A technological advance for 21st century obstetricians: the electronically-controlled vacuum extractor

2018 ◽  
Vol 46 (3) ◽  
pp. 279-286 ◽  
Author(s):  
Nicola Perone
Keyword(s):  
Negative Pressure ◽  
Outcome Measure ◽  
Warning Signal ◽  
Adhesive Force ◽  
Technological Advance ◽  
Time Limit ◽  
Main Outcome Measure ◽  
Vacuum Extractor ◽  
Vacuum Delivery ◽  
Fetal Scalp

Abstract Objective: To describe an innovative electronically-controlled vacuum extractor (VE) in detail and to illustrate its performance characteristics, as observed in a laboratory study. Design: Thirty simulated, vacuum-assisted deliveries. Main outcome measure(s): (1) The ability to measure in real-time of the pull applied and to sound an alert, when the traction approaches the negative pressure under the cup, to prevent its detachment. (2) The recording and printing of a graphic representation of the pull applied (vacuum delivery graph). (3) The emission of a warning signal when the 15-min time limit of continuous cup application on the fetal scalp, is reached. Results: No cup detachment occurred in any of the 15 vacuum-assisted deliveries, in which traction was kept below the adhesive force of the cup [44 lb (20 kg)], except in three cases, due to loss of negative pressure. In the remaining 15 tests, in which traction was greater than the adhesive force of the cup, “pull-offs” inevitably occurred. Furthermore, upon reaching the 15-min time limit of continuous cup application on the fetal cephalic model, a warning signal was emitted, as programmed. Conclusions We demonstrated that the electronically-controlled VE, with its distinctive pull-sensing handle, performs suitably for its intended purposes. The ability of the modernized device to decrease the incidence of cup detachment, secondary to the inadvertent application of excessive traction, may result in considerable safety, medico-legal and didactic advantages.

Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth

2020 ◽  
pp. fetalneonatal-2020-320816
Author(s):  
Theodore Dassios ◽  
Emma E Williams ◽  
Ann Hickey ◽  
Catey Bunce ◽  
Anne Greenough
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Head Circumference ◽  
Outcome Measure ◽  
Postnatal Growth ◽  
Z Score ◽  
Main Outcome Measure ◽  
Extremely Preterm ◽  
Postmenstrual Age ◽  
Extremely Preterm Birth ◽  
Current Incidence

ObjectivesTo report the current incidence of bronchopulmonary dysplasia (BPD) and to compare changes in weight and head circumference between infants who developed BPD and infants who did not.DesignRetrospective, whole-population study.SettingAll neonatal units in England between 2014 and 2018.PatientsAll liveborn infants born <28 completed weeks of gestation.InterventionsThe change in weight z-score (ΔWz) was calculated by subtracting the birthweight z-score from the weight z-score at 36 weeks postmenstrual age (PMA) and at discharge. The change in head circumference z-score (ΔHz) was calculated by subtracting the birth head circumference z-score from the head circumference z-score at discharge.Main outcome measureBPD was defined as the need for any respiratory support at 36 weeks PMA.Results11 806 infants were included in the analysis. The incidence of BPD was 57.5%, and 18.9% of the infants died before 36 weeks PMA. The median (IQR) ΔWz from birth to 36 weeks PMA was significantly smaller in infants who developed BPD (−0.69 (−1.28 to −0.14), n=6105) than in those who did not develop BPD (−0.89 (−1.40 to −0.33), n=2390; adjusted p<0.001). The median (IQR) ΔHz from birth to discharge was significantly smaller in infants who developed BPD (−0.33 (−1.69 to 0.71)) than in those who did not develop BPD (−0.61 (−1.85 to 0.35); adjusted p<0.001).ConclusionsPostnatal growth was better in infants diagnosed with BPD compared with infants without BPD possibly due to more aggressive nutrition strategies.

S153 – Radiological Balloon Dilatation of Neo-Pharyngeal Strictures

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P127-P128
Author(s):  
Robert L Harris ◽  
Grundy Alan ◽  
Tunde A Odutoye
Keyword(s):  
Total Laryngectomy ◽  
Balloon Dilatation ◽  
Malignant Disease ◽  
Outcome Measure ◽  
Tertiary Care ◽  
Case Series ◽  
Stent Insertion ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Main Outcome Measure

Objectives Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post-total laryngectomy and pharyngolaryngectomy neo-pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy. Methods A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post-total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure. Results 5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation. Conclusions Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.

