scholarly journals 53 Does the Community Geriatrician’s Role in Advanced Care Planning Help Community Dwellers Achieve Their Preferred Place of Care?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
K Honney ◽  
H Judd ◽  
A Mitchell ◽  
H Nash ◽  
J Ford ◽  
...  

Abstract Introduction Advanced Care Planning (ACP) is well established for patients with terminal cancer diagnoses but is poorly utilised when caring for elderly patients with other terminal illnesses. We aimed to assess the effectiveness of ACP in our older, community dwellers following a period of increased awareness. Methods A closed loop audit was undertaken, assessing deaths from a dementia care home within rural Norfolk, before and after implementation of an education and focus programme (cycle 1=Jan 2017-Jan 2018, cycle 2: Feb 2018-Jan-2019). Deceased patients were identified from care home records and data from electronic hospital and general practice records were analysed. Results were compared according to existing guidance outlined in the Palliative Gold Standards Framework (GSF) and Department of Health End of Life Care Strategy 2009. Compliance between cycles was compared using the chi-square test with p=.05 indicative of statistical significance. Results 59 patients were included (median age=84, male=31). Results of the audit for each criterion are shown in table 1. More patients achieved their preferred place of care (PPOC) following the implementation of the education programme, with access to end of life medications significantly improving. Conclusions Increasing awareness and understanding of ACP in the community has been shown to improve compliance with GSF standards, particularly access to end of life medications. Further efforts are still required to improve care and a third cycle is scheduled for January 2020, following further training.

2017 ◽  
Vol 33 (4) ◽  
pp. 282-287 ◽  
Author(s):  
Fabricio R Santiago ◽  
Mario Piscoya ◽  
Yung-Wei Chi

Objective To evaluate patients’ self-perception of cosmetic improvement before and after they were presented with pre- and postprocedure photographs after sclerotherapy with 75% dextrose. Methods Treatments included sclerotherapy of reticular and varicose veins using 75% dextrose. All treated limbs were photographed and classified according to Clinical, Etiology, Anatomy, and Pathology classification and Venous Clinical Severity Score pre- and posttreatment. The patients were queried before and after viewing the photos during these visits and indicated if they were very unsatisfied, dissatisfied, satisfied, or very satisfied. Nonparametric kappa correlation coefficient and a Chi square test were used to measure associations among agreement (p < 0.05 indicated statistical significance). The paired Wilcoxon test was used to compare statistical differences in mean Venous Clinical Severity Scores measured at different times (p < 0.05 indicated statistical significance). Data were analyzed using STATA software (version 12). Results Individuals were more satisfied with the results of sclerotherapy after exposure to images portraying their limbs two months after the procedure (p = 0.0028). This effect was maintained six months after sclerotherapy (p = 0.0027). Conclusion Patient exposure to pre- and postsurgical photographs is a simple intervention with the potential of improving patient satisfaction up to six months after treatment with sclerotherapy.


2021 ◽  
Vol 20 ◽  
pp. 153473542098834
Author(s):  
Abdolazim Sedighi Pashaki ◽  
Kamal Mohammadian ◽  
Saeid Afshar ◽  
Mohammad Hadi Gholami ◽  
Abbas Moradi ◽  
...  

Objective: Fatigue associated with malignant conditions and their treatments is a disabling condition. This trial assessed the anti-fatigue effects of melatonin coadministration during adjuvant treatment of patients with the breast cancer. Material and Methods: Patients with breast cancer were randomly assigned to receive melatonin or placebo during adjuvant chemotherapy and radiotherapy. Thirty-seven patients were randomly enrolled in each group. The mean ages of patients in the intervention and control groups were 50.47 ± 10.79 and 46.05 ± 10.55 years, respectively ( P = .223). The intervention group received oral melatonin (18 mg/day) from 1 week before until 1 month after the adjuvant radiotherapy. The level of fatigue was assessed before and after intervention using Brief Fatigue Inventory (BFI) in both groups. To analyze data, the Student’s t-test and the Chi-square test were used at a significance level of P ≤ .05. Results: The BFI score was similar before the intervention in both groups, however, after the intervention, it was significantly lower in the melatonin group ( P < .001). Moreover, the frequency of severe fatigue in the melatonin group was significantly lower than in the placebo group after intervention (42.1% vs 83.3%, P < .001). Conclusion: Coadministration of melatonin during adjuvant chemotherapy and radiotherapy of women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments.


