P90 TRACTION ON THE SEPTUM DURING TRANSORAL SEPTOTOMY FOR ZENKER DIVERTICULUM IMPROVES THE FINAL OUTCOME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
L Provenzano ◽  
R Salvador ◽  
C Cutrone ◽  
L Moletta ◽  
E Pierobon ◽  
...  
Keyword(s):  
Symptom Score ◽  
Final Outcome ◽  
Barium Swallow ◽  
Complication Rates ◽  
Duration Of Symptoms ◽  
Zenker Diverticulum ◽  
Before And After ◽  
Study Population ◽  
Classic Technique ◽  
Additional Procedure

Abstract Background Transoral Diverticulostomy/Septotomy has become a popular treatment for patients with Zenker Diverticulum (ZD) because of the low complication rates, reduced procedure time, and shorter hospital stay. However, the outcome of this procedure is not, so far, as positive as the open techniques. In order to improve the results of transoral septotomy (TS), a modification of the technique by tractioning the septum with stiches, has been introduced. In this study we aimed to compare the final outcome of a Modify Transoral Septotomy (MTS) with those of the Traditional Transoral Septotomy (TTS) in patients with ZD. Methods Seventy-seven consecutive patients with ZD underwent Transoral Septotomy between 2010-2019. Patients who had already been treated with surgical or endoscopic procedures were excluded. TTS was performed with the classic technique. Since 2015, we adopted a MTS, by positioning 2 sutures at the lateral edges of the septum, for traction. Symptoms were collected and scored using a detailed questionnaire; barium-swallow (to assess the size of the pouch), endoscopy and manometry were performed before and after surgical treatment. Failures were defined when a patient needed an additional procedure for recurrent symptoms. Results Of the 52 patients representing the study population (M:F=49:28), 25 had TTS and 52 had MTS. The patients’ demographic and clinical parameters (sex, age, symptom-score, duration of symptoms, diverticulum size) were similar in both groups. Only two intraoperative mucosal lesions were detected and mortality was nil. The median time of the procedure was 25 min (IQR:22-35) in the TTS and 30 min (IQR:25-36) in the MTS (p<0.07). The median follow-up was 85 months in the TTS and 24 months in the MTS. All the patients in both groups had a reduction in the symptom score after the procedure but the failure rate was 32% (8/25) in the TTS and 1.9% (1/52) in the MTS (p<0.01). At the univariate and multivariate analyses, the surgical procedure was the only factor predictive of a positive final result. Conclusions Transoral Septotomy improves the final outcome of this treatment in patients with ZD.

P88 EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS IMPROVES THE FINAL OUTCOME IN MANOMETRIC PATTERN III ACHALASIA PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
L Moletta ◽  
R Salvador ◽  
G Capovilla ◽  
L Provenzano ◽  
E Pierobon ◽  
...  
Keyword(s):  
Symptom Score ◽  
Final Outcome ◽  
Barium Swallow ◽  
Partial Fundoplication ◽  
Laparoscopic Myotomy ◽  
Duration Of Symptoms ◽  
Before And After ◽  
Mucosal Perforation ◽  
Study Population ◽  
Manometric Pattern

Abstract Background Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (LLM) in patients with pattern III achalasia. Methods The study population consisted of 61 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997-2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry were performed, before and after surgical treatment. In CLM the total length of the myotomy was ≤ 9 cm, while myotomies extended both downwards and upwards to a length >9 cm were defined as LLM. Results Of the 61 patients representing the study population, 24 had CLM and 37 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients’ demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. One mucosal perforation was detected and repaired intraoperatively in the LLM group. The median length of the myotomy was 8 cm (IQR:8-9) in the CLM and 10 cm (IQR:10-12) in the LLM (p<0.001). The median of follow-up was 94 months (IQR:52-126) in the CLM and 24 months (IQR:16-40) in the LLM. As a whole, the two groups had a different drop in their symptom score: 22 (17-26) versus 4 (0-8), and 20 (18-27) versus 3 (0-6) for the CLM and LLM respectively (p<0.01). Moreover, failures were 8/24 (33.3%) in the CLM and 4/37 (10.8%) in the LLM (p<0.05). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM (p=n.s.). Conlcusions The extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux.