Skeletal and Dental Correction and Stability Following LeFort I Advancement in Patients With Cleft Lip and Palate With Mild, Moderate, and Severe Maxillary Hypoplasia

2021 ◽  
pp. 105566562199610
Author(s):  
Buddhathida Wangsrimongkol ◽  
Roberto L. Flores ◽  
David A. Staffenberg ◽  
Eduardo D. Rodriguez ◽  
Pradip. R. Shetye
Keyword(s):  
Retrospective Study ◽  
Outcome Measures ◽  
Cleft Lip ◽  
Outcome Measure ◽  
Cleft Lip And Palate ◽  
Inclusion Criteria ◽  
Maxillary Hypoplasia ◽  
Main Outcome Measure ◽  
Lateral Cephalograms

Objective: This study evaluates skeletal and dental outcomes of LeFort I advancement surgery in patients with cleft lip and palate (CLP) with varying degrees of maxillary skeletal hypoplasia. Design: Retrospective study. Method: Lateral cephalograms were digitized at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3) and compared to untreated unaffected controls. Based on the severity of cleft maxillary hypoplasia, the sample was divided into 3 groups using Wits analysis: mild: ≤0 to ≥−5 mm; moderate: <−5 to >−10 mm; and severe: ≤−10 mm. Participants: Fifty-one patients with nonsyndromic CLP with hypoplastic maxilla who met inclusion criteria. Intervention: LeFort I advancement. Main Outcome Measure: Skeletal and dental stability post-LeFort I surgery at a 1-year follow-up. Results: At T2, LeFort I surgery produced an average correction of maxillary hypoplasia by 6.4 ± 0.6, 8.1 ± 0.4, and 10.7 ± 0.8 mm in the mild, moderate, and severe groups, respectively. There was a mean relapse of 1 to 1.5 mm observed in all groups. At T3, no statistically significant differences were observed between the surgical groups and controls at angle Sella, Nasion, A point (SNA), A point, Nasion, B point (ANB), and overjet outcome measures. Conclusions: LeFort I advancement produces a stable correction in mild, moderate, and severe skeletal maxillary hypoplasia. Overcorrection is recommended in all patients with CLP to compensate for the expected postsurgical skeletal relapse.

scholarly journals Ultrasound Screening for Thyroid Carcinoma in Childhood Cancer Survivors: A Case Series

2008 ◽  
Vol 93 (12) ◽  
pp. 4840-4843 ◽  
Author(s):  
Enrico Brignardello ◽  
Andrea Corrias ◽  
Giuseppe Isolato ◽  
Nicola Palestini ◽  
Luca Cordero di Montezemolo ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Outcome Measure ◽  
Childhood Cancer Survivors ◽  
Ultrasound Screening ◽  
Thyroid Ultrasound ◽  
Main Outcome Measure ◽  
Head Neck

Context: Childhood cancer survivors need regular monitoring into young adulthood and beyond, because they are at risk for developing late-onset complications of cancer therapy, including second malignancies. Objective: This study focuses on the use of thyroid ultrasound to screen for thyroid carcinoma in a population of childhood cancer survivors. Patients: A total of 129 subjects who had received radiotherapy to the head, neck, or upper thorax for a pediatric cancer were studied in the setting of a long-term follow-up unit. Design: Thyroid ultrasound usually began 5 yr after radiotherapy and was repeated every third year, if negative. Median follow-up time since childhood cancer diagnosis was 15.8 yr (range 6.1–34.8 yr). Solid thyroid nodules were found in 35 patients. Fine-needle aspiration was performed in 19 patients, of which 14 had nodules above 1 cm. Main Outcome Measure: The main outcome measure was the finding of not palpable thyroid cancers. Results: Cytological examination of specimens diagnosed papillary carcinoma in five patients who underwent surgery. The cytological diagnosis of papillary thyroid carcinoma was confirmed in all cases by histological examination. Notably, only two of these patients had palpable nodules; the other three were smaller than 1 cm and were detected only by ultrasound. However, histological examination showed nodal metastases in two of these. Conclusions: Although ultrasound screening for thyroid cancer in the general population is not cost effective and could lead to unnecessary surgery, due to false positives, we believe that in childhood cancer survivors who received radiotherapy involving the head, neck, or upper thorax, it would be worthwhile.

scholarly journals The value of domiciliary medication reviews: a thematic analysis of patient views

