Identifying Effectors of Outcomes in Patients with Large Umbilical Hernias

2016 ◽  
Vol 82 (7) ◽  
pp. 613-621 ◽  
Author(s):  
Steven A. Groene ◽  
Davis W. Heniford ◽  
Tanushree Prasad ◽  
Amy E. Lincourt ◽  
Vedra A. Augenstein
Keyword(s):  
Umbilical Hernia ◽  
Defect Size ◽  
Long Term Outcomes ◽  
Preoperative Pain ◽  
The Mean ◽  
The Difference ◽  
One Year

Quality of life (QOL) has become an important focus of hernia repair outcomes. This study aims to identify factors which lead to ideal outcomes (asymptomatic and without recurrence) in large umbilical hernias (defect size ≥9 cm2). Review of the prospective International Hernia Mesh Registry was performed. The Carolinas Comfort Scale was used to measure QOL at 1-, 6-, and 12-month follow-up. Demographics, operative details, complications, and QOL data were evaluated using standard statistical methods. Forty-four large umbilical hernia repairs were analyzed. Demographics included: average age 53.6 ± 12.0 and body mass index 34.9 ± 7.2 kg/m2. The mean defect size was 21.7 ± 16.9 cm2, and 72.7 per cent were performed laparoscopically. Complications included hematoma (2.3%), seroma (12.6%), and recurrence (9.1%). Follow-up and ideal outcomes were one month = 28.2 per cent, six months = 42.9 per cent, one year = 55.6 per cent. All patients who remained symptomatic at one and two years were significantly symptomatic before surgery. Symptomatic preoperative activity limitation was a significant predictor of nonideal outcomes at one year ( P = 0.02). Symptomatic preoperative pain was associated with nonideal outcomes at one year, though the difference was not statistically significant ( P = 0.06). Operative technique, mesh choice, and fixation technique did not impact recurrence or QOL. Repair of umbilical hernia with defects ≥9 cm2 had a surprising low rate of ideal outcomes (asymptomatic and no recurrence). All patients with nonideal long-term outcomes had preoperative pain and activity limitations. These data may suggest that umbilical hernia should be repaired when they are small and asymptomatic.

scholarly journals Preliminary Results of first Belgian Cohort of Juvenile Idiopathic Arthritis: Where Do we Stand in Terms of Quality of Care and Remission?

2020 ◽  
Author(s):  
Céline La ◽  
Phu Quoc Lê ◽  
Alina Ferster ◽  
Laurence Goffin ◽  
Bernard Lauwerys ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Quality Of Care ◽  
Long Term Outcomes ◽  
Disease Characteristics ◽  
French Speaking ◽  
Das28 Remission ◽  
The Mean

Abstract BackgroundJuvenile idiopathic arthritis (JIA) represents a very heterogeneous disease, and our objectives were to describe the first Belgian cohort of children with JIA, assess their disease characteristics and outcome and identify potential markers of prognosis.MethodsThe CAP48 cohort is a multicentric observational study of children with a recent or well-established diagnosis of JIA (naïve or not to treatment at baseline), evaluated every 6 months during a follow-up of 5 to 10 years.ResultsThere were 125 children included in the cohort, composed of 25 naïve and 100 established patients. The patients had a median age of 6.2 and 4.2 years at onset in the naïve and established cohort respectively, with a predominance of female. All subtypes of JIA were represented in both cohorts. The mean DAS28-CRP and JADAS10-CRP at baseline in naïve patients was 2.52 and 6.0 respectively. Uveitis occurred in 19% of patients and was strongly associated with presence of antinuclear antibodies (odds ratio of 6). Fifty-five percent of naïve patients were in remission at 12 months of follow-up according to the ACR criteria and JADAS10 scores, in contrast with 100% achieving DAS28 remission. ConclusionThis first cohort study in Belgium allowed to compare its data to other existing cohorts and to evaluate quality of care in Belgian French-speaking hospitals. Additionally, it highlighted a superiority of JADAS10 over DAS28 to monitor and evaluate remission in JIA. This study also underlined a need for more accurate markers of prognosis to improve treatment and long-term outcomes.

