Anticoagulation after Iliofemoral Vein Stenting - Old Versus New

2019 ◽  
Vol 24 (38) ◽  
pp. 4525-4533 ◽  
Author(s):  
Anja B. Drebes ◽  
Neil H. Davies
Keyword(s):  
Thrombus Formation ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Published Data ◽  
Antithrombotic Treatment ◽  
Related Factors ◽  
Stent Patency ◽  
Venous Outflow Obstruction ◽  
The Impact

In recent years, there has been an increasing interest in endovascular iliofemoral vein stenting to prevent/ alleviate symptoms related to proximal venous outflow obstruction. Maintaining long-term stent patency is one of the main challenges, and risk factors for the development of re-thrombosis are not well understood. Published data on the safety and efficacy of the procedure predominantly come from cohort studies mainly focusing on mechanical aspects relating to stent placement and flow. Aetiology of thrombus formation and thrombotic tendencies of patients due to underlying medical conditions are not captured well or linked to clinical outcomes, and the impact of choice and length of antithrombotic therapy have not been specifically investigated. Here, we review different procedure-related factors and patient characteristics that might increase the risk of re-thrombosis and the utility of antithrombotic treatment options currently available.

scholarly journals Defensive medicine in neurosurgery: the Canadian experience

2016 ◽  
Vol 124 (5) ◽  
pp. 1524-1530 ◽  
Author(s):  
Timothy R. Smith ◽  
M. Maher Hulou ◽  
Sandra C. Yan ◽  
David J. Cote ◽  
Brian V. Nahed ◽  
...  
Keyword(s):  
Online Survey ◽  
Insurance Coverage ◽  
Patient Characteristics ◽  
Defensive Medicine ◽  
Published Data ◽  
Risk Environment ◽  
Malpractice Insurance ◽  
The Us ◽  
Survey Responses ◽  
The Impact

OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian neurosurgeons and used to measure Canadian neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosurgeons felt confident with their insurance coverage, and 60% reported that they rarely felt the need to practice defensive medicine. The majority of the respondents reported that the perceived medicolegal risk environment has no bearing on their preferred practice location. Only 1 in 5 respondent Canadian neurosurgeons (21.8%) reported viewing patients as a potential lawsuit. Only 4.9% of respondents would have selected a different career based on current medicolegal risk factors, and only 4.1% view the cost of annual malpractice insurance as a major burden. CONCLUSIONS Canadian neurosurgeons perceive their medicolegal risk environment as more favorable and their patients as less likely to sue than their counterparts in the US do. Overall, Canadian neurosurgeons engage in fewer defensive medical behaviors than previously reported in the US.

scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

Measuring the impact of integrating palliative care into a multidisciplinary brain and spine oncology clinic.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 163-163
Author(s):  
Matthew Manning ◽  
Mary Larach ◽  
Susan Boyles ◽  
Abigail Stern
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Disease Status ◽  
Patient Characteristics ◽  
High Rate ◽  
Do Not Resuscitate ◽  
Goals Of Care ◽  
Cancer Centers ◽  
Metastatic Lung ◽  
The Impact

163 Background: Recent literature indicates that palliative care (PC) improves the outcomes of patients with cancer. Integration of PC providers into cancer centers is increasingly recognized to enhance symptom management with a beneficial effect on patient survival. In order to predict the impact of widespread PC integration, we hypothesized that a small pilot program may provide evidence supporting broader implementation. The current study endeavors to measure the result of adding a dedicated PC provider to a multidisciplinary brain and spine oncology program. Methods: Over the six month study period, a PC nurse practitioner was integrated into an existing weekly multidisciplinary brain and spine oncology conference and clinic. The provider participated in the multidisciplinary conference reviewing recent MRIs and discussing current disease status and treatment options. Following conference, the PC provider would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. Results: The PC provider participated in 14 multidisciplinary clinics with a total of 180 subjects. Of those, 24 subjects met with the PC provider in formal consultation. The most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Conclusions: This study suggests that the integration of a PC provider into an existing multidisciplinary cancer program can produce a high rate of establishing goals of care and result in changes in treatment in a significant number of cases. Further study on the impact of integrating PC in cancer centers seems to be warranted.

