679 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: EFFICACY OF DIFFERENT INITIAL TREATMENT STRATEGIES FOR ANASTOMOTIC LEAKAGE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sander Ubels ◽  
Moniek Verstegen ◽  
Stefan Bouwense ◽  
Gerjon Hannink ◽  
Peter Siersema ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Primary Outcome ◽  
Treatment Strategies ◽  
Primary Treatment ◽  
Healing Time ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Secondary Treatment ◽  
Detailed Data ◽  
Leakage Characteristics

Abstract   Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which primary treatments are most effective for which type of leak. We aimed to investigate the effectiveness of different primary treatments of AL. Methods International retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction were included in the period 2011-2019. Detailed data regarding case mix, resection, leakage characteristics (e.g. organ failure, leak circumference, contamination, drains present) and leakage treatment (e.g. hours from diagnosis to treatment, primary and secondary treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Different clinically relevant leakage groups have been defined. Efficacy of different treatment strategies adjusted for leakage severity will be analyzed in these clinical groups. The study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1451 patients with AL was collected from 71 centers in 20 countries. Data accuracy was 96.5%. Preliminary results showed that the overall 90-day mortality was 11.6%. The analysis of TENTACLE—Esophagus data is currently being performed and efficacy of different leakage treatment strategies is being assessed. The efficacy of initial leakage treatment strategies will be ready to be presented at the ISDE meeting. Conclusion This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence-based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of anastomotic leakage.

380 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: OUTCOME OF VARIOUS LEAKAGE TREATMENTS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
F Van Workum ◽  
M Verstegen ◽  
S Ubels ◽  
G Hannink ◽  
B Klarenbeek ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Primary Outcome ◽  
Muscle Flap ◽  
Final Analysis ◽  
Primary Treatment ◽  
Healing Time ◽  
Tube Placement ◽  
Treatment Modalities ◽  
Detailed Data ◽  
Full Study

Abstract   Anastomotic leakage (AL) is a common and severe complication after esophagectomy. It is largely unknown which initial treatments are most effective for what type of leak. We aimed to investigate the effectiveness of initial treatments of AL in daily clinical practice. Methods The TENTACLE—Esophagus is a multinational retrospective cohort study, in which patients with AL after esophagectomy with gastric tube reconstruction in the period 2011–2019 were included. Detailed data regarding casemix, surgery, leak characteristics (e.g. organ failure, leak circumference, contamination, drains present) and treatment (e.g. hours from diagnosis to treatment, treatment modalities) were collected. Primary outcome was 90-day mortality and secondary outcomes included length of stay and leak healing time. Regression analysis will be used to analyze the effectiveness of primary treatments after correction for patient-, surgery- and leak characteristics. The full study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1407 patients with AL from 70 centers in 20 countries is currently being validated and is awaiting final analysis. Preliminary results showed that AL was diagnosed 0–43 days after surgery and 90-day mortality rate was 11.1%. Primary treatments included re-operation (23.0%), stenting (16.8%), radiological drainage (10.5%), tube placement through the defect in the leak cavity (8.7%) and endoVAC placement (3.4%). Re-operations (n = 323) were drainage only (54.6%), oversewing the leak (15.5%), anastomotic resection and re-anastomosis (5,3%), repair with muscle flap (2.5%), disconnection and esophagostomy (11.8%) and other or unknown procedures (10.3%). Conclusion This is the largest study on effectiveness of AL treatments. The final results of initial leak treatments, which will be available for presentation at the ISDE meeting, could provide an evidence based basis that can be used by clinicians to determine the preferred primary treatment strategy in patients with a given type of AL.

