scholarly journals 966 Comparison of Lord and Jaboulay Procedure for Hydrocele Repair

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Henderson ◽  
S Simpkins ◽  
S Nalagatla
Keyword(s):  
Complication Rate ◽  
Statistical Difference ◽  
One Health ◽  
Late Complications ◽  
Current Evidence ◽  
Health Board ◽  
Operative Techniques ◽  
Nice Guidelines ◽  
Ultrasound Assessment ◽  
Operative Ultrasound

Abstract Aim Hydrocele is a common surgical pathology with a variety of operative techniques described, including Lord plication and Jaboulay procedure. Whilst current evidence suggests no difference in the recurrence rate between different techniques, the Lord’s procedure is described as having the lowest complication rate. NICE guidelines state all men aged 20 - 40 should receive a pre-operative ultrasound scan. We aimed to audit the complication rate between the two procedures as well as the rate of pre-operative ultrasound assessment. Method A retrospective review of all elective hydrocele repairs was performed within one health board over a 17-month period. All elective patients over the age of twelve and three-quarters were included, with emergency repairs excluded. Patient records were accessed, and data collected including hydrocele side and size, procedure performed, co-morbidities, medication, pre-operative ultrasound, and incidence of immediate and late complications. Results 83 cases were identified. All men aged 20 - 40 received pre-operative ultrasound assessment. 27 (33%) repairs utilised Lord’s technique, whilst 56 (67%) used Jaboulay’s technique. There was no statistical difference in complication rate for all complications (10% vs. 16% p = 0.48), haematoma (3.4% vs. 12% p = 0.16), infection (1.7% vs. 12% p = 0.08) or reoccurrence (1.7% vs 0% p = 1.0) between Jaboulay’s and Lord’s respectfully. Conclusions Analysis in this series showed the complication rate is higher for Lord’s procedure versus Jaboulay’s, however this was not found to be statistically significant. All patients aged 20-40 within our analysis received pre-operative ultrasound assessment.

scholarly journals Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola S. Gray ◽  
Ann John ◽  
Aimee McKinnon ◽  
Stephanie Raybould ◽  
James Knowles ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Evaluation ◽  
Suicide Risk ◽  
Professional Judgment ◽  
Health Board ◽  
Safety Planning ◽  
Nice Guidelines ◽  
Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

scholarly journals Efficacy of various core decompression techniques versus non-operative treatment for osteonecrosis of the femoral head: a systemic review and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Quanzhe Liu ◽  
Wenlai Guo ◽  
Rui Li ◽  
Jae Hyup Lee
Keyword(s):  
Surgical Treatment ◽  
Bone Graft ◽  
Statistical Difference ◽  
Radiographic Progression ◽  
Meta Analysis ◽  
Core Decompression ◽  
Systemic Review ◽  
Current Evidence ◽  
Cochrane Library ◽  
Non Surgical Treatment

Abstract Background Various Joint-preserving therapy (JPT) methods have been performed and tried in recent decades, but their results and efficacy were inconsistent and controversial. The purpose of this study is to evaluate its effectiveness and whether there are statistical differences in treatment between different interventions based on published RCT studies. Methods Following the PRISMA-NMA checklist, Medline, EMBASE, Web of Science, and Cochrane Library databases were searched and collected related RCT studies. The sources were searched from inception up to October 30, 2020. The primary outcomes including the rate of radiographic progression and conversion to THA and the secondary outcome -Harris Hip Scores (HHS) were extracted and compared in a Network meta-analysis. Results Seventeen RCT studies involving 784 patients (918 hips) with seven interventions including CD (core decompression), CD + BG (bone graft), CD + TI (tantalum rod implantation), CD + CT (Cell therapy), CD + BG + CT, VBG (vascularized bone graft), and nonsurgical or conservative treatment for ONFH were evaluated. In the radiographic progression results, CD + CT showed a relatively better result than CD, CD + BG and non-surgical treatment, the surface under the cumulative ranking curve (SUCRA) plot displayed that CD + CT (96.4%) was the best, followed by CD (64.1%).In conversion to THA results, there were no significant differences between the JPT methods and non-surgical treatment. In HHS, there was also no significant difference, other than CD + BG showed a statistical difference than non-surgical treatment only in terms of Cis, but the SUCRA was highest in non-surgical treatment (80.5%) followed by CD + CT (72.8%). Conclusions This Net-work meta-analysis demonstrated that there was no statistical difference in the outcome of radiographic progression and conversion to THA, also in HHS, other than CD + CT showed a relatively superior result in radiographic progression than nonsurgical treatment, namely, it’s maybe an effective method for delaying disease progression or reducing disease development based on current evidence.

