The impact of spontaneous echo contrast on tunneled dialysis catheter patency

2021 ◽  
pp. 112972982110355
Author(s):  
Sertan Özyalçın ◽  
Hülya Topçu
Keyword(s):  
Ultrasound Guidance ◽  
Hematological Parameters ◽  
Dialysis Catheter ◽  
Jugular Veins ◽  
Spontaneous Echo Contrast ◽  
The Mean ◽  
The Impact ◽  
Different Levels ◽  
Internal Jugular Veins

Background: Spontaneous echo contrast (SEC) is an ultrasonographic image of swirling blood flow resembling a dynamic, cigarette smoke-like image. It is mostly observed during the insertion of tunneled dialysis catheters (TDC) into internal jugular veins with ultrasound guidance, often different levels of SEC can be seen. The aim of this study is to investigate the impact of SEC detected during TDC insertion on the patency of the catheter. Methods: Patients who had a TDC insertion in our clinic between January 2015 and December 2020 were prospectively evaluated. The patients were grouped into five groups according to the sec level and followed. Results: A total of 226 patients were examined, among which 107 were male (47.3%). The mean age of all patients was 63.1 ± 9.5 years. SEC grade and catheter occlusion was evaluated, it was observed that higher SEC grades were correlated with faster catheter thrombosis postinsertion. During the follow-up period, it was found that, compared to the SEC 0 group, catheter thrombosis occurred 3.22 times faster in the SEC 1 group, 2.66 times faster in the SEC 2 group, 5.80 times faster in the SEC 3 group, and 26.33 times faster in the SEC 4 group. (HR: 3.22, 2.66, 5.80, 26.33, respectively). Hematological parameters were evaluated by regression analysis, it was observed that hemoglobin, fibrinogen, and platelet count were not risk factors for SEC formation and SEC grade. Conclusion: Significant relationship was found between SEC grade detected during catheter insertion and catheter thrombosis in patients undergoing hemodialysis with a TDC.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

scholarly journals Patient Satisfaction With Extended International Normalized Ratio Follow-up Intervals in a Veteran Population

2019 ◽  
Vol 54 (5) ◽  
pp. 442-449
Author(s):  
Rebecca R. Schoen ◽  
Michael W. Nagy ◽  
Andrea L. Porter ◽  
Amanda R. Margolis
Keyword(s):  
Patient Satisfaction ◽  
Focus Group ◽  
International Normalized Ratio ◽  
Limited Data ◽  
Participant Satisfaction ◽  
Small Effect Size ◽  
The Mean ◽  
The Impact ◽  
Improve Patient

Background: For highly stable warfarin patients, limited data exists regarding patient satisfaction on extended international normalized ratio (INR) follow-up intervals and how this population compares with patients on a direct oral anticoagulant (DOAC). Objective: To assess the impact on patient satisfaction of extending INR follow-up intervals. Methods: Veterans on stable warfarin doses had extended INR follow-up intervals up to 12 weeks in a single-arm prospective cohort study for 2 years. This analysis included participants who completed at least 2 Duke Anticoagulation Satisfaction Scales (DASS). The primary outcome was the change in the DASS. A focus group described participant experiences. Participant satisfaction was compared to patients on a DOAC. Results: Of the 51 participants, 48 were included in the warfarin extended INR follow-up group. Compared with baseline, the mean DASS score (42.9 ± 12.08) was worse at 24 months (46.82 ± 15.2, P = 0.0266), with a small effect size (Cohen’s d = 0.29). The 8 participants in the focus group were satisfied with the extended INR follow-up interval but would be uncomfortable extending follow-up past 2 to 3 months. The extended INR follow-up interval study had similar DASS scores as the 33 participants included on DOAC therapy (46.8 ± 15.1, P = 0.9970) but may be limited by differing populations using DOACs. Conclusion and Relevance: For patients currently stable on warfarin therapy, extending the INR follow-up interval up to 12 weeks or changing to a DOAC does not appear to improve patient satisfaction.

Discordant GH and IGF-1 Results in Treated Acromegaly: Impact of GH Cutoffs and Mean Values Assessment

2020 ◽  
Author(s):  
Claudia Campana ◽  
Francesco Cocchiara ◽  
Giuliana Corica ◽  
Federica Nista ◽  
Marica Arvigo ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Area Under The Curve ◽  
Receiver Operator Characteristic Curve ◽  
Mean Values ◽  
Pituitary Diseases ◽  
Discordance Rate ◽  
Values Assessment ◽  
The Mean ◽  
The Impact