2005 ◽  
Vol 17 (2) ◽  
pp. 276 ◽  
Author(s):  
J. Pryor ◽  
S. Romo ◽  
D.D. Varner ◽  
K. Hinrichs ◽  
C.R. Looney

In commercial bovine in vitro fertilization (IVF) companies, there is a continuous need to improve results. Efforts to maximize in vitro embryo production have included modifications in the use of sperm separation gradients. The development of commercially available sperm centrifugation gradients represents a new possibility of increasing the number of viable sperm that can be obtained from low concentration (fresh or frozen, sexed or unsexed) semen samples in order to improve the efficiency of the IVF system to make embryo production as efficient as possible. The objective of this study was to compare two different separation gradients, as follows: Group 1: Percoll (Sigma, St. Louis, MO, USA), in 45% and 90% gradients; Group 2: EquiPure (Nidacon, Gathenburg, Sweden), in top and bottom layers. Before and after separation, sperm were evaluated at 200× magnification for total motility, and then stained to assess viability at 400× with fast-green/eosin stain (Sigma). Sperm separation was performed using frozen/thawed semen from one bull. Semen was separated by centrifugation at 200g for 30 min in both density gradients. Results obtained from Groups 1 and 2 were compared by chi-square test. Sperm separation with Percoll yielded lower numbers of sperm (average sperm concentration after separation of 92 × 106, vs. 159 × 106 sperm/mL for EquiPure; P < 0.05) but resulted in higher motility (60% vs. 39%, respectively; P < 0.05) of separated sperm. Rates of live sperm cells were not significantly different between groups (69.5% vs. 70%, respectively; P > 0.1). These results indicate that the commercial separation medium EquiPure may be associated with higher sperm concentration levels but with lowered sperm motility when compared to Percoll for bovine sperm separation. However, Equipure provided similar percentages of live sperm when compared to Percoll, which is currently used in our laboratory.


2021 ◽  
Vol 30 (02) ◽  
pp. 103-106
Author(s):  
Ajeet Kumar ◽  
◽  
Naveed Iqbal ◽  
Javaria Farooq ◽  
Saad Uddin Siddiqui

OBJECTIVE: This study was performed to compare incidence of perforations in Latex and Nitrile examination gloves during Minor Oral surgical procedures performed under local anesthesia. METHODOLOGY: 100 pairs of latex and 100 pairs of Nitrile examination gloves where used to perform 200 minor oral surgical procedures under local anesthesia. After completion of every minor oral surgical procedure each gloves was examined by Water Inflation method to observe presence or absence of Perforations. A data sheet was used to collect data including type of Gloves used (Latex or Nitrile) presence of perforations, sites of perforations and nature of minor oral surgical procedures. Data was entered and analyzed using SPSS version 20. Descriptive analysis was conducted to calculate frequency and percentages of Number and sites of perforations for both Nitrile and latex examination gloves. Chi Square test was used to find out statistical significance of difference of perforations rate between Nitrile and Latex gloves. P value of < 0.05 was considered significant. RESULTS: Out of 200 latex gloves 23 (11.5) had 29 perforations whereas out of total 200 Nitrile gloves 28 (14%) had 22 perforations. Nitrile gloves had a statistically significant higher rate of perforations as compared to Latex gloves. (P value 0.043). For both Nitrile and Latex gloves left non dominant hand had highest frequency of perforations Latex 18 (81.81%) perforations and Nitrile 18(62.06%). Index finger and thumb were most frequent sites of perforations in both Latex and Nitrile gloves. CONCLUSION: Gloves perforations were more common in Nitrile examination gloves however total number of perforations was more in Latex examination gloves.


2021 ◽  
Vol 7 (2) ◽  
pp. 366-371
Author(s):  
Sunil Ganekal ◽  
Varun Ganekal

To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL). : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables.: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes.: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.


Author(s):  
Briseida Mayel Perez-Avelino ◽  
Nicolás Padilla-Raygoza ◽  
Verónica Benitez-Guerrero ◽  
María Luisa Sánchez Padilla ◽  
Vicente Beltrán-Campos ◽  
...  