scholarly journals Disability and progression in Afro-descendant patients with multiple sclerosis

2016 ◽  
Vol 74 (10) ◽  
pp. 836-841 ◽  
Author(s):  
Juliana Calvet Kallenbach Aurenção ◽  
Claudia Cristina Ferreira Vasconcelos ◽  
Luiz Claudio Santos Thuler ◽  
Regina Maria Papais Alvarenga
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
African Ancestry ◽  
Clinical Aspects ◽  
Published Data ◽  
Therapeutic Decision ◽  
Disease Outcomes ◽  
The Impact ◽  
Clinical Characteristic

ABSTRACT Multiple sclerosis (MS) prevalence is higher in Caucasian (CA) populations, narrowing the analysis of the impact of Afro-descendant (AD) populations in disease outcomes. Even so, recent studies observed that AD patients have a more severe course. The main objective of this study is to confirm and discuss, through a systematic review, that being AD is a risk factor for disability accumulation and/or severe progression in patients with MS. A systematic review of published data in the last eleven years was performed, which evaluated clinical aspects and long term disability in patients with MS. Fourteen studies were included. Of these fourteen articles, thirteen observed a relationship between ancestry and poorer outcome of MS. African ancestry is a condition inherent in the patient and should be considered as an initial clinical characteristic affecting prognosis, and influencing which therapeutic decision to make in initial phases.

scholarly journals THE IMPACT OF MEDICATION REGIMEN COMPLEXITY ON ADHERENCE TO LONG-TERM THERAPIES

2021 ◽  
pp. 40-43
Author(s):  
SHAKEEL AHMAD MIR ◽  
DANISH SHAKEEL
Keyword(s):  
Drug Administration ◽  
Term Therapy ◽  
Medication Regimen ◽  
Related Factors ◽  
Cross Sectional ◽  
Medication Regimen Complexity ◽  
Regimen Complexity ◽  
High Adherence ◽  
The Impact

Objective: Adherence is a multifactorial phenomenon. Medication-related factors have long been the focus of attention. However, the results are inconsistent. Methods: In a cross-sectional questionnaire-based study of outpatients, we assessed 180 patients suffering from chronic conditions. The objective of this study is to determine the impact of medication regimen complexity on adherence to long-term drug therapies. Results: 91.66% of patients receiving more than four drugs had good or high adherence. 80.94% of patients on thrice a day (or more) drug administration had good or high adherence. 91.66% of patients receiving drug therapy for more than 5 years had good or high adherence. In all other groups, the adherence was low. The adherence was significantly (p<0.05) and positively (rs=0.792 and 0.846) correlated to the frequency of drug administration and duration of treatment. Adherence was positively correlated to the number of drugs per day (rs=0.668) but the relationships were not statistically significant (p=0.102). All the correlations were large. Conclusions: We found adherence positively correlated with medication regimen complexity. An improved understanding of the determinants of medication adherence is needed. Keywords: Medication regimen complexity, Adherence, Long-term therapy, Chronic disease

Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hoang T Phan ◽  
Mathew J Reeves ◽  
Leigh Blizzard ◽  
Amanda Thrift ◽  
Dominique Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Population Based ◽  
Stroke Severity ◽  
Related Factors ◽  
Post Stroke ◽  
Modifiable Factors ◽  
Mortality Rate Ratio ◽  
The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

scholarly journals Intestinal microbiota during early life – impact on health and disease

2014 ◽  
Vol 73 (4) ◽  
pp. 457-469 ◽  
Author(s):  
Lotta Nylund ◽  
Reetta Satokari ◽  
Seppo Salminen ◽  
Willem M. de Vos
Keyword(s):  
Intestinal Microbiota ◽  
Early Life ◽  
Later Life ◽  
Related Factors ◽  
Life Impact ◽  
Health And Disease ◽  
And Function ◽  
The Impact