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

scholarly journals An update of the long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan-Xia Yu ◽  
Yuan Yang ◽  
Yan-Bing Wu ◽  
Xiao-Juan Wang ◽  
Li-Li Xu ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Malignant Disease ◽  
Long Term Outcomes ◽  
Benign Diseases ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Medical Thoracoscopy ◽  
One Year

Abstract Background Medical thoracoscopy (MT) is recommended in patients with undiagnosed exudative pleural effusion and offers a degree of diagnostic sensitivity for pleural malignancy. However, not all patients who undergo MT receive an exact diagnosis. Our previous investigation from 2014 summarized the long-term outcomes of these patients with nonspecific pleurisy (NSP); now, we offer updated data with the goal of refining our conclusions. Methods Between July 2005 and August 2018, MT with pleural biopsies were performed in a total of 1,254 patients with undiagnosed pleural effusions. One hundred fifty-four patients diagnosed with NSP with available follow-up data were included in the present study, and their medical records were reviewed. Results A total of 154 patients were included in this study with a mean follow-up duration of 61.5 ± 43.7 months (range: 1–180 months). No specific diagnosis was established in 67 (43.5%) of the patients. Nineteen patients (12.3%) were subsequently diagnosed with pleural malignancies. Sixty-eight patients (44.2%) were diagnosed with benign diseases. Findings of pleural nodules or plaques during MT and the recurrence of pleural effusion were associated with malignant disease. Conclusions Although most NSP patients received a diagnosis of a benign disease, malignant disease was still a possibility, especially in those patients with nodules or plaques as noted on the MT and a recurrence of pleural effusion. One year of clinical follow-up for NSP patients is likely sufficient. These updated results further confirm our previous study’s conclusions.

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

2021 ◽  
pp. postgradmedj-2020-139021
Author(s):  
Manoj Kumar ◽  
Maasila Arcot Thanjan ◽  
Natarajan Gopalakrishnan ◽  
Dhanapriya Jeyachandran ◽  
Dineshkumar Thanigachalam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Urine Protein ◽  
Renal Outcomes ◽  
Snake Envenomation ◽  
The Mean ◽  
New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

scholarly journals Impact of adherence to long-term oxygen therapy on patients with COPD and exertional hypoxemia followed for one year

2018 ◽  
Vol 44 (5) ◽  
pp. 390-397 ◽  
Author(s):  
Carolina Bonfanti Mesquita ◽  
Caroline Knaut ◽  
Laura Miranda de Oliveira Caram ◽  
Renata Ferrari ◽  
Silmeia Garcia Zanati Bazan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oxygen Therapy ◽  
Severe Hypoxemia ◽  
Bode Index ◽  
One Year ◽  
Long Term Oxygen Therapy ◽  
Minute Walk

ABSTRACT Objective: To determine the impact of adherence to long-term oxygen therapy (LTOT) on quality of life, dyspnea, and exercise capacity in patients with COPD and exertional hypoxemia followed for one year. Methods: Patients experiencing severe hypoxemia during a six-minute walk test (6MWT) performed while breathing room air but not at rest were included in the study. At baseline and after one year of follow-up, all patients were assessed for comorbidities, body composition, SpO2, and dyspnea, as well as for anxiety and depression, having also undergone spirometry, arterial blood gas analysis, and the 6MWT with supplemental oxygen. The Saint George’s Respiratory Questionnaire (SGRQ) was used in order to assess quality of life, and the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index was calculated. The frequency of exacerbations and the mortality rate were noted. Treatment nonadherence was defined as LTOT use for < 12 h per day or no LTOT use during exercise. Results: A total of 60 patients with COPD and exertional hypoxemia were included in the study. Of those, 10 died and 11 experienced severe hypoxemia during follow-up, 39 patients therefore being included in the final analysis. Of those, only 18 (46.1%) were adherent to LTOT, showing better SGRQ scores, higher SpO2 values, and lower PaCO2 values than did nonadherent patients. In all patients, SaO2, the six-minute walk distance, and the BODE index worsened after one year. There were no differences between the proportions of adherence to LTOT at 3 and 12 months of follow-up. Conclusions: Quality of life appears to be lower in patients with COPD and exertional hypoxemia who do not adhere to LTOT than in those who do. In addition, LTOT appears to have a beneficial effect on COPD symptoms (as assessed by SGRQ scores). (Brazilian Registry of Clinical Trials - ReBEC; identification number RBR-9b4v63 [http://www.ensaiosclinicos.gov.br])

scholarly journals THE ASSIMILATION PROCESS OF PROBLEMATIC EXPERIENCES AND LONG-TERM OUTCOMES IN PSYCHOTHERAPY FOR DEPRESSION: COMPARING A RELAPSED AND A NON-RELAPSED CASE

