scholarly journals Outcomes after slipped capital femoral epiphysis: a population-based study with three-year follow-up

2018 ◽  
Vol 12 (5) ◽  
pp. 434-443 ◽  
Author(s):  
B. Herngren ◽  
M. Stenmarker ◽  
K. Enskär ◽  
G. Hägglund
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Slipped Capital Femoral Epiphysis ◽  
Safe Procedure ◽  
Number Of Patients ◽  
Patient Reported ◽  
Hip Function ◽  
Physeal Closure

Purpose To evaluate outcomes three years after treatment for slipped capital femoral epiphysis (SCFE): development of avascular necrosis (AVN), subsequent surgery, hip function and the contralateral hip. Methods This prospective cohort study included a total national population of 379 children treated for SCFE between 2007 and 2013. A total of 449 hips treated for SCFE and 151 hips treated with a prophylactic fixation were identified. The Barnhöft questionnaire, a valid patient-reported outcome measure (PROM), was used. Results In all, 90 hips had a severe slip, 61 of these were clinically unstable. AVN developed in 25 of the 449 hips. Six of 15 hips treated with capital realignment developed AVN. A peri-implant femur fracture occurred in three slipped hips and in two prophylactically pinned hips. In three of these five hips technical difficulties during surgery was identified. In 43 of 201 hips scheduled for regular follow-up a subsequent SCFE developed in the contralateral hip. Implant extraction after physeal closure was performed in 156 of 449 hips treated for SCFE and in 51 of 151 prophylactically fixed hips. Children with impaired hip function could be identified using the Barnhöft questionnaire. Conclusion Fixation in situ is justified to remain as the primary treatment of choice in SCFE. Overweight is more common in children with SCFE than in the average population. Prophylactic fixation is a safe procedure when performed using a correct technique. The number of patients who developed AVN after capital realignment is of concern. We recommend rigorous follow-up of both hips, including PROM evaluation, until physeal closure. Level of Evidence II - prospective cohort study

339 Outcome of Tibial Selective Motor Fasiculotomy in the Management of Equinovarus Deformity Due to Cerebral Palsy (A Prospective Cohort Study in 14 Children)

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Pavankumar Pelluru ◽  
Aneelkumar Pulugopu ◽  
Aniruddhkumar Purohit ◽  
Naveenkumar Balane
Keyword(s):  
Cerebral Palsy ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lower Limbs ◽  
Safe Procedure ◽  
Plantar Flexors ◽  
Motor Abilities ◽  
Modified Ashworth Scale

Abstract INTRODUCTION Tibial Selective Motor fasiculotomy involves ablation of hyperexcitable tibial nerve fasicles, which help in reduction of spasticity in ankle plantr flexors METHODS This prospective cohort study included 14 children with cerebral palsy, age ranging from 5–18 (mean 10.21) years and M: F ratio is 5:1 having spasticity in the lower limbs. All the children were assessed pre and post operatively by Modified Ashworth Scale (MAS), Selective Voluntary Control (SVC) grade and locomotor Abilities (kneel walking, squat to stand, standing and walking). Tibial SMF was performed (n = 23) for relief of spasticity in ankle plantar flexors in 14 children and were followed for a mean of 30 (6-60) months. All the children were given physical therapy pre and post operatively. RESULTS >During a mean follow up (30 months) there was statistically significant reduction in spasticity (MAS, P < 0.005) from1.92 to 0.31 in ankle plantar flexors. Pre and post operative SVC grade also improved from 2.65 to 3.35 in ankle plantar flexors (p > 0.005). There were no complications and spasticity did not recur during follow up. 9 children required Z plasty simultaneously to relieve the contracture. CONCLUSION The Tibial SMF of tibial nerves significantly relieves spasticity in the ankle plantar flexors and thereby improves SVC equinous deformity and motor abilities in children having cerebral palsy. It is quite a safe procedure and the spasticity does not recur during a mean follow up of 30 months.

scholarly journals Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study

2020 ◽  
Vol 29 (5) ◽  
pp. 1335-1347 ◽  
Author(s):  
Liv Marit Valen Schougaard ◽  
Annette de Thurah ◽  
Jakob Christensen ◽  
Kirsten Lomborg ◽  
Helle Terkildsen Maindal ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Literacy ◽  
Prospective Cohort Study ◽  
Self Efficacy ◽  
Prospective Cohort ◽  
General Health ◽  
Patient Activation ◽  
Well Being ◽  
Patient Reported

Abstract Purpose We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRO-based follow-up). Methods We conducted a prospective cohort study among outpatients with epilepsy at the Department of Neurology at Aarhus University Hospital, Denmark. Included were all persons aged ≥ 15 years visiting the department for the first time during the period from May 2016 to May 2018. Patients received a questionnaire containing questions about health literacy, self-efficacy, patient activation, well-being, and general health. We also collected data regarding sociodemographic status, labour market affiliation, and co-morbidity from nationwide registers. Associations were analysed as time-to-event using the pseudo-value approach. Missing data were handled using multiple imputations. Results A total of 802 eligible patients were included in the register-based analyses and 411 patients (51%) responded to the questionnaire. The results based on data from registers indicated that patients were less likely to be referred to PRO-based follow-up if they lived alone, had low education or household income, received temporary or permanent social benefits, or if they had a psychiatric diagnosis. The results based on data from the questionnaire indicated that patients were less likely to be referred to PRO-based follow-up if they reported low levels of health literacy, self-efficacy, patient activation, well-being, or general health. Conclusion Both self-reported and register-based analyses indicated that socioeconomically advantaged patients were referred more often to PRO-based follow-up than socioeconomically disadvantaged patients.

scholarly journals A Prospective Cohort Study Towards Improving Enhanced Recovery After Cesarean (ERAC) Pathways.