PS01.023: EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS FOR MANOMETRIC PATTERN III ACHALASIA PATIENTS IMPROVES THE FINAL OUTCOME

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-57
Author(s):  
Renato Salvador ◽  
Giovanni Capovilla ◽  
Luca Provenzano ◽  
Dario Briscolini ◽  
Anna Perazzolo ◽  
...  
Keyword(s):  
Symptom Score ◽  
Time Window ◽  
Conflicts Of Interest ◽  
Final Outcome ◽  
Barium Swallow ◽  
Partial Fundoplication ◽  
Laparoscopic Myotomy ◽  
Duration Of Symptoms ◽  
Study Population

Abstract Background Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (length ≤ 8cm, CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (length > 8cm, LLM) in patients with pattern III achalasia. Methods The study population consisted of 50 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997–2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Patients before 2010 had a traditional CLM procedure while patients after 2010 had a LLM. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry (conventional or HRM) were performed, before and after surgical treatment. Results Of the 50 patients representing the study population, 23 had CLM and 27 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients’ demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. No intraoperative mucosal lesions were detected. The median length of the myotomy was 7 cm (IQR:7–8) in the CLM and 10 cm (IQR:10–11) in the LLM (P < 0.001). The median of follow-up was 61 months (IQR:35–93) in the CLM and 24 months (IQR:16–36) in the LLM. As a whole, the two groups had a different drop in their symptom score: 21 (17–26) versus 6 (0–8), and 21 (18–27) versus 3 (0–6) for the CLM and LLM respectively (P < 0.05). Moreover, failures were 7/23 (30%) in the CLM and 3/27 (11.1%) in the LLM (P < 0.001). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM (P = n.s.). Conclusion In spite of intrinsic limitations of the study (retrospective, different time window of the two procedures and different follow-up), the extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux. Disclosure All authors have declared no conflicts of interest.

EVALUATION OF DYSPHAGIA USING THE EATING ASSESSMENT TOOL QUESTIONNAIRE (EAT-10) BEFORE AND AFTER ENDOSCOPIC TREATMENT OF THE ZENKER DIVERTICULUM

2018 ◽  
Author(s):  
M Guerra Veloz ◽  
M Jose González-Mariscal ◽  
M Belvis Jimenez ◽  
J Loscertales ◽  
H Galera-Ruiz ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Assessment Tool ◽  
Zenker Diverticulum ◽  
Before And After

Improving Student Creativity Activeness And Implementation Approach In Cbsa On Civics Lesson Grade Ii Sd Negeri 39 Lengayang Gompong.Kec Markets Academic Year 2016/2017

2018 ◽  
Vol 1 (2) ◽  
pp. 89-96
Author(s):  
Darleli Darleli
Keyword(s):  
Civic Education ◽  
Evaluation Study ◽  
Class Action ◽  
Peer Tutors ◽  
Implementation Approach ◽  
Before And After ◽  
Study Population ◽  
Grade Ii ◽  
The Subject ◽  
Academic Year

    The purpose of this study is to prove that the use of the environment around the school can improve students' understanding of the subject Civic Education in Elementary School student 39 Class II Gompong Market. This study uses a class action approach. The study population was taken of all students in grade II , the data collection techniques used artificial teacher learning achievement test. Actions performed a total of two cycles. Data analysis techniques used analysis of the percentage of change in the results of the evaluation study before and after tutoring services with peer tutors. Thus there is an increase in students' mastery of the first cycle and the second cycle. Based on the above, it can be made a conclusion as follows: " Improving Student Creativity activeness And Implementation Approach In CBSA On Civics Lesson Grade II SD Negeri 39 Lengayang Gompong.Kec Markets Academic Year 2016/2017 " .    

scholarly journals 3416 Building Resilience & Wisdom in Clinical and Translational Researchers: A Mixed-Method Study of a Pilot Curricular Intervention

2019 ◽  
Vol 3 (s1) ◽  
pp. 63-63
Author(s):  
Sandra Burks ◽  
Karen Johnston ◽  
Nicole Chiotta-McCollum ◽  
Natalie May ◽  
John Schorling ◽  
...  
Keyword(s):  
Development Program ◽  
Junior Faculty ◽  
Early Career ◽  
Structured Interviews ◽  
Curricular Intervention ◽  
Resilience Scale ◽  
Before And After ◽  
Study Population ◽  
Career Development Program ◽  
Research Workforce