Abstract Context Discordant growth hormone (GH) and insulin-like growth factor-1 (IGF-1) values are frequent in acromegaly. Objective To evaluate the impact of different GH cutoffs on discordance rate. To investigate whether the mean of consecutive GH measurements impacts discordance rate when matched to the last available IGF-1 value. Design Retrospective study. Setting Referral center for pituitary diseases. Patients Ninety acromegaly patients with at least 3 consecutive evaluations for GH and IGF-1 using the same assay in the same laboratory (median follow-up 13 years). Interventions Multimodal treatment of acromegaly. Main Outcome Measures Single fasting GH (GHf) and IGF-1 (IGF-1f). Mean of 3 GH measurements (GHm), collected during consecutive routine patients’ evaluations. Results At last evaluation GHf values were 1.99 ± 2.79 µg/L and age-adjusted IGF-1f was 0.86 ± 0.44 × upper limit of normality (mean ± SD). The discordance rate using GHf was 52.2% (cutoff 1 µg/L) and 35.6% (cutoff 2.5 µg/L) (P = 0.025). “High GH” discordance was more common for GHf <1.0 µg/L, while “high IGF-1” was predominant for GHf <2.5 µg/L (P < 0.0001). Using GHm mitigated the impact of GH cutoffs on discordance (GHm <1.0 µg/L: 43.3%; GHm <2.5 µg/L: 38.9%; P = 0.265). At receiver-operator characteristic curve (ROC) analysis, both GHf and GHm were poor predictors of IGF-1f normalization (area under the curve [AUC] = 0.611 and AUC = 0.645, respectively). The prevalence of disease-related comorbidities did not significantly differ between controlled, discordant, and active disease patients. Discussion GH/IGF-1 discordance strongly depends on GH cutoffs. The use of GHm lessen the impact of GH cutoffs. Measurement of fasting GH levels (both GHf and GHm) is a poor predictor of IGF-1f normalization in our cohort.

MULTIPLE SIMULTANEOUS APPROACH IN LOWER EXTREMITY SPASTICITY SURGERY

2000 ◽  
Vol 04 (03) ◽  
pp. 221-229
Author(s):  
Ugur Sayli ◽  
Sinan Avci
Keyword(s):  
Lower Extremity ◽  
Orthopedic Surgery ◽  
Daily Living ◽  
Operation Time ◽  
Postoperative Rehabilitation ◽  
Horse Riding ◽  
Simultaneous Surgery ◽  
The Mean ◽  
Different Levels

Lower extremity spasticity in CP interferes with daily living activities, such as ambulation and sitting as well as hygiene. Orthopedic surgery may be needed in the prevention and correction of the deformities and malalignments. Seven girls and nine boys with ages ranging from 7 to 17 years who had at least four surgeries at different levels of their lower extremities in a single stage were presented. Minimum follow-up was two years. The mean number of surgeries performed simultaneously was 6 (4 to 11). The mean operation time was 115 minutes (35 to 225 minutes) and the mean blood loss was 200 ml (100 to 600 ml) during surgery. The hospital stay ranged from two to six days. No complication which may be related to multiple simultaneous surgery was observed. Rehabilitation was begun as soon as the pain permitted. In the postoperative period, the diplegics attended sessions of hippotherapy — therapy by horse riding — in addition to formal therapy modalities. At the latest follow-up postoperatively, all the patients had increase in their level of activities. As a conclusion, whenever needed, simultaneous correction of the lower extremity deformities in spastic CP patients decreases costs and simplifies postoperative rehabilitation without increasing surgical risk for the patients.

scholarly journals An intervention of physical activity promotion in an university hospital. A prospective cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Ladner ◽  
S D Mihailescu ◽  
D Cerasuolo
Keyword(s):  
Physical Activity ◽  
Health Workers ◽  
Public Health Intervention ◽  
Physical Activity Promotion ◽  
University Hospital ◽  
Activity Promotion ◽  
The Mean ◽  
High Level ◽  
The Impact

Abstract Background Rouen University Hospital implements a policy of health promotion hospital since 2016. The objective of this study was to evaluate prospectively the impact of physical activity promotion in hospital health workers (HW), using pedometers over a period of six months. Methods Physical activity was measured by electronic pedometers distributed to HW, with the aim to improve their physical activity and to measure it during six months. Online questionnaires collected at different points of follow-up, from inclusion to sixth month (a total of seven points of follow-up). Socio-demographic and characteristics on type of health work were collected as well as the number of steps and the behavior regarding their routine physical activity. Results A total of 680 HW were included in the cohort. The sex ratio M:W was 0.16. The mean age was 41.6 years (SD = 10.7). 44.0% were non-medical caregivers, 32.1% were in administrative section, 14.3% were technical workers and 9.7% were physicians or pharmacists; 53.7% of HW reported doing sport regularly. At inclusion the mean number of daily steps was 8662. The mean progression for all professional profiles between first week and sixth month was of 1082 steps daily, with difference according to position: 1319 in physicians, 1234 in non-medical caregivers, 1106 in administrative workers and 314 in technical workers. In linear regression model, the mean number of progression of daily steps was 964 in physicians, 752 in non-medical caregivers. Conclusions The study shows a significant increase in the number of daily steps measured objectively using an incentive tool, as pedometer during six months of intervention. Further researches are needed to determine if these changes are sustainable over a long period of time Key messages Despite high level of daily steps at baseline, the longitudinal study shows an increase of daily steps over a 6-month period. Such public health intervention is a relevant method to engage people in self-monitoring their physical activity.