2021 ◽  
Author(s):  
Patricia McCormick ◽  
Bridget Coleman ◽  
Ian Bates
Keyword(s):  
Thematic Analysis ◽  
Outcome Measure ◽  
Service Users ◽  
Structured Interviews ◽  
Main Outcome Measure ◽  
Healthcare Settings ◽  
Medication Reviews ◽  
Informal Carers ◽  
The Individual ◽  
Patient Centric

AbstractBackground Medication reviews are recognised as essential to tackling problematic polypharmacy. Domiciliary medication reviews (DMRs) have become more prevalent in recent years. They are proclaimed as being patient-centric but published literature mainly focuses on clinical outcomes. However, it is not known where the value of DMRs lies for patients who participate in them. Objective To determine the value of domiciliary medication reviews to service users. Setting Interviews took place with recipients of domiciliary medication reviews residing in the London boroughs of Islington and Haringey. Method Semi-structured interviews analysed using thematic analysis. Main outcome measure Themes and sub-themes identified from interview transcripts. Results Five themes were identified: advantages over traditional settings, attributes of the professional, adherence, levels of engagement and knowledge. Conclusion For many patients, the domiciliary setting is preferred to traditional healthcare settings. Patients appreciated the time spent with them during a DMR and felt listened to. Informal carers felt reassured that the individual medication needs of their relative had been reviewed by an expert.

scholarly journals Association of Cryptorchidism with a Specific Haplotype of the Estrogen Receptor α Gene: Implication for the Susceptibility to Estrogenic Environmental Endocrine Disruptors

2005 ◽  
Vol 90 (8) ◽  
pp. 4716-4721 ◽  
Author(s):  
Rie Yoshida ◽  
Maki Fukami ◽  
Isoji Sasagawa ◽  
Tomonobu Hasegawa ◽  
Naoyuki Kamatani ◽  
...  
Keyword(s):  
Estrogen Receptor ◽  
Endocrine Disruptors ◽  
Outcome Measure ◽  
Estrogen Receptor Α ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Main Outcome Measure ◽  
Environmental Endocrine Disruptors ◽  
Estrogenic Effects ◽  
Specific Haplotype

Context: The prevalence of cryptorchidism (CO) has increased during the past few decades in several countries, and this event has primarily been ascribed to the estrogenic effects of environmental endocrine disruptors (EEDs). Little is known, however, about the role of genetic susceptibility to EEDs in this phenomenon. Objective: The objective of this study was to determine whether CO is associated with a specific haplotype of the gene for estrogen receptor α (ESR1) that mediates the estrogenic effects of EEDs. Design: This was a case-control study. Setting: The study was performed at the National Research Institute and University Hospitals. Subjects: Sixty-three cryptorchid males, aged 1–13 yr, and 47 control males, aged 4–12 yr, were studied. Intervention: After genotyping 15 single nucleotide polymorphisms widely distributed in the greater than 300-kb genomic sequences of ESR1, haplotype analysis was performed. Main Outcome Measure: Identification of a specific ESR1 haplotype associated with CO was the main outcome measure. Results: A haplotype block was identified for an approximately 50-kb region encompassing single nucleotide polymorphisms 10–14 in the 3′ region of ESR1 in both groups. The frequency of the estimated AGATA haplotype within the block was higher in the patients than in the control males (34.0% vs. 21.3%; P = 0.037), and the association of this haplotype with CO phenotype was significant in a recessive mode (P = 0.0060). The homozygosity for this haplotype was identified only in the patients, and the frequency of the homozygotes was significantly different between the two groups (10 of 63 vs. zero of 47; P = 0.0042). Conclusions: The association of CO with homozygosity for the specific ESR1 haplotype suggests the relevance of genetic susceptibility to EEDs in the development of CO.

The Effects of Superficial Heating before 1-MHz Ultrasound on Tissue Temperature

2003 ◽  
Vol 12 (2) ◽  
pp. 95-103 ◽  
Author(s):  
William R. Holcomb ◽  
Chris Blank
Keyword(s):  
Athletic Training ◽  
Repeated Measures ◽  
Outcome Measure ◽  
Tissue Temperature ◽  
Temperature Elevation ◽  
Main Outcome Measure ◽  
Cooling Period ◽  
Dependent Variables ◽  
Within Subjects ◽  
Independent Variable