Objective: To determine the relationship of the perception of lifestyle with the level of physical activity in people with type 2 diabetes and without type 2 diabetes. Study Design: Analytical cross-sectional observational study in Celaya, Guanajuato, Mexico. Methodology: Sample composed of 100 people with type 2 diabetes and 100 people without type 2 diabetes, the lifestyle questionnaire and IPAQ questionnaire were used. Descriptive statistics were calculated for sociodemographic variables; it was calculated Chi-square test and Odds Ratio.  To demonstrate the statistical significance of results, the value of P was set at .05. Statistical analysis was performed in STATA 13.0 ®. Results: In patients with Type 2 Diabetes predominated females, married, who never went school and elementary and BMI ≥ 25 kg/m2; among patients without Type 2 Diabetes, predominant males, singles, went school or university, BMI ≥25 kg/m2; no relationship was found between lifestyle perception and level of physical activity in adults with type 2 diabetes (X² = 0.0022 gl 1 P = .96) neither it was found a significant relationship between lifestyle perception and level of physical activity in adults without type 2 diabetes (X² = 5.23 gl 1 P = .02 RM = 2.85 95% CI = 0.80 to 10.4). Conclusion: The results show that self-perception of lifestyle and physical activity is different in people with less age, more schooling, males.


2020 ◽  
pp. 9-11
Author(s):  
Madhu Kumari ◽  
Kumari Bibha ◽  
Abha Sinha ◽  
Debarshi Jana

Objective: The objective of this study is to find out association between scar thickness, assessed sonographically, and intraoperative findings (IOF). Study Design: Descriptive study. Place and Duration of Study: Department of Obstetrics and Gynecology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar from June 2019 to May 2020. Methodology: A total of 70 pregnant patients were included in this study. Transabdominal ultrasound was done for scarred uteri. Sonographic findings were co-related with introperative findings. All the given data were entered on SPSS version 23. Age was expressed as mean ± SD. Parity, gestational age, and interval between cesarean sections were expressed as frequencies with percentages. Statistical analysis was done by using Chi-square test for categorical data for association between sonographic scar thickness and intraoperative findings. The statistical significance was set at p-value <0.05. Results: The age range of the patients was 20- 36 years with a mean of 27.91 ±3.690 years. Gestational age at the time of cesarean section was between 27-40 weeks of gestation with a mean of 37 ±2.126 weeks. The interval from previous cesarean was 10 months at the minimum, and 6 years at the maximum with a mean of 2.29 ±1.0 months. Mean scar thickness was 2.5 mm. Association between scar thickness (<1-3 mm) and intaoperative findings of dehiscence and rupture showed a p-value of <0.001. Conclusion: Sonographic assessment of a uterine scar has a practical application to determine the thickness of previous scar, and assess its integrity.


2019 ◽  
Vol 3 (9) ◽  
pp. 283-289
Author(s):  
Shuchi Sukul ◽  
Goldy Rathee ◽  
Parimal Anand ◽  
Sakshi Kataria ◽  
Pratibha Taneja

OBJECTIVES: The present research was conducted to assess incidences of root microcracks caused by hand and rotary file system at different lengths MATERIAL AND METHODS: This in-vitro study was undertaken to assess incidence of root microcracks caused by hand and rotary file system at different lengths In total, 100 the mandibular premolar with straight roots determined with intact, fully formed apices were taken. Samples were randomly distributed into 5 groups based on the file system used: a) Group A: Control, b) Group B: Reciproc, c) Group C: WaveOne, d) Group D: One Shape and e) Group E: ProTaper. Pearson Chi-square test was used to determine the differences between groups. The dentinal defects were expressed as percentage of samples with microcracks in each group. Level of statistical significance was set at p-value less than 0.05. RESULTS: The chi square test was used to compare the Distribution of the number of teeth in which cracks were observed on the horizontal sections. It was found to be significant with group ProTaper showing maximum cracks at 3,6,9 mm level as compared to other file systemCONCLUSION: Nickel-titanium instruments causes cracks on the apical root surface or in the root canal wall. ProTaper causes maximum dentinal cracks as compared to other file systems


CytoJournal ◽  
2015 ◽  
Vol 12 ◽  
pp. 23 ◽  
Author(s):  
Nora K. Frisch ◽  
Yasin Ahmed ◽  
Seema Sethi ◽  
Daniel Neill ◽  
Tatyana Kalinicheva ◽  
...  

