Evaluation of two alternative ablation treatments for cervical pre-cancer against standard gas-based cryotherapy: a randomized non-inferiority study

2019 ◽  
Vol 29 (5) ◽  
pp. 851-856 ◽  
Author(s):  
Miriam Cremer ◽  
Karla Alfaro ◽  
Jillian Garai ◽  
Manuel Salinas ◽  
Mauricio Maza ◽  
...  
Keyword(s):  
Low Income ◽  
Histological Evaluation ◽  
Cervical Tissue ◽  
Post Surgery ◽  
Pain Scores ◽  
Patient Pain ◽  
The Difference ◽  
Cure Rates ◽  
Treatment Application ◽  
Standard Gas

IntroductionGas-based cryotherapy is the conventional ablative treatment for cervical pre-cancer in low-income settings, but the use of gas poses significant challenges. We compared the depth of necrosis induced by gas-based cryotherapy with two gas-free alternatives: cryotherapy using CryoPen,and thermoablation.MethodsWe conducted a five-arm randomized non-inferiority trial: double-freeze carbon dioxide (CO2) cryotherapy (referent), single-freeze CO2 cryotherapy, double-freeze CryoPen, single-freeze CryoPen, and thermoablation. Subjects were 130 women scheduled for hysterectomy for indications other than cervical pathology, and thus with healthy cervical tissue available for histological evaluation of depth of necrosis post-surgery. The null hypothesis was rejected (ie, conclude non-inferiority) if the upper bound of the 90% confidence interval (90% CI) for the difference in mean depth of necrosis (referent minus each experimental method) was <1.14 mm. Patient pain during treatment was reported on a scale of 0 (no pain) to 10 (worst pain).ResultsA total of 133 patients were enrolled in the study. The slides from three women were deemed unreadable. One patient was excluded because her hysterectomy was postponed for reasons unrelated to the study, and two patients were excluded because treatment application did not follow the established protocol. For the remaining 127 women, mean depth of necrosis for double-freeze CO2 (referent) was 6.0±1.6 mm. Differences between this and other methods were: single-freeze CO2 = 0.4 mm (90% CI −0.4 to 1.2 mm), double-freeze CryoPen= 0.7 mm (90% CI 0.04 to 1.4 mm), single-freeze CryoPen= 0.5 mm (90% CI −0.2 to 1.2 mm), and thermoablation = 2.6 mm (90% CI 2.0 to 3.1 mm). Mean pain levels were 2.2±1.0 (double-freeze CO2 cryotherapy), 1.8±0.8 (single-freeze CO2 cryotherapy), 2.5±1.4 (double-freeze CryoPen), 2.6±1.4 (single-freeze CryoPen), and 4.1±2.3 (thermoablation).DiscussionCompared with the referent, non-inferiority could not be concluded for other methods. Mean pain scores were low for all treatments. Depth of necrosis is a surrogate for treatment efficacy, but a randomized clinical trial is necessary to establish true cure rates.

Functional Outcomes of Nerve Root Sparing Posterior Corpectomy in Lumbar Vertebral Burst Fractures

2021 ◽  
pp. 219256822098412
Author(s):  
Abhinandan Reddy Mallepally ◽  
Nandan Marathe ◽  
Abhinav Kumar Shrivastava ◽  
Vikas Tandon ◽  
Harvinder Singh Chhabra
Keyword(s):  
Blood Loss ◽  
Burst Fracture ◽  
Operating Time ◽  
Deformity Correction ◽  
Neurological Status ◽  
Height Loss ◽  
Vas Score ◽  
Post Surgery ◽  
Burst Fractures ◽  
The Difference

Study Design: Retrospective observational. Objectives: This study aimed to document the safety and efficacy of lumbar corpectomy with reconstruction of anterior column through posterior-only approach in complete burst fractures. Methods: In this retrospective study, we analyzed complete lumbar burst fractures treated with corpectomy through posterior only approach between 2014 and 2018. Clinical and intraoperative data including pre and post-operative neurology as per the ISNCSCI grade, VAS score, operative time, blood loss and radiological parameters, including pre and post-surgery kyphosis, height loss and canal compromise was assessed. Results: A total of 45 patients, with a mean age of 38.89 and a TLICS score 5 or more were analyzed. Preoperative VAS was 7-10. Mean operating time was 219.56 ± 30.15 minutes. Mean blood loss was 1280 ± 224.21 ml. 23 patients underwent short segment fixation and 22 underwent long segment fixation. There was no deterioration in post-operative neurological status in any patient. At follow-up, the VAS score was in the range of 1-3. The difference in preoperative kyphosis and immediate post-operative deformity correction, preoperative loss of height in vertebra and immediate post-operative correction in height were significant (p < 0.05). Conclusion: The posterior-only approach is safe, efficient, and provides rigid posterior stabilization, 360° neural decompression, and anterior reconstruction without the need for the anterior approach and its possible approach-related morbidity. We achieved good results with an all posterior approach in 45 patients of lumbar burst fracture (LBF) which is the largest series of this nature.

