A Simplified Nonsurgical Method for the Correction of Neonatal Deformational Auricular Anomalies

2016 ◽  
Vol 56 (2) ◽  
pp. 132-139 ◽  
Author(s):  
Catherine S. Chang ◽  
Scott P. Bartlett
Keyword(s):  
Plastic Surgeon ◽  
Improved Outcomes ◽  
Before And After ◽  
Polysiloxane Gel ◽  
Delay In Treatment

Despite reported success of early nonsurgical splinting of congenital ear deformities, the technique has not been widely utilized due to difficulty with application and positional maintenance of these devices. Delay in treatment can result in unnecessary surgery for the child later in life. In response to this need, we developed a simplified system consisting of Velcro, conformers, and polysiloxane gel that can be applied in 3 steps. Before and after photos after application of the device were graded by a plastic surgeon independent of the study. A total of 33 ear deformities were treated. In all, 92.3% of ears achieved significant improvement and normalization of their ears after therapy. This device allows for a more straightforward and individualized application than current products available. Our hope is that practitioners involved early in the infant’s care will utilize this technology resulting in improved outcomes and avoiding unnecessary surgery.

scholarly journals Do Mental Health First Aid™ courses enhance knowledge?

2017 ◽  
Vol 12 (2) ◽  
pp. 69-76 ◽  
Author(s):  
Hana Morrissey ◽  
Simon Moss ◽  
Nektarios Alexi ◽  
Patrick Ball
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Inclusion ◽  
First Aid ◽  
Human Interaction ◽  
Mental Health First Aid ◽  
Content Type ◽  
Improved Outcomes ◽  
Provision Of Services ◽  
Before And After

Purpose Biased assumptions and unhelpful tendencies in human nature can lead people who are experiencing mental illness to shun help and support. Mental illness is often perceived as immutable and/or a sign of weakness. Even those seeking support may not receive the assistance they need. Advice may be unsuitable or people feel too nervous and challenged to help. The Mental Health First Aid™ courses, like general first aid, are designed to enhance community knowledge and thereby support appropriate assistance. The purpose of this paper is to evaluate the extent to which this is achieved. Design/methodology/approach An educational audit based upon a short quiz administered anonymously to 162 tertiary students from a range of disciplines, before and after delivery of the standard 12 hour Mental Health First Aid™ course. This was used to examine assumptions and proposed actions before and after training. Findings Analysis of the 162 responses found that the Mental Health First Aid™ courses significantly improve knowledge. This has the potential to increase understanding and support for those suffering mental illness. Research limitations/implications This educational audit looked only at knowledge improvement. Whether this really does translate into improved outcomes requires further investigation. Practical implications Tertiary students who are enrolled in health courses and others which involve human interaction as provision of services will be empowered with skills that enable them to interact with those who they will be serving at well-informed level and equity. Social implications Social inclusion and de-stigmatising mental health issues Originality/value Mental health first aid courses potentially enable individuals who are not otherwise involved in mental health to assist people in need.

Influence of Specialist Title On Perceived Surgical Ability

1994 ◽  
Vol 2 (4) ◽  
pp. 149-154 ◽  
Author(s):  
Michael L Kreidstein ◽  
Hugh G Thomson ◽  
Peter C Neligan
Keyword(s):  
Plastic Surgery ◽  
Plastic Surgeon ◽  
Reconstructive Procedures ◽  
Operative Results ◽  
Before And After ◽  
Facial Plastic ◽  
The Face ◽  
Operative Result ◽  
Surgery Resident ◽  
Nose And Throat

ML Kreidstein, HG Thomson, PC Neligan. Influence of specialist title on perceived surgical ability. Can J Plast Surg 1994;2(4):149-154. This study was conducted to test the hypothesis that patients associate specialist titles with superior surgical ability, and that operative results are viewed more favorably if believed to be the handiwork of a specialist. Subjects (n=130) were randomly selected from among patients at a medical walk-in clinic. All subjects were presented with an identical set of ‘before and after’ photographs depicting six unrelated facial operations. However, each set of photographs was attributed at random to one of the following surgeons: plastic surgeon, plastic surgery resident, aesthetic plastic surgeon, facial plastic surgeon, ear nose and throat/ head and neck surgeon, cosmetic surgeon. Subjects completed a questionnaire evaluating the quality of the result from each operation, and then for each operation indicated which of the above surgeons was likely to achieve the best operative result. The attribution of identical operative results to the different surgeons resulted in evaluations that were not statistically different (P>0.05). Cosmetic surgeons were chosen most frequently as the type of surgeon likely to perform the best quality rhytidectomy or rhinoplasty, and facial plastic surgeons were chosen most frequently as best for repairs of facial lacerations or removal of skin tumours on the face (P<0.00l). Plastic surgeons and ear nose and throat surgeons received intermediate ratings, and aesthetic plastic surgeons and plastic surgery residents received low ratings. As hypothesized, specialist titles were associated with superior surgical ability, with cosmetic surgeons thought to provide the best cosmetic procedures, and facial plastic surgeons thought to provide the best reconstructive procedures. Despite this bias, evaluations of the operative results were not influenced by the type of surgeon credited with the operation, refuting the hypothesis of a placebo-type effect.