OBJECTIVES/SPECIFIC AIMS: The clinical and translational research workforce is in jeopardy due to investigator attrition and competing demands upon researchers. Resilience and wisdom are measurable traits that can be acquired. The aim of this study was to examine a pilot curricular intervention promoting resilience and wisdom formation in early-career translational researchers. METHODS/STUDY POPULATION: We conducted a prospective, mixed-methods evaluation of a curricular intervention promoting the development of wisdom and resilience among junior faculty in a career development program. Six 90 minute sessions were delivered between September 2017 and January 2018. Pre- and post- resilience and wisdom were measured using the Connor Davidson Resilience Scale and 3D-Wisdom Scale. Individual semi-structured interviews were conducted before and after the intervention RESULTS/ANTICIPATED RESULTS: Five scholars participated. Median resilience and wisdom scores revealed moderate levels of each trait; pre- and post-scores were not significantly different. Four themes emerged from the analysis of interview transcripts: 1. “Success” broadly defined; 2. Adversity threatens success; 3. Community breeds resilience; and 4. Wisdom formation parallels growth towards independence. DISCUSSION/SIGNIFICANCE OF IMPACT: An intervention aimed at developing capacities of resilience and wisdom is feasibly delivered to early career researchers. The relationship between these capacities and the sustainability of a research career warrants additional study.

scholarly journals Pengaruh Akreditasi Rumah Sakit dalam Perubahan Tingkat Kepatuhan Pengisian Surgical Safety Checklist di RS Nur Hidayah

2020 ◽  
Vol 20 (1) ◽  
pp. 258
Author(s):  
Annisa Firdausi ◽  
Arlina Dewi ◽  
Susanto Susanto
Keyword(s):  
Compliance Rate ◽  
Hospital Accreditation ◽  
Sample Number ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Before And After ◽  
Study Population ◽  
Descriptive Approach ◽  
Quantitative Descriptive

Death and complication due to surgeries or surgical actions is a global health problem. The WHO estimates that at least half a million deaths that are caused by surgeries can be prevented. On 2008, the WHO released a campaign about safe surgery and the surgical safety checklist to improve the quality of our surgery cases and decrease the number of complication and deaths caused by surgeries. Hospital accreditation is used to improve the quality of hospital management, including in reducing numbers of death and complication due to surgeries.  This is a quantitative descriptive approach study. The study population used were all surgical safety checklist. Sample number of 75 surgical safety checklist, 15 surgical safety checklist each from June 2017, August 2017, January 2018, June 2018, and January 2019. Data analysis shown by statistic table and percentage. There was a change of number in completing compliance of the surgical safety checklist before and after hospital accreditation. It showed that nearing hospital accreditation, the compliance rate was almost 100% on all the items. This continued a month after, but some of the items had a lower rate of compliance further after the hospital accreditation. The number of completing compliance of the surgical safety checklist nearing hospital accreditation is higher than after hospital accreditation. The sign in item have the highest rate of completing compliance whereas the sign out item had the lowest number of compliance.

scholarly journals Is fibroid location associated with hemorrhage and complication rates following laparoscopic myomectomy?

2020 ◽  
Author(s):  
Kiper Aslan ◽  
Adnan Orhan ◽  
Engin Turkgeldi ◽  
Ebru Suer ◽  
Nergis Duzok ◽  
...  
Keyword(s):  
Posterior Wall ◽  
Anterior Wall ◽  
Uterine Wall ◽  
Laparoscopic Myomectomy ◽  
Complication Rates ◽  
Analgesic Requirement ◽  
Hospitalization Period ◽  
Before And After ◽  
Wall Groups ◽  
Type 3