Background: ThinPrep® (TP) cervical cytology, as a liquid-based method, has many benefits but also a relatively high unsatisfactory rate due to debris/lubricant contamination and the presence of blood. These contaminants clog the TP filter and prevent the deposition of adequate diagnostic cells on the slide. An acetic acid wash (AAW) protocol is often used to lyse red blood cells, before preparing the TP slides. Design: From 23,291 TP cervical cytology specimens over a 4-month period, 2739 underwent AAW protocol due to initial unsatisfactory smear (UNS) with scant cellularity due to blood or being grossly bloody. Randomly selected 2739 cervical cytology specimens which did not undergo AAW from the same time period formed the control (non-AAW) group. Cytopathologic interpretations of AAW and non-AAW groups were compared using the Chi-square test. Results: About 94.2% of the 2739 cases which underwent AAW were subsequently satisfactory for evaluation with interpretations of atypical squamous cells of undetermined significance (ASCUS) 4.9% (135), low-grade squamous intraepithelial lesions (LSIL) 3.7% (102), and high-grade squamous intraepithelial lesions (HSIL) 1% (28). From the 2739 control cases, 96.3% were satisfactory with ASCUS 5.5% (151), LSIL 5.1% (139), and HSIL 0.7% (19). The prevalence of ASCUS interpretations was similar (P = 0.33). Although there were 32% more HSIL interpretations in the AAW group (28 in AAW vs. 19 in non-AAW), the difference was statistically insignificant (P = 0.18). AAW category; however, had significantly fewer LSIL interpretations (P = 0.02). The percentage of UNS cases remained higher in the AAW group with statistical significance (P < 0.01). Conclusions: While AAW had a significantly higher percent of UNS interpretations, the protocol was effective in rescuing 94.2% of specimens which otherwise may have been reported unsatisfactory. This improved patient care by avoiding a repeat test. The prevalence of ASCUS and HSIL interpretations between AAW and non-AAW groups were comparable. Though not statistically significant, HSIL interpretations were relatively higher in the AAW group. LSIL interpretations showed lower prevalence in AAW group.


CytoJournal ◽  
2020 ◽  
Vol 17 ◽  
pp. 22
Author(s):  
Pingping Zhong ◽  
Chenghong Yin ◽  
Yulan Jin ◽  
Tianbao Chen ◽  
Yang Zhan ◽  
...  

Objectives: Atypical glandular cells (AGC) detected by Papanicolaou (Pap) smears are in close relation with adenocarcinoma and precursors detected by histopathology. Yet, sometimes the cytological diagnosis of AGC has been neglected. With increase of adenocarcinoma and precursors, we need more focus on glandular abnormalities. Material and Methods: Clinicopathological data of patients who had AGC on Pap smears between April 2015 and October 2018 and underwent histological follow-up were retrieved from the computerized database of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Patients with a prior history of cancer were excluded from the study. Statistical analyses were performed using Pearson’s Chi-square test in SPSS software version 23. P < 0.05 (two sided) was considered as statistical significance. Results: Liquid-based cytological examination of the uterine cervix was carried out in 164,080 women. Five hundred and twenty-five women were diagnosed with AGC, 314 with not otherwise specified (AGC-NOS), and 211 with favor neoplastic (AGC-FN). Only 310 cases had histological follow-up, 168 women (168/314, 53.5%) originally with AGC-NOS on Pap smears, and 142 (142/211, 67.3%) with AGC-FN. The median age of histological significant abnormalities was 46.7 years, and 126 women (126/162, 77.8%) were postmenopausal. Sixty-six cases (66/168, 39.3%) of AGC-NOS had significant abnormalities (96/142, 67.6%, AGC-FN). One hundred and sixty-two cases of significant abnormalities included 40 high-grade squamous abnormalities and 122 glandular abnormalities. AGC-FN was more likely to be associated with a clinically significant abnormalities (P < 0.001) compared to AGC-NOS. Conclusions: Patients with AGC on Pap smears are in close relation with significant abnormalities, especially with significant glandular abnormalities on histopathology slices. AGC should be evaluated vigilantly with histological workup, especially if patients are diagnosed with AGC-FN and are aged 41–60 years. We need more focus on AGC.


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