maintaining correction and can be a cost-effective alternative to the more costly braces, for use in developing countries.

scholarly journals 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH)

2021 ◽  
Vol 3 (1) ◽  
pp. e000071
Author(s):  
Nikisha Patel ◽  
Nathan Yung ◽  
Ganesh Vigneswaran ◽  
Laure de Preux ◽  
Drew Maclean ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Artery Embolization ◽  
Prostate Artery Embolization ◽  
Cost Effective Alternative ◽  
The Cost

ObjectiveTo determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up.Design, setting and main outcome measuresA retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions.ResultsThe mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up.ConclusionOur findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years.Trial registration numberNCT02434575.

Fat graft myringoplasty: a cost-effective but underused procedure

2005 ◽  
Vol 119 (4) ◽  
pp. 277-279 ◽  
Author(s):  
O B Ozgursoy ◽  
I Yorulmaz
Keyword(s):  
Clinical Trial ◽  
Adipose Tissue ◽  
Tympanic Membrane ◽  
Cost Effective ◽  
Fat Graft ◽  
Temporalis Fascia ◽  
Tympanic Membrane Perforations ◽  
Cost Effective Alternative ◽  
One Year

Objectives: The objective of this study was to evaluate the success of fat graft myringoplasty and to discuss the utilities and advantages of a fat graft in primary versus revision myringoplasties.Methods: Eighteen patients who had not had previous otological surgery, and twelve patients whose tympanic membrane perforations have persisted despite myringoplasty with temporalis fascia were included in this prospective clinical trial. All patients were treated by fat graft myringoplasty and followed up for one year.Results: Successful closure of the perforation was obtained in 82.4 per cent of the ears at the final follow up. The success rate in the group of patients who had not had previous otological surgery was higher than those of revision cases.Conclusions: Adipose tissue provides the basic requirements for grafting of the tympanic membrane, with its own favourable characteristics. Fat graft myringoplasty is a cost-effective alternative in small perforations of the tympanic membrane, including revision cases.

scholarly journals Single Center Experience on Implementation of the Postpartum Intrauterine Device (PPIUD) in Sri Lanka: A Retrospective Study.

2020 ◽  
Author(s):  
DLW Dasanayake ◽  
Malitha Patabendige ◽  
Yamuna Amarasinghe
Keyword(s):  
Sri Lanka ◽  
Intrauterine Device ◽  
Tertiary Care ◽  
Cost Effective ◽  
Health Staff ◽  
Short Report ◽  
Single Center Experience ◽  
Resource Limited ◽  
One Year

Abstract Objectives to study the institutionalization of PPIUD services at Teaching Hospital, Mahamodara, Galle (THMG) and to study the feasibility, challenges and barriers for implementation.Results Total of 46,815 deliveries had occurred in the facility during the study period. Out of that 23,117 (49.4%) women had been counseled and 5775 (25.0%) of them were primigravida and 892 (3.9%) were teenage mothers. Total of 14,051 (60.8%) women were interviewed, but only 772 (5.5%) women consented for PPIUD. Consent withdrawal was seen in 29 (3.8 %) cases. A total of 409 community health staff were trained for counseling and follow up. PPIUD uptake was 470 (3.4%) which is comparable to national figures. Follow up data at one year was available from 199 women and spontaneous expulsion had occurred in eight (6.7%) cases with no cases of perforation or failure in terms of pregnancy. This short report gives the impression that PPIUD can be successfully implemented in resource limited settings and this also provides a feedback for the policy makers to take the necessary actions to improve the uptake of this cost effective, safe PPFP method. A routine PPIUD service has been successfully established within a tertiary care maternity setting in Sri Lanka.

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