scholarly journals Short-term outcomes of treatment of active stage of Charcot foot in outpatient setting

2020 ◽  
Vol 23 (4) ◽  
pp. 316-323
Author(s):  
Anastasia G. Demina ◽  
Vadim B. Bregovskiy ◽  
Irina A. Karpova
Keyword(s):  
Treatment Group ◽  
Treatment Options ◽  
Outpatient Setting ◽  
Healing Time ◽  
Acute Stage ◽  
High Rate ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Active Stage ◽  
Foot Lesions

Background: Treatment options in patients with an acute Charcot foot is not well standardized and still challenging.Aims: To evaluate the results of the non-operative treatment of patients with active stage of diabetic charcot arthropathy in outpatient foot clinic and to identify factors influenced on treatment results.Materials and methods: Medical files of 141 patients with unilateral ulcer-free active charcot arthropathy were reviewed. 78 patients agreed for treatment (total contact cast or walker), 63 patients refused of treatment (follow-up only). The time of resolution of the acute stage, severity of final deformities and foot-related complications were evaluated. Refusers were asked about the cause of their decision.Results: Mean delay of the diagnosis was 3,2±2,8 months. Main causes of the refuse were: mistrust to doctor - 38%, problems with employment - 33%, home/family problems - 18%, medical reasons - 11%. Median healing times (months) in the treatment group vs controls: 9 (6 - 19) 15 (13 - 25) (p=0,001) and progression of the initial deformity: 14% and 35%, respectively (p=0,01). Foot-related complications: 17,5% in the treatment group and in 55,6% of controls (including 6 amputations) (p=0,001). Frequency of breaking the cast/walker - 32%/16,6%. Foot lesions due to cast/walker: 13,6%/41,7% (p<0,01). Median healing times (months) with walkers - 13 (11 - 19), with casts - 9 (6 - 15) months (р=0,02). The use of crutches shortened healing time.Conclusions: The significant delay of diagnosis was revealed. The refuse rate in our cohort was high and main causes of the refuse were social and psychological. Neglect of treatment leads to high frequency and severity of foot-related complications. We noticed high rate of breaking of walkers and casts and device-related foot lesions. Total contact casts were more effective and safe compared with walkers.

Neurofeedback for Opioid Dependent Patients in an Outpatient Setting: A Pilot Feasibility Study

2021 ◽  
Author(s):  
Helena A. Rempala ◽  
Justin A. Barterian
Keyword(s):  
Large Scale ◽  
The United States ◽  
Outpatient Setting ◽  
Opioid Use Disorder ◽  
High Rate ◽  
Treatment Center ◽  
Opioid Use ◽  
Treatment As Usual ◽  
Factors Affecting ◽  
Study Approach

Abstract Background: Neurofeedback (NF) has been described as “probably efficacious” when used in conjunction with other interventions for substance use disorders, including the most recent studies in population of individuals with opioid use disorder. Despite these promising outcomes, the seriousness of the opioid epidemic, and the high rate of relapse even with the most effective medication-assisted maintenance treatments NF continues to be an under-researched treatment modality. This article explores factors that affected the feasibility of adding Alpha/Theta Neurofeedback to treatment as usual for opioid dependence in an outpatient urban treatment center. The study strived to replicate previous research completed in Iran that found benefits of NF for opioid dependence.Methods: Out of approximately two dozen patients eligible for Alpha/Theta NF, about 60% (n=15) agreed to participate; however, only 2 participants completed treatment. The rates of enrollment in response to active treatment were monitored. Results: The 4 factors affecting feasibility were: 1) the time commitment required of participants, 2) ineffectiveness of standard incentives to promote participation, 3) delayed effects of training, and 4) the length and number of treatments required.Conclusion: The findings indicate a large scale study examining the use of NF for the treatment of opioid use disorder in the United States will likely be difficult to accomplish without modification to the traditional randomized control study approach and suggests challenges to the implementation of this treatment in an outpatient setting.

scholarly journals Biopince Full Core Biopsy Device for Percutaneous Lung Biopsy: A Retrospective Analysis of 184 Procedures Analyzing Complication Rates and Procedure Success

2021 ◽  
pp. 17-25
Author(s):  
Robert Bernstein ◽  
Ryan Garrow
Keyword(s):  
Core Biopsy ◽  
Lung Biopsy ◽  
Research Question ◽  
Outpatient Setting ◽  
High Rate ◽  
Complication Rates ◽  
Core Needle ◽  
Biopsy Device ◽  
Percutaneous Lung Biopsy ◽  
Full Core