Complications of continent orthotopic urinary diversions

1996 ◽  
Vol 63 (4) ◽  
pp. 519-521
Author(s):  
A. Tasca ◽  
C. Valotto ◽  
L. Pizzol
Keyword(s):  
Complication Rate ◽  
Late Complications ◽  
Continent Urinary Reservoir ◽  
Urinary Reservoirs ◽  
Urinary Reservoir

Although techniques for continent urinary reservoirs and neobladders are still being developed, these procedures can be performed on properly selected patients with an acceptable complication rate. A series of five continent urinary reservoir procedures are presented. Early and late complications are shown.

Adherence to Nice Guidelines on Recall Intervals and the FGDP(UK) Selection Criteria for Dental Radiography

2013 ◽  
Vol 2 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Nicholas A Drage ◽  
Kristian JM Davies
Keyword(s):  
Risk Assessment ◽  
Selection Criteria ◽  
Disease Risk ◽  
Dental Radiography ◽  
Adult Patients ◽  
Health Board ◽  
Caries Risk ◽  
Caries Risk Assessment ◽  
Nice Guidelines ◽  
Child Patients

Aim The study investigated adherence of GDPs to National Institute for Health and Clinical Excellence (NICE) guidelines on recall intervals and the FGDP(UK)'s Selection Criteria for Dental Radiography. It also explored any factors that might influence GDPs’ compliance with the guidelines. Method A previously piloted questionnaire was circulated to all GDPs within the district of the Cardiff and Vale University Health Board (UHB). The questionnaire sought demographic data as well as answers to questions relating to compliance with guidelines. Results Of 215 questionnaires, 133 (61.9%) were returned. One hundred a nd thirty (97.7%) respondents were familiar with NICE recall guidelines and 112 (84.2%) were familiar with the FGDP(UK) publication Selection Criteria for Dental Radiography. Thirty six (27.7%) ‘always’ followed the NICE recall guidelines and, overall, 108 (81.8%) ‘always or mostly’ followed the guidance. Fifty one (38.6%) respondents ‘always’ carried out a caries risk assessment for adult patients and 57 (43.5%) ‘always’ carried out a caries risk assessment for child patients. Seventy nine (59.8%) reported that they ‘always or mostly’ recorded the patient's disease risk category in the notes. Fifty two (39.7%) respondents ‘always’ took bitewing radiographs that corresponded to disease risk. Overall, however, 119 GDPs (90.8%) ‘always or mostly’ took bitewing radiographs at appropriate intervals according to disease risk. Bitewing radiographs for new adult patients were prescribed more often for new child patients. The dentist's length of experience, NHS commitment, country of graduation, access to digital radiography or panoramic machines, receipt of any postgraduate qualifications or involvement in dental foundation training were proven not to have any statistically significant association with adherence to NICE or FGDP(UK) guidelines. Conclusions Most dentists are familiar with NICE guidelines on recall intervals and the FGDP(UK)'s Selection Criteria for Dental Radiography. The number of dentists who always comply with these sets of guidance is low. None of the variables investigated were shown to have any statistically significant association with adherence to these guidelines.