scholarly journals Music Intervention to Orthopedic Patients: A Possible Alternative Solution to Control Pain

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Chuchu Wang ◽  
Fanli Tian
Keyword(s):  
Pain Relief ◽  
Pain Control ◽  
Music Intervention ◽  
Postoperative Patient ◽  
Pain Scores ◽  
Mp3 Players ◽  
Patient Pain ◽  
Quasi Experimental ◽  
Control Pain ◽  
Orthopedic Patients

Aims and Objective. Pain is a common problem associated with postoperative orthopedic patients; the current study is aimed at evaluating music intervention as an alternative method to control pain. Methodology. The experimental design of the current study was comparative, descriptive, and quasi-experimental. 38 postoperative orthopedic patients were equipped with pocket-size MP3 players with prerecorded music tracks (instrumental and lyrical) in Hindi, English, and Urdu. After that, pre-post-pain scores were recorded with the help of designed brief patient logs. Ultimately, a satisfactory survey was completed at discharge. Major Findings. It was found that during the intervention of music, the pain was significantly reduced from 5.40 to 2.98. There was a slight relationship between listening time and pain relief. It was also found that the feedback was extremely positive and each patient suggested the use of music to others with 96.6% recommendation. Conclusion. From the current study, it was found that music intervention can be beneficial to postoperative patient pain control. Further, it is hoped that the findings of the current experimental work will lead to improvements in the care of postoperative patients.

scholarly journals Imperialismo en el siglo XXI

2016 ◽  
Vol 6 (10) ◽  
pp. 49-74
Author(s):  
John Smith ◽  
Keyword(s):  
North America ◽  
Low Income ◽  
Great Part ◽  
Low Income Countries ◽  
Capitalist Development ◽  
Neoliberal Globalization ◽  
The North ◽  
Foreign Labor ◽  
Economic Foundation ◽  
The Difference

The globalization of production and its spread to low-income countries is the most notable transformation of the neoliberal era. Its driving force is the efforts by companies in Europe, North America and Japan to cut costs and raise profits, replacing relatively well-paid domestic labor for cheaper foreign labor. The gap in global wages, in great part the result of the suppression of the free movement of labor, provides a distorted view of the global differences in the rate of exploitation (simply, the difference between the value generated by the workers and what they are paid) upon which profits, prosperity and social peace in Europe, North America and Japan are ever-more reliant. Thus, neoliberal globalization should be seen as a new imperialist stage in capitalist development, where «imperialism» is defined by its economic foundation: the exploitation of labor in the South by capitalists from the North.

scholarly journals Recovery Trajectories Over Six Weeks in Patients Selected for A High-Intensity Physiotherapy Program After Total Knee Arthroplasty: A Latent Class Analysis

2020 ◽  
Author(s):  
K.E.M. Harmelink ◽  
R. Dandis ◽  
P.J. Wees ◽  
A.V.C.M. Zeegers ◽  
M.W. Nijhuis-van der Sanden ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Physical Functioning ◽  
Latent Class ◽  
Class Analysis ◽  
Timed Up And Go ◽  
Surgery Outcome ◽  
Post Surgery ◽  
Multivariable Regression ◽  
The Difference ◽  
One Year

Abstract Background: Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes. Methods: Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery. Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes.Results: TUG showed three classes: “gain group” (n=203), “moderate gain group” (n=8) and “slow gain group” (n=7), KOOS showed two classes: “gain group” (n=86) and “moderate gain group” (n=132), and VAS-pain three classes: “no/very little pain” (n=151), “normal decrease of pain” (n=48) and “sustained pain” (n=19). The ”low gain group” scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the “moderate gain group” group, and the KOOS “gain group” scored 11.97 [95% CI 8.62, 15.33] points better than the “moderate gain group” after one year.Patients who had an early trajectory of “sustained pain” had less chance to become free of pain at one year than those who reported “no or little pain” (odds ratio 0.11 [95% CI 0.03,0.42]. Conclusion: The findings of this study indicate that different recovery trajectories can be detected. Especially the difference in TUG and KOOS-ADL between the “gain” and “moderate gain” group was considered clinically relevant, while for VAS scores differences between “no/very little pain,” and “sustained pain” were statistically significant but small.

scholarly journals Mirror therapy for phantom limb and stump pain: a randomized controlled clinical trial in landmine amputees in Cambodia