Background: Unlike fine needle aspiration, core needle biopsies allow the collection of intact tissue for pathological and molecular evaluation. In outpatient clinical practice, full core needle lung biopsy may be underused because of concerns that it might be too dangerous. We describe our experience using a full core device for percutaneous lung biopsy in a large cohort of patients. Research Question: Is percutaneous full core needle lung biopsy effective and safe in the outpatient setting? Study Design and Methods: The analyzed population comprised patients with lung masses >1.1 cm who underwent percutaneous lung biopsy with a full core device. Analyzed data included core mass dimensions, distance from pleural edge to mass, lobe location, type, outcomes, and complications. Biopsy success was defined as adequate tissue acquisition for pathological evaluation that yielded a diagnosis. Biopsy procedures with incomplete data were excluded from this analysis. Results: We analyzed data from 184 lung biopsies performed on 182 patients (mean age, 70±11.7 years). Most biopsies were parenchymal (54.9%). The overall diagnostic success rate was 98.4%. No complications were reported for 77.2% of biopsies. Minor complications occurred during 39 biopsies (21.2%) and were primarily pneumothorax (16.8%). Major complications occurred during 4 biopsies (2.1%): 3 patients with pneumothorax required emergency department (ED) management and 1 patient went to the ED for severe pain. All complications resolved within 24 hours without hospitalization or transfusion. Crosstabulation analyses showed no significant differences between the lung lobe locations in terms of rates of disposition and complications, and between the lesion types in terms of rates of disposition and complications. Interpretation: Percutaneous lung biopsy performed using a full core biopsy device demonstrated a high rate of diagnostic success and a low risk of clinically significant procedural complications in an outpatient setting.

scholarly journals 116 Retrospective Analysis of Clozapine Augmentation in Treatment-Resistant Schizophrenia in an Outpatient Setting

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 73-74
Author(s):  
Charles Odom ◽  
Frozan Walyzada ◽  
Pankaj Manocha ◽  
Monika Gashi ◽  
Ashaki Martin ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Treatment Options ◽  
D2 Receptor ◽  
Treatment Strategies ◽  
Outpatient Setting ◽  
Mood Stabilizers ◽  
Adjunctive Treatment ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Augmentation Strategies

AbstractStudy ObjectivesThis retrospective analysis hopes to add to the literature about Treatment Resistant Schizophrenia (TRS), augmentation strategies with antipsychotics used in our patient population with the hopes of clarifying what possibilities should be further studied. In addition, we aim to emphasize the need for focusing on individualized treatment and multidisciplinary efforts to ensure compliance and appropriate disposition options.MethodWe reviewed retrospectively 3025 charts of patients between January 2017 to March 2017 in our outpatient department establishing which antipsychotic clozapineaugmentation strategies were being used. We also did a literature review to establish what augmentation strategies are recommended. These patients will then be compared to a random sample of patients in the clinic who were not prescribed clozapine and compared for readmission rate, side effect profile, length of stay while admitted, frequency of clinic attendance and compliance with outpatient appointments.ResultsOut of 3025 patients 35 were prescribed Clozapine as monotherapy and 5 patients had clozapine plus psychopharmacological augmentation. Ages ranged from 21-86. Out of the 39 patients, there were 13 male and 26 female. The predominant diagnosis was mood disorder or MDD with psychotic features followed by schizophrenia. The augmentation antipsychotics used were aripiprazole and risperidone. In the literature, the most frequent augmentation strategy for TRS is adding another antipsychotic with more D2 receptor blockade. Other strategies involve identifying and treating the symptoms not controlled by clozapine.ConclusionsCurrently augmentation of Clozapine in TRS is highly individualized due to lack of supporting evidence to state the contrary. When working with treatmentresistant patients who are not responding to clozapine alone, it is imperative to thoroughly review and consider all treatment options and augmentation strategies. More studies should be done in controlled settings to better evaluate possibilities as well as more evaluations to be done on other ways of augmentation of clozapine. Literature has stated between 20-60% of patients are defined as TRS. Clozapine is considered as one of the most effective treatment available at present time for TRS. Recent literature suggests despite its superior efficacy, as many as 70% of those suffering from TRS on clozapine continue to suffer from positive, negative or cognitive symptoms. The literature has abundant adjunctive treatment strategies such as the addition of antipsychotics, mood stabilizers, antidepressants, or even with the use of electroconvulsive therapy. We emphasize the importance of correctly identifying TRS patients who may benefit from the initiation of clozapine, what would be beneficial for them if they do not respond, how to tailor their treatment to target symptoms not being ameliorated, and recommend treatment in these complex cases be multidisciplinary.Funding AcknowledgementsNo funding.

scholarly journals Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

2020 ◽  
Vol 32 (4) ◽  
pp. 485-493
Author(s):  
Dora Kanellopoulos ◽  
Paul Rosenberg ◽  
Lisa D. Ravdin ◽  
Dalynah Maldonado ◽  
Nimra Jamil ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Treatment Group ◽  
Major Depression ◽  
Rating Scale ◽  
Treatment Options ◽  
Supportive Therapy ◽  
Psychosocial Interventions ◽  
World Health ◽  
Time Interaction

ABSTRACTObjectives:Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability.Design:This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up).Setting:Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home.Participants:Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND).Interventions:PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy.Measurements:Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE.Results:PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period.Conclusions:PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.