388 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: FACTORS ASSOCIATED WITH ANASTOMOTIC LEAKAGE SEVERITY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
S Ubels ◽  
M Verstegen ◽  
S Bouwense ◽  
G Hannink ◽  
P Siersema ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Classification System ◽  
Study Data ◽  
Evidence Based ◽  
Detailed Data ◽  
Ivor Lewis ◽  
Severity Classification ◽  
Appropriate Treatment ◽  
Full Analysis ◽  
Leakage Characteristics

Abstract   Anastomotic leakage is a common and severe complication after esophagectomy. It is largely unknown which characteristics contribute to leakage severity. We aimed to investigate which factors are associated with leakage severity and to create an anastomotic leakage severity classification. Methods The TENTACLE—Esophagus is a multinational retrospective cohort study in which patients with anastomotic leakage after esophagectomy in the period 2011–2019 were included. Detailed data regarding casemix (e.g. age, sex, physical condition, comorbidity, tumor characteristics), surgical procedure (e.g. McKeown, Ivor Lewis, Orringer, anastomotic technique, omental wrap, pleural flap), leakage characteristics (e.g. contamination, drainage at leakage diagnosis, leak circumference) and treatment were collected. The primary outcome is 90-day mortality. Regression analysis will be used to analyze which leakage characteristics are associated with 90-day mortality and to compose an evidence-based anastomotic leakage severity score. The study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1407 patients with anastomotic leakage from 70 centers in 20 countries were collected. Anastomotic leakage occurred 0–43 days after surgery and 90-day mortality rate was 11.1%. The TENTACLE—Esophagus study data is currently being validated and it is awaiting full analysis. The results and the evidence based anastomotic leakage severity classification system will be ready for presentation at the ISDE meeting. Conclusion This is the largest study that investigates which factors contribute to anastomotic leakage severity after esophagectomy. The evidence-based anastomotic leakage severity classification system can be used by clinicians to grade severity of a given leak and might aid clinicians in choosing the most appropriate treatment.

388 TREATMENT OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY (TENTACLE—ESOPHAGUS) STUDY: FACTORS ASSOCIATED WITH ANASTOMOTIC LEAKAGE SEVERITY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sander Ubels ◽  
Moniek Verstegen ◽  
Stefan Bouwense ◽  
Gerjon Hannink ◽  
Peter Siersema ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Classification System ◽  
Study Data ◽  
Evidence Based ◽  
Detailed Data ◽  
Ivor Lewis ◽  
Severity Classification ◽  
Appropriate Treatment ◽  
Full Analysis ◽  
Leakage Characteristics

Abstract   Anastomotic leakage is a common and severe complication after esophagectomy. It is largely unknown which characteristics contribute to leakage severity. We aimed to investigate which factors are associated with leakage severity and to create an anastomotic leakage severity classification. Methods The TENTACLE—Esophagus is a multinational retrospective cohort study in which patients with anastomotic leakage after esophagectomy in the period 2011-2019 were included. Detailed data regarding casemix (e.g. age, sex, physical condition, comorbidity, tumor characteristics), surgical procedure (e.g. McKeown, Ivor Lewis, Orringer, anastomotic technique, omental wrap, pleural flap), leakage characteristics (e.g. contamination, drainage at leakage diagnosis, leak circumference) and treatment were collected. The primary outcome is 90-day mortality. Regression analysis will be used to analyze which leakage characteristics are associated with 90-day mortality and to compose an evidence-based anastomotic leakage severity score. The study protocol is accessible at www.tentaclestudy.com. Results Detailed data of 1407 patients with anastomotic leakage from 70 centers in 20 countries were collected. Anastomotic leakage occurred 0-43 days after surgery and 90-day mortality rate was 11.1%. The TENTACLE—Esophagus study data is currently being validated and it is awaiting full analysis. The results and the evidence based anastomotic leakage severity classification system will be ready for presentation at the ISDE meeting. Conclusion This is the largest study that investigates which factors contribute to anastomotic leakage severity after esophagectomy. The evidence-based anastomotic leakage severity classification system can be used by clinicians to grade severity of a given leak and might aid clinicians in choosing the most appropriate treatment.