The Impact of Regionalization of Pancreaticoduodenectomy for Pancreatic Cancer in North Carolina since 2004

2014 ◽  
Vol 80 (6) ◽  
pp. 561-566 ◽  
Author(s):  
Ryan Z. Swan ◽  
David J. Niemeyer ◽  
Ramanathan M. Seshadri ◽  
Kyle J. Thompson ◽  
Amanda Walters ◽  
...  
Keyword(s):  
North Carolina ◽  
Significant Risk ◽  
High Volume ◽  
Major Morbidity ◽  
The North ◽  
Time Period ◽  
Improved Outcomes ◽  
Before And After ◽  
Low Volume ◽  
The Impact

Pancreaticoduodenectomy (PD) carries a significant risk. High-volume centers (HVCs) provide improved outcomes and regionalization is advocated. Rapid regionalization could, however, have detrimental effects. North Carolina has multiple HVCs, including an additional HVC added in late 2006. We investigated regionalization of PD and its effects before, and after, the establishment of this fourth HVC. The North Carolina Hospital Discharge Database was queried for all PDs performed during 2004 to 2006 and 2007 to 2009. Hospitals were categorized by PD volume as: low (one to nine/year), medium (10 to 19/year), and high (20/year or more). Mortality and major morbidity was assessed by comparing volume groups across time periods. Number of PDs for cancer increased 91 per cent (129 to 246 cases) at HVCs, whereas decreasing at low-volume (62 to 58 cases) and medium-volume (80 to 46 cases) centers. Percentage of PD for cancer performed at HVCs increased significantly (47.6 to 70.3%) while decreasing for low- and medium-volume centers ( P < 0.001). Mortality was significantly less at HVCs (2.8%) compared with low-volume centers (10.3%) for 2007 to 2009. Odds ratio for mortality was significantly lower at HVCs during 2004 to 2006 (0.31) and 2007 to 2009 (0.34). Mortality for PD performed for cancer decreased from 6.6 to 4.6 per cent ( P = 0.31). Major morbidity was not significantly different between groups within either time period; however, there was a significant increase in major morbidity at low-volume centers ( P = 0.018). Regionalization of PD for cancer is occurring in North Carolina. Mortality was significantly lower at HVCs, and rapid regionalization has not detracted from the superior outcomes at HVCs.

Abstract 483: Out of Hospital Cardiac Arrest Outcomes After Transitioning to Pit Crew Model

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mohinder Reddy Vindhyal ◽  
Paul M Ndunda ◽  
Shravani Vindhyal ◽  
Brent Duran
Keyword(s):  
Cardiac Arrest ◽  
Vegetative State ◽  
Fire Department ◽  
Spontaneous Circulation ◽  
Return Of Spontaneous Circulation ◽  
Cardio Pulmonary Resuscitation ◽  
Improved Outcomes ◽  
Before And After ◽  
Hospital Cardiac Arrest ◽  
Model Approach