Context:Ultrasound significantly raises tissue temperature, but the time of temperature elevation is short.Objective:To assess the effectiveness of superficial preheating on temperature elevation and decline when using ultrasound.Design:Within-subjects design to test the independent variable, treatment condition; repeated-measures ANOVAs to analyze the dependent variables, temperature elevation and decline.Setting:Athletic training laboratory.Intervention:Temperature at a depth of 3.75 cm was measured during ultrasound after superficial heating and with ultrasound alone.Subjects:10 healthy men.Main Outcome Measure:Temperature was recorded every 30 s during 15 min of ultrasound and for 15 min afterward.Results:Temperature elevation with ultrasound was significantly greater with preheating (4.0 ± 0.21 °C) than with ultrasound alone (3.0 ± 0.22 °C). Temperature decline was not significantly different between preheating and ultrasound alone.Conclusions:Superficial preheating significantly increases temperature elevation but has no effect on temperature decline during a 15-min cooling period.

scholarly journals Self-Monitoring Symptoms in Glaucoma: A Feasibility Study of a Web-Based Diary Tool

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Leanne McDonald ◽  
Fiona C. Glen ◽  
Deanna J. Taylor ◽  
David P. Crabb
Keyword(s):  
Outcome Measure ◽  
Visual Field Loss ◽  
Qualitative Synthesis ◽  
Self Monitoring ◽  
Web Based ◽  
Main Outcome Measure ◽  
Negative Feelings ◽  
Behavioural Aspects ◽  
Study Questionnaire ◽  
Eye Clinic

Purpose. Glaucoma patients annually spend only a few hours in an eye clinic but spend more than 5000 waking hours engaged in everything else. We propose that patients could self-monitor changes in visual symptoms providing valuable between clinic information; we test the hypothesis that this is feasible using a web-based diary tool. Methods. Ten glaucoma patients with a range of visual field loss took part in an eight-week pilot study. After completing a series of baseline tests, volunteers were prompted to monitor symptoms every three days and complete a diary about their vision during daily life using a bespoke web-based diary tool. Response to an end of a study questionnaire about the usefulness of the exercise was a main outcome measure. Results. Eight of the 10 patients rated the monitoring scheme to be “valuable” or “very valuable.” Completion rate to items was excellent (96%). Themes from a qualitative synthesis of the diary entries related to behavioural aspects of glaucoma. One patient concluded that a constant focus on monitoring symptoms led to negative feelings. Conclusions. A web-based diary tool for monitoring self-reported glaucoma symptoms is practically feasible. The tool must be carefully designed to ensure participants are benefitting, and it is not increasing anxiety.

scholarly journals Effect of anterior capsular polishing on the incidence of YAG capsulotomy

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Muhammad A Ahad ◽  
Mohammad Rashad Qamar ◽  
Sameh K Hindi ◽  
Martin N Kid
Keyword(s):  
Outcome Measure ◽  
Early Postoperative Period ◽  
Controlled Study ◽  
Control Group ◽  
Anterior Capsule ◽  
Main Outcome Measure ◽  
Group I ◽  
Group 2 ◽  
One Year ◽  
Group 1

Purpose: To study the effect of anterior capsule polishing during phacoemulsification on the incidence of post operative YAG laser capsulotomy. Method: A retrospective controlled study of 159 patients who underwent uncomplicated phacoemulsification with anterior capsular polishing between October 1998 and March 2000. 169 age matched patients who underwent phacoemulsification but without anterior capsule polishing served as controls. Main outcome measure: Incidence of visually significant YAG capsulotomy, which improved the Snellen acuity for more than 1 line or at least 1 line with subjective improvements in symptoms. Results: 2.51 % of patients with anterior capsular polishing (Group 1) had YAG capsulotomy compared to 7.1% of patients in control group at one year. However, after two years, 11.3% of patients in Group I had YAG capsulotomy compared to 12.4% in Group 2. Conclusion: Anterior capsular polishing during cataract surgery may delay the opacification of posterior capsule during the early postoperative period. But does not decrease the incidence of YAG capsulotomy after two years.

Dynamic Postural Control Two Years Following Anterior Cruciate Ligament Reconstruction in a Female Collegiate Soccer Player

2015 ◽  
Vol 20 (2) ◽  
pp. 24-29 ◽  
Author(s):  
Michael A. Samaan ◽  
Eric K. Greska ◽  
Matthew C. Hoch ◽  
Joshua T. Weinhandl ◽  
Sebastian Y. Bawab ◽  
...  
Keyword(s):  
Knee Joint ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Minimal Detectable Change ◽  
Joint Stability ◽  
Compensatory Mechanisms ◽  
Main Outcome Measure

Context:ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.Objective:To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).Participant:One Division I female athlete.Main Outcome Measure:The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.Results:ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.Conclusion:Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

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