2018 ◽  
Vol 18 (4) ◽  
pp. 603-610 ◽  
Author(s):  
Ha Sam Ol ◽  
Yang Van Heng ◽  
Lena Danielsson ◽  
Hans Husum
Keyword(s):  
Low Income ◽  
Controlled Trial ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Controlled Clinical Trial ◽  
Mirror Therapy ◽  
Randomized Controlled ◽  
Stump Pain ◽  
The Difference ◽  
Therapy Interventions

Abstract Background and aims The aim of the study was to examine the effect of mirror and tactile therapy on phantom and stump pain in patients with traumatic amputations, with particular reference to amputees in low-income communities. Methods The study was conducted with an open, randomized, semi-crossover case-control design in rural Cambodia. A study sample of 45 landmine victims with trans-tibial amputations was allocated to three treatment arms; mirror therapy, tactile therapy, and combined mirror-and-tactile therapy. Non-responders from the mono-therapy interventions were crossed over to the alternative intervention. The intervention consisted of 5 min of treatment every morning and evening for 4 weeks. Endpoint estimates of phantom limb pain (PLP), stump pain, and physical function were registered 3 months after the treatment. Results All three interventions were associated with more that 50% reduction in visual analogue scale (VAS)-rated PLP and stump pain. Combined mirror-tactile treatment had a significantly better effect on PLP and stump pain than mirror or tactile therapy alone. The difference between the three treatment arms were however slight, and hardly of clinical relevance. After treatment, the reduction of pain remained unchanged for an observation period of 3 months. Conclusions The study documents that a 4-week treatment period with mirror and/or tactile therapy significantly reduces PLP and stump pain after trans-tibial amputations. Implications The article reports for the first time a randomized controlled trial of mirror therapy in a homogenous sample of persons with traumatic amputations. The findings are of special relevance to amputees in low-resource communities.

Partners’ Educational Pairings and Subjective Well-Being in China: An Analysis Using the Diagonal Mobility Model

2021 ◽  
pp. 0192513X2110380
Author(s):  
Xiaohang Zhao ◽  
Skylar Biyang Sun
Keyword(s):  
Low Income ◽  
Sex Role ◽  
General Social Survey ◽  
Well Being ◽  
Mobility Model ◽  
Subjective Well Being ◽  
Psychological Benefits ◽  
Educational Homogamy ◽  
The Difference ◽  
Chinese General Social Survey

Using pooled data from the Chinese General Social Survey in 2010, 2012, 2013, and 2015, this study investigated the relationship between partners’ educational pairings and subjective well-being among Chinese. Diagonal mobility models were employed to avoid conflating the effect of each partner’s education and the effect of the difference in education between partners. The findings reveal that regarding the well-being consequences of partners’ educational pairings, the hypothesis of satisfaction with marrying up outweighs the hypothesis of educational homogamy advantages and the hypothesis of sex roles. Specifically, for both women and men, persons marrying up in education are more likely to feel happy than their educationally homogamous counterparts. Moreover, educational hypergamy confers more psychological benefits to women in high-income communities than those in low-income communities. In addition, the earnings difference between partners plays a part in men’s SWB. Husbands who earn less than their wives are more likely to be unhappy than those whose earnings are 1–1.5 times those of their wives, suggesting that sex-role norms are at work. Our study contributes to a deeper understanding of the well-being consequences of educational heterogamy.

Toward the Pursuit of What People Value

2021 ◽  
Vol 10 (2) ◽  
pp. 59-73
Author(s):  
Mendiola Teng-Calleja ◽  
Jose Antonio R. Clemente ◽  
Ma. Ligaya Menguito ◽  
Donald Jay Bertulfo
Keyword(s):  
Low Income ◽  
Good Life ◽  
Well Being ◽  
The Philippines ◽  
Living Wage ◽  
The Good Life ◽  
Initial Attempt ◽  
The Difference ◽  
Research And Policy ◽  
The Capability Approach

Abstract. This study sought to initiate conversations on the utility of the capability approach and a psychological lens in approximating a living wage. We put forth the concept of capability gap – defined as the difference between what one values and what one perceives as attainable. We used a set of valued domains of a good life that were identified based on well-being indicators in determining capability gaps. Five hundred workers (all breadwinners) belonging to households selected through stratified random sampling from purposively chosen middle- and low-income communities in the Philippines participated in the survey. From the data, we constructed a weighted capability measure that determines the capability gap, weighted by the perceived importance of each of the good life domains. We likewise derived an estimate of a living wage that yields a weighted capability that represents individuals' capabilities to achieve and pursue valued outcomes, freedoms, and entitlements. This initial attempt at estimating a living wage based on individuals' capability to achieve and pursue a good life is presented as the main contribution of the research. The limitations of the study as well as its implications to living wage research and policy are discussed.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

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