734 PL11.06 PROGNOSTIC FACTORS FOR MORTALITY IN PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR CANCER (TENTACLE—ESOPHAGUS STUDY)

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sander Ubels ◽  
Moniek Verstegen ◽  
Stefan Bouwense ◽  
Gerjon Hannink ◽  
Bastiaan Klarenbeek ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Anastomotic Leakage ◽  
Primary Outcome ◽  
Gastric Conduit ◽  
Confounding Bias ◽  
Prognostic Effect ◽  
Life Threatening ◽  
Leakage Characteristics ◽  
Fluid Collections ◽  
Esophagectomy For Cancer

Abstract   Anastomotic leakage (AL) is a common and potentially life-threatening complication after esophagectomy. In patients with AL it is largely unknown which patient parameters and leakage characteristics are associated with leak severity and mortality. We aimed to identify prognostic factors for mortality in patients with anastomotic leakage after esophagectomy. Methods The TENTACLE—Esophagus study is an international retrospective cohort study, in which 1451 patients with AL after esophagectomy between 2011 and 2019 were included in 71 centers from 20 countries. Potential prognostic factors were selected from literature and a hypothetical association with mortality. Confounders of (individual) prognostic factors were identified using a directed acyclic graph approach to minimize bias. Primary outcome was 90-day mortality. Logistic regression analysis was performed to estimate crude and adjusted odds ratios (AOR) and 95% confidence intervals (95%CI). The study protocol is accessible at www.tentaclestudy.com. Results Overall 90-day mortality rate was 11.6%. Leakage characteristics with the largest prognostic effect on mortality were gastric conduit ischemia/necrosis (AOR 2.23, 95%CI 1.43-3.49), defect circumference ≥ 25% (AOR 2.10, 95%CI 1.32-3.36) and intrathoracic fluid collections (drained AOR 1.98, 95%CI 1.05-3.75; undrained AOR 2.43, 95%CI 1.57-3.75). Patient parameters with the largest prognostic effect were ASA-score ≥ 3 (AOR 4.18, 95%CI 1.67-10.51), ECOG-score ≥ 2 (AOR 2.83, 95%CI 1.56-5.14) and respiratory failure (AOR 3.89, 95%CI 2.67-5.66), hemodynamic failure (AOR 3.09, 95%CI 1.96-4.88) or renal failure (AOR 4.08, 95%CI 2.20-7.59) at time of AL diagnosis. Conclusion Defect circumference, intrathoracic fluid collections, gastric conduit condition and several patient parameters were identified as prognostic factors for mortality in patients with AL. Adjusting for these prognostic factors may reduce confounding bias in future studies assessing efficacy of AL treatments. The identified prognostic factors contribute to the understanding of the severity of anastomotic leakage after esophagectomy and may be used to recognize the severity of an anastomotic leak in individual patients.

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.

A search in the surge of treatment for COVID-19 patients: A narrative literature review

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 822-831
Author(s):  
Sridevi Ugrappa ◽  
Ajay Jain ◽  
Akshay Bhargava ◽  
Neeraj Kumar Fuloria ◽  
Shivkanya Fuloria
Keyword(s):  
Immune Therapy ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Pubmed Search ◽  
Blood Purification Therapy ◽  
Narrative Literature ◽  
Narrative Literature Review

Today, our understanding towards COVID-19 pandemic is that it is contagious and based on the of the virus, the signs and symptoms of this viral resemble the viral infectionlike Severe Acute-Respiratory (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). Currently, documented vaccines or drugs are not available for the treatment of COVID-19, SARS-CoV-2 viral infection. The main objective of this article is to compile the available literature on the treatment modalities for COVID-19, currently being advocated. Furthermore, there is no time to wait for evidence-based treatment, hence in such a scenario; an attempt has been made to collect the available scientific literature and understand the treatment of the disease with this insight. A MEDLINE-PUBMED search was performed in the surge of the treatment strategies for COVID-19 using the keywords "COVID-19", "", "novel ", "treatment of " and "therapies". We have reviewed the multiple articles from recently published literature and various proofs from up-to-date journals. Based on the reviewed literature, various categories of drugs are under trial or have been tried for the treatment of infection, which are as medications (anti-viral agents, and , ACE-2 inhibitors, etc.), immune therapy, traditional Chinese medicine, plasma exchange therapy, and blood purification therapy, etc. We attempted to go through the literature available for the treatment of COVID-19 and tried to compile it all together. Still, clinical trials are under process, and there are no evidence-based treatment strategies available to manage the cases of COVID-19 patients.