Introduction: One of the leading causes of untimely death as per the Resuscitation Outcomes Consortium Epistry for cardiac arrest is out of hospital cardiac arrest (OHCA). Adoption of the choreographed approach of the pit crew model resuscitation improved outcomes after OHCA in some previous studies. Hypothesis: Compare outcomes post OHCA before and after adopting a pit crew model approach in one of the largest counties in Kansas. Methods: The data was collected before (2010 – 2012) and after the pit crew (2013-2016) approach from 2010 to 2016. The patient demographics and resuscitation variables were similar and comparable including the emergency and fire department personnel. The primary outcome was the proportion of patients having sustained return of spontaneous circulation (ROSC). Secondary outcomes were average number of pauses >10 seconds, cerebral performance post return of spontaneous circulation, and average cardio-pulmonary resuscitation (CPR) cycles to ROSC. Results: The patients who had sustained ROSC post pit crew approach was 67.9% vs 32.1% (p=< 0.001). Average number of CPR pause time > 10 seconds post pit crew model was 1 vs 5 (p=0.01). Cerebral performance post return of spontaneous circulation using pit crew approach with good cerebral performance was 47% vs 56% (p=0.2), moderate cerebral disability was 17% vs 23% (p=0.19), severe cerebral disability was 8% vs 11% (p=0.44) and in coma/vegetative state was 8% vs 16% (p=0.001). Average CPR cycles to ROSC was 6.63. Conclusion: This focused model of high-quality CPR performance with individualized assigned tasks with minimal interruptions has shown increased numbers of sustained ROSC. The pit crew model approach also has showed decline in the rates of cerebral performance especially with moderate and severe cerebral performance including the patients in coma or vegetative state which is mainly through continuous cerebral perfusion pressures. More studies with better follow-up care in coordination with hospital outcomes will be key for the pit crew approach to be adopted.

Abstract TP437: Clinical Outcomes of the First Neurocritical Care Unit in Korea

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jin-Heon Jeong ◽  
Minju Yeo ◽  
Jeong-Ho Hong ◽  
Kyu Sun Yum ◽  
Jun Young Chang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Neurocritical Care ◽  
Tertiary Care ◽  
Care Hospital ◽  
Icu Mortality ◽  
Primary Object ◽  
Icu Outcome ◽  
Improved Outcomes ◽  
Before And After ◽  
Admission Glasgow Coma Scale

Introduction: In neurocritically ill patients, admission to a specialized neurocritical care unit (NCU) is associated with improved outcome. The first NCU in Korea was established on 15 March 2013. In Korea, the data of intensive care unit (ICU) outcome were collected in general ICUs, but there are only sparse data of NCU outcome. Hypothesis: The primary object of this study is to evaluate clinical outcomes of neurocritically ill patients in Korea. Methods: This study was conducted in 20 NCU beds of a large academic tertiary care hospital. We retrospectively analyzed the clinical data from neurocritically ill patients. A comparison was made between those patients admitted before and after the establishment of NCU. The primary outcome examined was ICU mortality. To evaluate functional outcome, the modified Rankin scale (mRS) at 6 months after NCU admission was obtained from medical records or telephone interview. Results: A total of 2487 patients were included, 1572 prior to and 915 after the establishment of NCU. The predominant admission cause were postoperative care and cerebrovascular disease; such as subarachnoid hemorrhage, malignant ischemic stroke, and intracerebral hemorrhage. There were no significant differences between the groups about demographic characteristics and admission Glasgow Coma Scale score. ICU mortality was significantly decreased in patients admitted to NCU (7.3% vs 4.7%, p=0.12). Admission to NCU also significantly decreased length of ICU stay and ventilator days. Among patient admitted NCU, 228 patients (48.1%) showed good functional recovery (mRS 0-2), while 245 patients (51.9%) had unfavorable outcomes (mRS 3-6). Conclusion: This is the first report about outcomes of neurocritically ill patients who admitted to NCU in Korea. Admission to specialized NCU and cared by neurointensivist improved outcomes and decreased ICU mortality.

scholarly journals Compliance with Updated Sepsis Bundles to Meet New Sepsis Core Measure in a Tertiary Care Hospital

2017 ◽  
Vol 52 (3) ◽  
pp. 177-186 ◽  
Author(s):  
Taylor H. Ramsdell ◽  
April N. Smith ◽  
Eric Kerkhove
Keyword(s):  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Hospital ◽  
Care Bundles ◽  
Sepsis Bundles ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Before And After ◽  
Core Measure ◽  
Bundle Compliance

Background The updated Surviving Sepsis Campaign care bundles are associated with improved outcomes in patients with sepsis, yet adherence to the bundles remains inconsistent. The Centers for Medicare & Medicaid Services has adopted similar care bundles as a core measure that went into effect with October 1, 2015 discharges. Objective The aim of this study was to assess bundle compliance, length of stay (LOS), and in-hospital mortality before and after introduction of the new sepsis core measure. Methods A retrospective cohort study was conducted in 158 patients with a diagnosis of severe sepsis or septic shock from April 2015 to February 2016. The before group ( n = 48) consisted of sequential patients discharged from April 1, 2015 to September 30, 2015 (prior to core measure implementation), and the after group ( n = 110) consisted of sequential patients discharged from October 1, 2015 to February 29, 2016 (after core measure implementation). Results Significant improvement was seen in the after group compared to the before group for bundle compliance with the 3-hour (66.4% vs 31.3%; p < 0.01) and 6-hour (75.5% vs 41.7%; p < 0.01) components and the overall core measure (51.8% vs 16.7%; p < 0.01). In-hospital mortality was lower in the after group compared to the before group (14.5% vs 27.1%; p = 0.05), but this difference was not statistically significant. There was no significant difference in LOS. Conclusions The study found a significant increase in compliance with the sepsis care bundles since the implementation of this core measure. Increased adherence to the care bundles may improve in-hospital survival.