scholarly journals Factors Affecting the Outcomes of Tibiotalocalcaneal Fusion

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Charles C. Pitts ◽  
Bradley Alexander ◽  
Joshua L. Washington ◽  
Hannah M. Barranco ◽  
Romil K. Patel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Postoperative Complications ◽  
Kidney Disease ◽  
Bone Graft ◽  
Postoperative Infection ◽  
High Rate ◽  
Diabetic Patients ◽  
Charcot Arthropathy ◽  
Infection Rates ◽  
Increased Risk

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. Methods: We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. Results: Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). Conclusion: We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. This helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. [Table: see text]

scholarly journals An unusual presentation of acute onset Charcot arthropathy

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Ammar Al-Najjar ◽  
Julien Al Shakarchi ◽  
Melwyn Pereira ◽  
Richard Downing
Keyword(s):  
Rare Complication ◽  
Major Amputation ◽  
Acute Onset ◽  
Lower Limbs ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Plantar Aspect ◽  
Patients With Diabetes ◽  
Fracture Dislocations ◽  
High Index Of Suspicion

Abstract Charcot arthropathy is a progressive condition primarily affecting the lower limbs in patients with diabetes mellitus. It is a rare complication of diabetic neuropathy and if left untreated can lead to severe limb destruction necessitating major amputation. Here, we report the case of a 41-year-old female who presented with rapidly progressive Charcot foot over a 10-day period, necessitating open reduction and internal fixation of Lisfranc-type fracture dislocations. Her presentation with a rapidly progressing red, swollen foot with a blister on the plantar aspect prompted initial treatment on the basis of a diabetic foot infection. The report will therefore serve as a useful reminder to maintain a high index of suspicion for Charcot foot, which may present in an atypical manner.

Improved healing with a collagen-alginate dressing in the chemical matricectomy

1998 ◽  
Vol 88 (9) ◽  
pp. 452-456 ◽  
Author(s):  
CC Van Gils ◽  
B Roeder ◽  
SM Chesler ◽  
S Mason
Keyword(s):  
Clinical Trial ◽  
Treatment Group ◽  
Patient Compliance ◽  
Wound Dressing ◽  
Postoperative Management ◽  
Healing Time ◽  
Prospective Clinical Trial ◽  
Control Group ◽  
Infection Rates

A prospective clinical trial was conducted to evaluate the efficacy of a collagen-alginate wound dressing in the postoperative management of chemical matricectomies. The study involved 20 patients and 23 separate procedures. The collagen-alginate-dressing treatment group had an average healing time of 24.4 days, compared with 35.8 days for the control group, which received treatment consisting of soaks and daily dressing changes (P &lt; .05). The authors suggest that using a collagen-alginate wound dressing in the postoperative management of chemical matricectomies will shorten healing time, thus reducing infection rates and increasing patient compliance and satisfaction.

The Practical Challenges of Diagnosis and Treatment Options in Persistent Pulmonary Hypertension of the Newborn: A Developing Country's Perspective

2018 ◽  
Vol 35 (14) ◽  
pp. 1366-1375 ◽  
Author(s):  
Narongsak Nakwan
Keyword(s):  
Pulmonary Hypertension ◽  
Low Income ◽  
Treatment Options ◽  
Limited Resource ◽  
High Rate ◽  
Persistent Pulmonary Hypertension ◽  
Timely Diagnosis ◽  
Pulmonary Vasodilators ◽  
High Frequency Oscillatory ◽  
Made In

AbstractPersistent pulmonary hypertension of the newborn (PPHN) is a complication of several respiratory diseases characterized by an elevation in pulmonary vascular resistance with resultant right-to-left shunting of blood and severe hypoxemia in the neonatal period. PPHN carries a high rate of morbidity and mortality, particularly in limited-resource settings (low-income and/or developing country). Echocardiography remains the gold standard for diagnosis of PPHN. Modern therapies such as inhaled nitric oxide, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation, and/or other pulmonary vasodilators agents can reduce the mortality rate of PPHN. Unfortunately, echocardiography and the use of these modern therapies are often difficult for a medical institution to provide for patients in developing countries, even when a timely diagnosis of PPHN has been made. In this review, the practical challenges of timely diagnosis of PPHN and efficient use of available treatment options faced by pediatricians or neonatologists in limited-resource settings are discussed.

Charcot Arthropathy of the Diabetic Foot. Current Concepts and Review of 36 Cases

2002 ◽  
Vol 91 (2) ◽  
pp. 195-201 ◽  
Author(s):  
T.-K. Pakarinen ◽  
H.-J. Laine ◽  
S. E. Honkonen ◽  
J. Peltonen ◽  
H. Oksala ◽  
...  
Keyword(s):  
Recent Literature ◽  
Diagnostic Delay ◽  
Patient Records ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Triple Arthrodesis ◽  
Charcot Neuroarthropathy ◽  
Cast Immobilisation ◽  
Tibiocalcaneal Arthrodesis ◽  
Time Period

Background and Aims: The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot. Materials and Methods: During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented. Results: 29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. radiological fusion was achieved in two thirds of the attempted arthrodeses. Conclusions: A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.

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