Toxic Epidermal Necrolysis Therapy with TPE and IVIG—10 Years of Experience of the Burns Treatment Center

2019 ◽  
Vol 40 (5) ◽  
pp. 652-657
Author(s):  
Andrzej Krajewski ◽  
Maciej Jan Mazurek ◽  
Elzbieta Mlynska-Krajewska ◽  
Krzysztof Piorun ◽  
Mateusz Knakiewicz ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Treatment Center ◽  
Evidence Based ◽  
Multicenter Trials ◽  
Life Threatening ◽  
Total Plasma Exchange ◽  
Evidence Based Guidelines ◽  
Severe Skin Reaction

Abstract Toxic epidermal necrolysis (TEN) is a potentially life-threatening, exfoliative disease. It is described as idiosyncratic, severe, skin reaction to drugs. With Stevens–Johnson’s Syndrome, it presents as a continuum of a disease being categorized relating to the percentage of affected skin. Without any multicenter trials comparing TEN treatment modalities, there is dearth of strong evidence-based guidelines of care. Total plasma exchange with intravenous immunoglobulin (IVIG) is one among plethora of possible treatment strategies. In our 10-year experience, we have observed 21 patients admitted to our burns center due to TEN. All of them were placed under intensive care with daily plasmapheresis (TPE) and IVIG. We have observed 52% mortality, with observed severe concomitant diseases in every patient in nonsurvivor group (average Acute Physiology and Chronic Health Evaluation II score at admission: 31.5%). We consider that TPE with IVIG might be of use in selected group of patients with TEN without any severe comorbidities. However, further multicenter trials are needed because in some cases it may raise mortality.

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.

DESAIN PILOT PLANT DAUR ULANG AIR LIMBAH DI INDUSTRI MIGAS Studi Kasus Kilang Minyak RU-VI Balongan PT. Pertamina (Persero)

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Nusa Idaman Said ◽  
Ikbal Ikbal ◽  
Satmoko Yudo
Keyword(s):  
Pilot Plant ◽  
Primary Treatment ◽  
Advanced Treatment ◽  
Preliminary Treatment ◽  
Secondary Treatment

Sejalan dengan pertumbuhan penduduk yang sangat pesat dan meningkatnya pencemaran air tanah maupun air permukaan, serta distribusi sumber air untuk konsumsi pemakaian air yang tidak merata telah menyebabkan ketidak-seimbangan antara  pasokan dan kebutuhan akan air. Oleh karena itu, menjadi perhatian yang penting dalam melakukan upaya-upaya dalam hal penyediaan sumber air. Salah satu alternatif yang banyak mendapat perhatian di banyak negara di dunia adalah menggunakan teknologi daur ulang air limbah sebagai sumber air baku untuk penyediaan air bersih. Industri migas merupakan salah satu industri yang mempunyai kebutuhan akan air bersih yang besar, khususnya kilang minyak. Pemakaian air di kilang minyak tersebut cukup besar yaitu sebesar 1.400 m3 perjam, apabila air hasil buangannya dapat di daur ulang sebesar 10% atau lebih saja maka kebutuhan air bersih akan dapat dihemat. Tujuan dari kegiatan ini adalah melakukan desain instalasi daur ulang air di suatu kilang minyak. Konsep yang umum dari daur ulang adalah melakukan pengolahan air limbah untuk dijadikan air bersih, dengan menggunakan kombinasi proses pra-pengolahan (preliminary treatment), pengolahan primer (primary treatment), pengolahan primer lanjutan (advanced primary treatment), pengolahan sekunder (secondary treatment), dan pengolahan tersier (tertiary/advanced treatment). Dengan kombinasi proses tersebut dapat mengolah air limbah sampai menghasilkan air olahan dengan kualitas sebagai air minum.  Hasil dari kegiatan ini adalah diperolehnya desain pilot plant instalasi daur ulang air limbah di industri migas dengan kapasitas  9 m3/jam. Kata kunci: pencemaran air, air limbah, desain daur ulang air, kilang minyak

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

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