2021 ◽  
Author(s):  
Beatriz Viana ◽  
◽  
Ricardo Machado ◽  
William B. Stiles ◽  
João Salgado ◽  
...  
Keyword(s):  
Relapse Prevention ◽  
Therapeutic Change ◽  
Long Term Outcomes ◽  
Emotion Focused Therapy ◽  
Therapy Termination ◽  
Assimilation Process ◽  
Problematic Experiences ◽  
One Year

"Over the years, research has demonstrated that psychotherapy is an effective treatment in different psychopathological conditions. However, which are the mechanisms or processes involved in therapeutic change that could explain its efficacy are not yet clear. The Assimilation of Problematic Experiences Model describes change in therapy as a process that occurs through the gradual assimilation of problematic experiences in the self – higher levels of assimilation seem to be associated with a better outcome at the end of therapy. However, little is known about the contribution of this process to the maintenance of therapeutic gains after the end of therapy. In the current study we aimed to explore how the level of assimilation achieved throughout therapy is associated with relapse prevention after treatment. We analyzed two good outcome cases of Emotion-Focused Therapy, previously diagnosed with depression: one case that remained asymptomatic and another that relapsed one year and a half after the end of therapy. The Assimilation of Problematic Experiences (APES) was used to assess the assimilation levels achieved and the Beck Depression Inventory-II (BDI-II) was used to assess the intensity of depressive symptoms. Five therapeutic sessions and three follow-up sessions were rated using the APES. The results showed that higher APES levels were associated with lower intensity of symptoms at the end and after therapy termination, being associated with relapse prevention in depression. These results suggest that a complete assimilation of the problematic experiences may help clients to maintain therapeutic gains reducing the probability of relapsing in depression."

scholarly journals Impact of atrial fibrillation pattern on left atrial appendage closure: insights from the prospective LAARGE registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S Kany ◽  
J Brachmann ◽  
T Lewalter ◽  
I Akin ◽  
H Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Left Atrial Appendage Closure ◽  
History Of ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Stiftung für Herzinfarkforschung Background  Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death compared with paroxysmal AF (PAF). This study investigates the procedural safety and long-term outcomes of left atrial appendage closure (LAAC) in patients with different forms of AF. Methods  Comparison of procedural details and long-term outcomes in patients (pts) with PAF against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC in Germany (LAARGE).  Results  A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. NPAF consisted of 31.6% patients with persistent AF and 68.4% with longstanding persistent AF or permanent AF. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The PAF group had significantly less history of heart failure (19.0% vs 33.0%, p &lt; 0.001) while the current median LVEF was similar (60% vs 60%, p = 0.26). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), but no difference in the HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was observed. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77) in both groups. In the three-month echo follow-up, device-related thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak &gt;5 mm (0.0% vs 7.1%, p= 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95%-CI: 1.02-2.72). Conclusion  Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE of patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality and combined outcome of death, stroke and systemic embolism.

Interposition GraftJacket allografts for irreparable rotator cuff tears

2022 ◽  
Vol 104-B (1) ◽  
pp. 91-96
Author(s):  
Amit Modi ◽  
Aziz Haque ◽  
Vijay Deore ◽  
Harvinder Pal Singh ◽  
Radhakant Pandey
Keyword(s):  
Rotator Cuff ◽  
Pain Score ◽  
Reverse Shoulder Arthroplasty ◽  
Young Patients ◽  
Rotator Cuff Tears ◽  
Long Term Outcomes ◽  
Open Reconstruction ◽  
One Year