scholarly journals 711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Bhandari ◽  
M Rao ◽  
G Bussa ◽  
C Rao
Keyword(s):  
Diabetes Mellitus ◽  
Gastric Bypass ◽  
Glycosylated Haemoglobin ◽  
Morbidly Obese ◽  
Diabetic Patients ◽  
Obese Patients ◽  
The Mean ◽  
The Impact

Abstract Aim Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period. Method We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up. Results At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment. Conclusions RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.

scholarly journals Association between the Use of Backpack and Static Foot Posture in Schoolchildren with Static Pronated Foot Posture: A 36-Month Cohort Study

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 800
Author(s):  
Pilar Alfageme-García ◽  
Julián Fernando Calderón-García ◽  
Alfonso Martínez-Nova ◽  
Sonia Hidalgo-Ruiz ◽  
Belinda Basilio-Fernández ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Multivariate Analysis ◽  
Cohort Study ◽  
Prospective Study ◽  
Odds Ratio ◽  
Univariate Analysis ◽  
Foot Posture ◽  
The Mean ◽  
The Impact

Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the association of the backpack use on static foot posture in schoolchildren with a pronated foot posture over 36 months of follow-up. Methods: This observational longitudinal prospective study was based on a cohort of consecutive healthy schoolchildren with pronated feet from fifteen different schools in Plasencia (Spain). The following parameters were collected and measured in all children included in the study: sex, age, height, weight, body mass index, metatarsal formula, foot shape, type of shoes, and type of schoolbag (non-backpack and backpack). Static foot posture was determined by the mean of the foot posture index (FPI). The FPI was assessed again after 36 months. Results: A total of 112 participants used a backpack when going to school. Over the 36-month follow-up period, 76 schoolchildren who had a static pronated foot posture evolve a neutral foot posture. Univariate analysis showed that the schoolchildren using backpacks were at a greater risk of not developing neutral foot (odds ratio [OR]: 2.09; 95% CI: 1.08–4.09). The multivariate analysis provided similar results, where the schoolchildren using a backpack (adjusted OR [aOR]: 1.94; 95% CI: 1.02–3.82) had a significantly greater risk of not developing a neutral foot posture. Conclusions: A weak relationship was found between backpack use and schoolchildren aged from five to eleven years with static pronated feet not developing a neutral foot posture over a follow-up period of 36 months.

scholarly journals What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

2019 ◽  
Author(s):  
Liukun Shi ◽  
Jin Yang ◽  
Jinyong Lin
Keyword(s):  
Electron Microscopy ◽  
Light Microscopy ◽  
Intravitreal Injection ◽  
Aqueous Humour ◽  
Neovascular Glaucoma ◽  
Panretinal Photocoagulation ◽  
The Mean ◽  
The Impact ◽  
Tgf Β1

Abstract Background The aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG). Methods Fifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5mg/0.05ml), and then trabeculectomy and panretinal photocoagulation were performed. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour that were collected during surgery were measured by enzyme-linked immunoabsorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed for 2 eyes, and light microscopy was used as the histopathological control. Results The follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 eyes completed the 1-year follow-up and 13 eyes were lost to follow up. Recurrence of iris neovascularization was observed in 5 eyes, 9 eyes had hyphema, 16 eyes had filter bled scarring, no eye had complication attributable to the drug. The mean IOP was reduced from 48.1±14.2 mmHg to 23.2±8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) at 1 year (both P < 0.05). The complete success rate was 76.9%, 76.9%, 71.0%, 51.6%, 32.3% at 1week, 1 month, 3 months, 6 months and 12months when the cut off of IOP was 18mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in aqueous humour in NVG patients decreased from 168.8±13.4 pg/ml and 159.6±15.4 pg/ml to 160.2±7.6 pg/ml and 151.9±2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cells degeneration in the conbercept-treated specimens. Conclusions Our initial findings suggest that intravitreal conbercept is an effective treatment for managing neovascular glaucoma, with fewer postoperative complications in the short-term. Trial registration Current Controlled Trials ChiCTR1800019918, 8 December 2018, Retrospectively registered.

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