The incidence of treatment related acute kidney injury in cancer patients: A retrospective analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14150-e14150
Author(s):  
Bohdan Baralo ◽  
Samia Hossain ◽  
Muhammad Hanif ◽  
Suhail Khokhar ◽  
Sana Mulla ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Close Monitoring ◽  
Repeat Test ◽  
Significant Incidence ◽  
Improved Outcomes ◽  
Platinum Based Chemotherapy ◽  
Before And After

e14150 Background: Development of the Acute kidney injury (AKI) in the patients receiving chemotherapy and immunotherapy is a factor associated with higher admission to the hospital, prolonged hospitalization, increased morbidity and mortality, dose reduction, moving to less effective regimens, inability to enroll in clinical trials. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analysed. The pool of the patients had multiple oncological pathologies and were on different chemo immunotherapeutic regimens. All creatinine levels before starting chemotherapy, before and after each cycle were assessed. We used a Kidney Disease: Improving Global Outcomes criteria to define AKI (at least 1.5 increase in creatinine within 7 days of cycle or 0.3 creatinine increase in 48 hours) and grades of AKI. We considered AKI related to chemotherapy, if it developed in specified timeframe after chemotherapy defined above. The cases when patient did not meet criteria for AKI, but had a patterns suggestive of it (no repeat test within 7 days, but repeat test within 3 weeks, with increase in creatinine > 37.5%) were defined as potentially missed AKI. Results: 12 patients developed chemoimmunotherapy related AKI (12.63%). 1 patient had 3 episodes of the AKI related to chemotherapy. 4 patients received platinum-based chemotherapy. On average every patient received 12cycles of chemotherapy. After the first two cycles of chemotherapy AKI developed in 7 Patients (58.33%). 10patients had AKI after 7 cycles (83.33%). It worth mentioning that only 42% of the chemotherapeutic cycles had follow-up creatinine within 7 days. 7 patients (7.37%) had fallen under a potentially missed AKI criteria. 2 more patients were diagnosed with AKI that was not related to the chemotherapy. Conclusions: In our study there was a significant incidence of AKI in the patients receiving chemoimmunotherapy. Current guidelines do not advocate close monitoring(weekly) of renal function in patients receiving chemoimmunotherapy unless the patient receives an chemotherapeutic agent known to cause nephrotoxicity. Repeat creatinine within 7 days after chemotherapy may be necessary to allow early detection of AKI, that can potentially to improved outcomes. Large prospective studies may be necessary to confirm our findings that very close monitoring of renal function can improve detection of the AKI and outcomes due to possibility of early intervention.

P1709A comprehensive meta-analysis on the impact of cardiopulmonary resuscitation guideline changes on outcomes after in- and out-of-hospital cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Nas ◽  
R Te Grotenhuis ◽  
J L Bonnes ◽  
J Thannhauser ◽  
J Furlaneto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Positive Impact ◽  
Guideline Development ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Improved Outcomes ◽  
Resuscitation Guidelines ◽  
Before And After ◽  
The Impact ◽  
Hospital Cardiac Arrest

Abstract Background Studies on international registries report improved outcomes after in- and out-of-hospital cardiac arrest over the last decade. The 2015 resuscitation guidelines incorporate initiatives derived from both guidelines 2005 and 2010, respectively. Purpose In order to assess the impact of these respective updates, we aim to provide the most comprehensive quantitative summary of comparative studies that specifically focused on outcomes before and after guideline updates. Methods PubMed, Web-of-Science, Embase and The Cochrane Libraries were searched for studies that compared clinical outcomes of patients resuscitated in the period before and after introduction of guidelines 2010 and 2005, respectively. Results For studies on guidelines 2010 vs. 2005 (n=6; 1,002 patients), the pooled estimate did not indicate a difference [OR 1.29 (95% CI 0.74–2.25) p=0.372] in return of spontaneous circulation (ROSC). For survival to discharge a significant benefit [OR 1.70 (1.01–2.84) p=0.045] was observed for patients resuscitated according to guideline 2010. As for guidelines 2005 vs. 2000 (n=23; 40,859 patients), the pooled estimates for ROSC, survival to admission, to discharge and favourable neurologic outcome consistently indicated benefit for guideline 2005 [OR 1.21 (1.04–1.42) p=0.014; OR 1.34 (1.09–1.65) p=0.005; OR 1.46 (1.25–1.70) p<0.001; OR 1.35 (1.01–1.81) p=0.040]. Conclusions This comprehensive meta-analysis quantifies the positive impact of resuscitation guideline updates on outcomes and supports the current way of guideline development. While there is robust evidence for improved overall outcomes after guidelines 2005, the 2010 guideline benefit was restricted to improved survival to discharge. In terms of quality control, our findings call for continued initiatives to monitor outcomes after guideline updates. Acknowledgement/Funding None