Abstract Objective To determine whether hemorrhage and complication rates vary according location of the dominant fibroid following laparoscopic myomectomy. Background Laparoscopic myomectomy is associated with less postoperative pain, analgesic requirement, shorter hospitalization period, and less febrile complications when compared to conventional laparotomy. Despite the advantages, complications like hemorrhage, blood transfusion, bowel and urinary tract injury and conversion to laparotomy may be seen in laparoscopic myomectomy. We don’t know whether fibroid location effect these complications. Materials & Methods Women, who underwent laparoscopic myomectomy at two different tertiary academic hospitals, were analyzed retrospectively. Only women with at least one intramural fibroid (Monroe type 3, 4 or 5) were included. Patients were categorized according to localization of the dominant fibroid, i.e. anterior uterine wall, posterior uterine wall, and fundus. Change in hemoglobin levels before and after surgery, and complication rates were compared across categories. Results 219 women with mean age of 35.7 +/-6 years were included. There were 81 women with fundal fibroid, 56 with anterior wall, and 72 with posterior wall fibroid. Other 10 women with intraligamentary and isthmic fibroid were excluded. The mean fibroid diameter was 6.7 ± 2.6, 6.6 ± 2.3, and 6.7 ± 2.3 cm in the fundal, anterior and posterior groups, respectively (p=0.9). The median (25 th – 75 th percentile) changes in hemoglobin levels were 1.5 (0.8 – 2.2), 1.3 (0.6 – 2.1), and 1.3 (0.9 – 2) g/dl in fundal, anterior and posterior wall groups, respectively (p = 0.55). There were 5 (6.2%), 5 (8.9%), and 2 (2.8%) complications in fundal, anterior, and posterior wall groups, respectively (p = 0.33). Conclusion Incidence of hemorrhage or complication does not seem to vary depending on fibroid location. However, the sample size was limited, the observed values suggest that fibroid location does not affect hemorrhage and complication rates.

scholarly journals Effect of Using a Safety Checklist on Patient Complications after Surgery

2014 ◽  
Vol 120 (6) ◽  
pp. 1380-1389 ◽  
Author(s):  
Brigid M. Gillespie ◽  
Wendy Chaboyer ◽  
Lukman Thalib ◽  
Melinda John ◽  
Nicole Fairweather ◽  
...  
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Cochrane Library ◽  
Number Needed To Treat ◽  
Complication Rates ◽  
Random Effects Models ◽  
Fixed And Random Effects ◽  
Before And After ◽  
Meta Analyses ◽  
The Cochrane Library

Abstract Background: Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods: A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results: Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P &lt; 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion: Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

scholarly journals UPAYA PENINGKATAN PENGETAHUAN DAN SIKAP KADER DALAM PENCEGAHAN PEMBERIAN MAKANAN PRALAKTAL PADA BAYI 0-3 HARI

2018 ◽  
Vol 10 (2) ◽  
pp. 173-178
Author(s):  
Iis Ria Fitriani
Keyword(s):  
Public Health ◽  
Health Center ◽  
Control Group ◽  
Public Health Center ◽  
Before And After ◽  
Post Test ◽  
Comparison Groups ◽  
Study Population ◽  
Knowledge And Attitude ◽  
And Control

Infant Mortality in Bengkulu Province is still high, this can be prevented through breastfeeding as a staple food in infants 0-6 months without other complementary foods because breast milk boosts immune status for infants and thus can reduce mobility and mortality rates but exclusive ASI coverage still low, this is influenced by pralactal feeding in infants 0-3 days of birth. Research Objective to increase knowledge and attitude of cadre through training as promotion effort of prevention of pralactal food in 0-3 days old baby. Quasi pre and post test experiments with comparison groups. The study population were all cadres in Talang Tinggi Public Health Center, which were 50 people in Talang Tinggi Public Health Center, Seluma District with experimental group samples were cadres who were given training by using module and control group were cadres who were trained by using lecture and question and answer method. There is an average difference of attitude and knowledge before and after intervention in the cadres given training on prevention of pralactal food in infants 0-3 days. There is an effect of training on prevention efforts of pralactal feeding using modules with cadre attitude. Puskesmas should increase the promotion of prevention of pralactal food to change cadre attitude to support program exclusive breastfeeding.

P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit

2019 ◽  
Vol 90 (3) ◽  
pp. e50.4-e51
Author(s):  
H Asif ◽  
CL Craven ◽  
U Reddy ◽  
LD Watkins ◽  
AK Toma
Keyword(s):  
Intensive Care Unit ◽  
External Ventricular Drain ◽  
Complication Rates ◽  
Single Centre ◽  
Acute Hydrocephalus ◽  
Clinical Notes ◽  
Before And After ◽  
Csf Diversion ◽  
Neurosurgical Operation ◽  
Mean Time

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.

Sign in / Sign up

Export Citation Format

Share Document