scholarly journals Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis

2020 ◽  
Vol 36 (1) ◽  
pp. 22-29 ◽  
Author(s):  
Seung Jae Roh ◽  
Sung Chan Park ◽  
Jaehee Choi ◽  
Joon Sang Lee ◽  
Dong Woon Lee ◽  
...  
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Mitomycin C ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Complication Rate ◽  
Hyperthermic Intraperitoneal Chemotherapy ◽  
Early Period ◽  
Disease Free Survival ◽  
Late Complications ◽  
The Mean

Purpose: This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer.Methods: A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC.Results: Median disease-free survival was 27.8 months (range, 13.4–42.2 months). Median overall survival was 56.0 months (range, 28.6–83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10–19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I–II complications (65.4%), compared to grades III–V (23.1%). All late complications, occurring in 7.7% of patients, were grades III–V. There was no treatment-related mortality.Conclusion: Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

The benefits of raising awareness of lymphoedema among care home staff

2020 ◽  
Vol 29 (4) ◽  
pp. 190-198
Author(s):  
Melanie Thomas ◽  
Karen Morgan ◽  
Ioan Humphreys ◽  
Karl Hocking ◽  
Diane Jehu
Keyword(s):  
One Health ◽  
Care Home ◽  
Pilot Project ◽  
Care Staff ◽  
Care Homes ◽  
Health Board ◽  
Care Home Staff ◽  
Raising Awareness ◽  
History Of ◽  
Education Tool

Background: Patients with lymphoedema referred to a lymphoedema service from care homes in one health board area in Wales were often complex cases, with repeated cellulitis, a history of falls and other complications. A pilot project was initiated to develop education and raise awareness of lymphoedema among care home staff. Aims: To enable care staff to identify residents with lymphoedema, promote prompt referrals, raise the importance of skin care and exercise in the management of lymphoedema and estimate the likely costs from complications associated with lymphoedema. Methods: An education tool was developed and 47 care homes were asked to participate. A lymphoedema therapist carried out a scoping review of the residents. Results: Forty-four care homes agreed to participate in the project with 1216 education packs being issued to care home staff. Initial findings suggest that of the 960 residents reviewed, 262 had lymphoedema (27%); 4% suffered with frequent falls, 1% had wounds and 3% had recurrent cellulitis. Only 13% (35/262) of residents with lymphoedema were known to the local lymphoedema service. Of the 31 residents reporting cellulitis, 81% had lymphoedema; of the 11 residents identified with a wound, 100% had lymphoedema and of the 40 residents reporting falls, 70% had lymphoedema. Conclusion: This educational project has identified the value of raising awareness of lymphoedema within care homes.

scholarly journals Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review

2019 ◽  
Vol 26 (3) ◽  
pp. 381-387 ◽  
Author(s):  
Gregorio Scerrino ◽  
Giuseppina Melfa ◽  
Cristina Raspanti ◽  
Giulia Rotolo ◽  
Giuseppe Salamone ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Complication Rate ◽  
Randomized Clinical Trials ◽  
High Volume ◽  
Conventional Technique ◽  
Late Complications ◽  
Video Assisted ◽  
Cervical Hematoma ◽  
Significant Difference

Background. Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. Methods. The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were “minimally invasive,” “video-assisted,” and “thyroidectomy.” We enrolled randomized clinical trials, nonrandomized trials, and noncontrolled trials. Results. Thirty-two articles were considered suitable. Complication rate of MIVAT was quite similar to conventional technique: only one randomized trial found a significant difference concerning overall skin complication, and a single trial highlighted hypocalcemia significantly increased in MIVAT, concerning serologic value only. No difference concerning symptomatic nor definitive hypocalcemia was found. Conclusions. We can confirm that MIVAT is a safe technique. It should be adopted in mean-high-volume surgery centers for thyroidectomy, if a strict compliance with indication was applied.

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