scholarly journals Improved outcomes in cystic fibrosis using modified Re-Education of Airway Clearance Technique (REACT) programme

2020 ◽  
Vol 9 (3) ◽  
pp. e000890
Author(s):  
Courtney Reamer ◽  
Catherine O'Malley ◽  
Julie Nufer ◽  
Adrienne Savant
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Outcome Measures ◽  
Participation Rate ◽  
Forced Expiratory Volume ◽  
Secondary Outcome ◽  
Statistical Process ◽  
Improved Outcomes ◽  
Before And After ◽  
Reduce Lung Function

Background and objectivesCystic fibrosis (CF) is known to reduce lung function as measured by per cent predicted for the forced expiratory volume in the first second (ppFEV1) over time. Our paediatric CF programme demonstrated significant gaps in benchmarked ppFEV1 predicted compared with the national median. Our objective was to assess whether the implementation of a modified Re-Education of Airway Clearance Techniques (REACT) programme could lead to an improvement in lung function as measured by ppFEV1.MethodsThis 2-year prospective quality improvement study at Lurie Children’s CF Center for children aged >6 years used improvement methodology to implement a modified REACT programme. Outcome measures were assessed for our entire programme via the CF Foundation Patient Registry (CFFPR) and statistical process control. Comparisons were also made before and after REACT for outcome measures.ResultsBy the end of implementation, monthly participation rate achieved 100%. Using CFFPR data and SPC, median ppFEV1 increased by 3.9%, whereas only body mass index (BMI) as a secondary outcome increased. Comparison of pre and post REACT showed improvements in average ppFEV1 (95% vs 96%, p<0.0001), FEF25%−75% (82% vs 83%, p=0.0590), rate of ppFEV1 decline (+2% vs −4%, p=0.0262) and BMI percentile (57% vs 60%, p<0.0001).ConclusionsImplementation of a modified REACT at Lurie Children’s paediatric CF programme led to an increase in ppFEV1, FEF25%−75% and BMI percentile.

Progress in the Front-line Treatment of Multiple Myeloma

2010 ◽  
Vol 00 (04) ◽  
pp. 70
Author(s):  
Stefan Knop ◽  
Klaus Martin Kortüm ◽  
Hermann Einsele ◽  
◽  
◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Trials ◽  
Allogeneic Transplantation ◽  
Bone Lesions ◽  
The Novel ◽  
Improved Outcomes ◽  
Before And After ◽  
High Doses ◽  
The 1960S ◽  
Near Future

Multiple myeloma (MM) is a clonal plasma cell tumour that requires systemic treatment once disease-related symptoms arise. Symptomatic MM is defined by at least one of the following: hypercalcaemia, renal failure, anaemia and/or bone lesions. Several therapeutic milestones have been achieved during the last few decades, resulting in improved prognosis for affected subjects. The alkylator melphalan has been a backbone of MM treatment since its introduction in the 1960s. The compound is currently used at high doses followed by autologous stem cell transplantation (ASCT) in patients ≤65–70 years of age in conventional doses in conjunction with prednisone and either thalidomide (MPT) or the proteasome inhibitor bortezomib (VMP). Both regimens have proved superior to MP alone in randomised clinical trials. In patients eligible for ASCT, initial cytoreduction should be performed using one of the ‘novel’ compounds (thalidomide, bortezomib, lenalidomide) in combination with dexamethasone because of enhanced response both before and after ASCT compared with standard anthracycline/dexamethasone. However, it has not yet been determined which combination should best be used in a given patient. Whether up-front allogeneic transplantation may contribute to improved outcomes in younger patients depends on results from clinical trials that have been fully recruited, but longer follow-up is awaited in the near future.

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