Aims Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. Methods This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The Oxford Shoulder Score (OSS), pain score, and range of motion (ROM) were recorded preoperatively and at one year and a mean of 9.1 years (7.0 to 12.5) postoperatively. Results There was significant improvement in the mean OSS from 24.7 (SD 5.4) preoperatively to 42.0 (SD 6.3) at one year, and this improvement was maintained at 9.1 years (p < 0.001), with a score of 42.8 (SD 6.8). Similar significant improvements in the pain score were seen and maintained at the final follow-up from 6.1 (SD 1.6) to 2.1 (SD 2.3) (p < 0.001). There were also significant improvements in the ROM of the shoulder, and patient satisfaction was high. Conclusion The use of an interposition human dermal allograft in patients with an irreparable rotator cuff tear leads to good outcomes that are maintained at a mean of nine years postoperatively. Cite this article: Bone Joint J 2022;104-B(1):91–96.

scholarly journals One-Year Follow-Up of Spa Treatment in Older Patients with Osteoarthritis: A Prospective, Single Group Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Jolanta Zwolińska ◽  
Aneta Weres ◽  
Justyna Wyszyńska
Keyword(s):  
Quality Of Life ◽  
Social Relations ◽  
Mineral Waters ◽  
Spa Therapy ◽  
Spa Treatment ◽  
Short And Long Term ◽  
One Year

Introduction. Few studies evaluated the effects of spa therapy on pain perception and quality of life in older people with osteoarthritis. Therefore, the aim of the study was to evaluate the short- and long-term effects of spa therapy on quality of life and pain in patients aged 60 years and older with osteoarthritis. Materials and Methods. 70 patients with generalized osteoarthritis were enrolled in the study. Spa treatment lasted 3 weeks (15 days of treatment) and was applied during a session lasting 120 to 150 minutes a day. All the patients benefited from kinesiotherapy, physical agent modalities, massage, peloid therapy, hydrotherapy with mineral waters, and crenotherapy. Visual Analogue Scale (VAS) for pain, the Laitinen scale, and WHOQOL-BREF questionnaire were used to assess the condition of the patients. The examinations were performed three times: at the beginning of the spa treatment, after three months, and one year after the first examinations. Results. Statistically significant improvements were observed in pain (VAS) between consecutive assessments (p <.001). Laitinen scale also reported beneficial, statistically significant changes in the level of pain (p <.001). The WHOQOL-BREF questionnaire reported a statistically significant improvement in the domain of social relations in 2-3 and 1-3 periods (p = .025 and p = .011, resp.). A significant improvement was recorded in the domain of environment between 2-3 and 1-3 periods (p <.001). Conclusion. Spa treatment reduced the level of pain in majority of the patients in short- and long-term follow-up and contributed to improving the quality of life in the domain of social relations and environment. To confirm the results of this study, there is a need for a randomized controlled trial comparing spa treatment with usual care in the older population with osteoarthritis. Trial Registration Number. This trial was retrospectively registered on 3 January 2018 with NCT03388801.

Outcomes of the Modified Endoscopic Lothrop Procedure

2002 ◽  
Vol 16 (5) ◽  
pp. 269-273 ◽  
Author(s):  
Stacey L. Schulze ◽  
Todd A. Loehrl ◽  
Timothy L. Smith
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Frontal Sinusitis ◽  
Long Term Outcomes ◽  
Postoperative Patient ◽  
Perceived Quality Of Life ◽  
Telephone Questionnaire

Background The aim of this study was to examine the long-term outcomes of the modified endoscopic Lothrop procedure for the management of the most severe forms of recalcitrant chronic frontal sinusitis. Methods This case series evaluated 13 consecutive cases of the modified endoscopic Lothrop procedure for chronic frontal sinusitis from April 1996 to December 1999. Patent communication to the frontal sinus was evaluated by postoperative endoscopic exam. Postoperative patient symptomatology and medication requirements were assessed during clinic evaluation and by standardized telephone questionnaire. Results At a mean follow-up period of 34.5 months, a 77% patency rate was obtained, with 2 of the 13 patients requiring an osteoplastic flap with obliteration. Telephone questionnaire results indicate improved symptoms and decreased medication requirements in the majority of patients who maintained patency. Conclusions These results show that the modified endoscopic Lothrop procedure provides a good alternative to the osteoplastic flap with obliteration for patients with the most severe forms of chronic frontal sinusitis. Initially, high patency rates decline with longer-term follow-up, and severe forms of chronic rhinosinusitis continue to significantly impact patient-perceived quality of life in some patients. The modified endoscopic Lothrop procedure should be reserved for patients who have failed more conservative endoscopic approaches to the frontal recess.

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