In the first years after birth, the intestinal microbiota develops rapidly both in diversity and complexity while being relatively stable in healthy adults. Different life-style-related factors as well as medical practices have an influence on the early-life intestinal colonisation. We address the impact of some of these factors on the consecutive microbiota development and later health. An overview is presented of the microbial colonisation steps and the role of the host in that process. Moreover, new early biomarkers are discussed with examples that include the association of microbiota and atopic diseases, the correlation of colic and early development and the impact of the use of antibiotics in early life. Our understanding of the development and function of the intestinal microbiota is constantly improving but the long-term influence of early-life microbiota on later life health deserves careful clinical studies.

scholarly journals Self-reported mould and long-term sickness absences from work

2020 ◽  
pp. 140349482091956
Author(s):  
Eerika Finell ◽  
Jouko Nätti
Keyword(s):  
Negative Binomial ◽  
Work Life ◽  
Quality Of Work Life ◽  
Related Factors ◽  
Occupational Physicians ◽  
Quality Of Work ◽  
Working Age ◽  
The Impact

Aims: The impact of indoor mould on employees’ long-term absence from sickness (more than 10 days of absence) is poorly understood. This paper examines whether self-reported mould was related to long-term absences from work between 1 and 3 years later. Methods: By using negative binomial modelling, we analysed a representative sample of the working-age population in Finland ( N = 16,084) from the Finnish Quality of Work Life Surveys in 1997, 2003, 2008 and 2013 combined with the register-based follow-up data of participants’ long-term sickness absences covering a period of 1 to 3 years after the Finnish Quality of Work Life Surveys was collected. Results: After all necessary background, work- and health-related factors were included in the model, employees who reported mould in their work had 1.20 higher rates of long-term sickness absence than those who did not report mould (mould: estimated marginal mean = 13.45 days; no mould: estimated marginal mean = 11.23). If employees perceived that mould caused strain, they had 1.30 higher rates of long-term absence than those who did not report such strain (mould caused strain: estimated marginal mean = 14.64 days; mould did not cause strain: estimated marginal mean = 11.25). In total, 10% ( N=1628) of employees reported mould in their workplace and 6% ( N=987) reported that mould caused strain. Conclusions: Supervisors, occupational physicians and other authorities need to take employees’ complaints of mould in the workplace seriously.

scholarly journals Introduction to odontoid fractures: controversies in the management of odontoid fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-3 ◽  
Author(s):  
Gregory J. Przybylski
Keyword(s):  
Treatment Options ◽  
Surgical Techniques ◽  
Patient Characteristics ◽  
Epidemiological Studies ◽  
Scientific Data ◽  
Published Data ◽  
Odontoid Fractures ◽  
Technological Advances ◽  
Increased Risk ◽  
Cord Injury

Although odontoid fractures were first classified more than 25 years ago,5 the management of these fractures remains controversial. Whereas the nonoperative management with external immobilization devices often leads to successful healing, certain fracture features and patient characteristics have been associated with an increased risk of bone nonunion.6,17 Recent technological advances in cervical spine instrumentation techniques have provided additional options for the management of these common fractures.1,12,13,24,27,28 However, an absence of rigorous studies in which the investigators compare management methods may contribute to the varying methods used by spine surgeons when approaching similar injuries. In this issue of Neurosurgical Focus, various aspects of the management of odontoid fractures are examined. In an evidence-based analysis of methods for treating odontoid fractures the authors examine the best available published data to determine the level of scientific data supporting the use of various treatment options.3 In epidemiological studies the investigators examine factors contributing to the unusual incidence of spinal cord injury with odontoid fractures as well as the unique considerations that may be attendant on the management of posteriorly displaced fractures. In two other studies the authors discuss the application of specific surgical techniques in treating odontoid fractures, whereas in an additional two reports the authors evaluate the difficulties in managing elderly patients with these injuries. Finally, the use of newer osteoinductive agents is examined as a potential adjunct in the surgical management of bony defects in the dens.

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