2021 ◽  
Author(s):  
Liviu Cojocaru ◽  
Autusa Pahlavan ◽  
Suzanne Alton ◽  
Martha Coghlan ◽  
Hyunuk Seung ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postpartum Depression ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Enhanced Recovery ◽  
Postoperative Recovery ◽  
Opioid Use ◽  
Pain Scores ◽  
Number Of Patients ◽  
Patient Reported

Background: Enhanced Recovery After Surgery (ERAS) or, more specifically for obstetrics, Enhanced Recovery after Cesarean (ERAC) pathways have emerged as a multidisciplinary standardized bundled care approach to improve maternal outcomes. Despite this, ERAS pathways have not been fully embraced in obstetrics, leaving significant space for improvement. Moreover, most of the studies have not extended ERAC pathways to specific populations such as opioid-naive patients, patients with postpartum depression, or patients receiving Magnesium Sulfate, allowing aforementioned confounders to affect the magnitude of the measured outcome. Objectives: To evaluate whether an Enhanced Recovery After Cesarean (ERAC) pathways reduces inpatient and outpatient opioid use, pain scores and improves the indicators of postoperative recovery. Furthermore, the specifics of our protocol are intended to decrease the knowledge gaps in ERAC pathways. Study design: This is a prospective cohort study of all patients older than 18 undergoing an uncomplicated cesarean delivery (CD) at an academic medical center. We excluded CD done under general anesthesia, those complicated by massive transfusion events, bowel injury, requiring recovery in the intensive care unit, and skin incision other than Pfannenstiel. Additionally, we excluded patients with chronic pain disorders, chronic opioid use, acute postpartum depression, or mothers whose neonate demised before their discharge. Lastly, we excluded non-English and non-Spanish speaking patients. Our study compared the outcomes in patients before (pre-ERAC) and after (post-ERAC) implementation of an ERAC pathways. Primary outcomes were inpatient morphine milligram equivalent (MME) use and the patient's delta pain scores (patient's reported goal subtracted from patient's pain score). Secondary outcomes were outpatient MME prescriptions as well as indicators of postoperative recovery (e.g., fasting time, time to feeding, time to indwelling urinary catheter removal, time to ambulation, and time to hospital discharge). Baseline demographics and outcomes were compared between pre-ERAC and post-ERAC cohorts. Multivariate logistic regression models were used to control for potential confounders. Results: Of 308 patients undergoing CD from October 2019 to September 2020, 196 were enrolled in the pre-ERAC cohort and 112 in the post-ERAC cohort. Patients in the post-ERAC cohort were less likely to require opioids in the postoperative period compared to the pre-ERAC cohort (35.7% vs. 18.4%, p<0.001). In addition, there was a significant reduction in the MME per stay in this cohort [16.8 MME (11.2-33.9) vs. 30 MME (20-49), p<0.001]. In the post-ERAC cohort, there was also a reduction in the number of patients who required prescribed opioids at the time of discharge (86.6 vs. 98%, p<0.001) as well as in the amount of MMEs prescribed [150 MME (112-150) vs. 150 MME (150-225), p<0.001; different shape of distribution]. Patients in the post-ERAC cohort had lower delta pain scores on postoperative days 1 to 4 as well as lower overall delta pain scores [2.2 (1.3-3.7) vs. 3.3 (2.3-4.7), p<0.001]. Conclusion: Our study has illustrated that our ERAC pathways reduced inpatient and outpatient opioid use as well as patient-reported pain scores while improving indicators of postoperative recovery.

scholarly journals Patient reported experiences of CT guided lung biopsy: a prospective cohort study

2014 ◽  
Vol 9 ◽  
Author(s):  
Naomi Winn ◽  
Jonathan Spratt ◽  
Enid Wright ◽  
Julie Cox
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Retrospective Review ◽  
Prospective Cohort ◽  
Lung Biopsy ◽  
Chest Drain ◽  
Complication Rates ◽  
Safe Procedure ◽  
Ct Guided ◽  
Patient Reported

Background: CT guided lung biopsy is a commonly performed procedure to obtain tissue for a histological diagnosis in cases of suspected lung cancer. Methods: This is a prospective cohort study to obtain information directly from patients about their experiences of the biopsy procedure, thus obtaining a more accurate picture of complications compared with previously performed retrospective reviews. Patients participated in a post-procedure telephone interview and information was gathered about any procedural complications and personal experiences. We also compared the patient reported complications with those obtained from a retrospective review of hospital databases, analogous to previously performed retrospective studies. Results: In our patient group, reported procedural complication rates were 10% pneumothorax rate (4% requiring a chest drain) and 10% haemoptysis. Post-procedural pain and shortness of breath showed positive correlation, with one patient experiencing prolonged pain. No statistical difference was found between the patient reported complication rates and those obtained from retrospective review of the hospital database. Conclusions: Our study demonstrates CT guided lung biopsy is a safe procedure and is generally well tolerated. Some patients may experience significant and lasting pain and therefore should be counselled about this pre-procedure.

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