scholarly journals STEENBEEK FOOT ABDUCTION BRACE FOR CLUBFOOT: COST EFFECTIVE BUT IS IT EFFECTIVE? A PROSPECTIVE STUDY

2017 ◽  
Vol 10 (5) ◽  
pp. 99 ◽  
Author(s):  
Thatikonda Sai Dinesh ◽  
Prem Kotian
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Exact Test ◽  
Pirani Score ◽  
Proven Efficacy ◽  
The Status ◽  
Cost Effective Alternative ◽  
A Prospective Study ◽  
Fischer Exact Test

Introduction: Foot Abduction Brace is recommended to prevent recurrence after casting phase in Ponseti method. Various types of braces are described, most current braces with proven efficacy are costly(100-300$) and difficult to acquire especially for the common man in India. Steenbeek brace can be made with locally available materials and is very simple to make and is cost effective(10$). Its efficacy is largely untested.Aim: To evaluate effectiveness of Steenbeek foot abduction brace to maintain correction achieved and to study the reasons for failure and complications associated with the brace.Materials and Methods: In KMC Mangalore and allied hospitals between Jun’2014-Aug’2016 25patients (38feet) who were treated by Ponseti method of cast application were given the Steenbeek foot abduction brace and followed up for a minimum duration of 1 year. The Status of foot was assessed using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and Compliance defined as brace application for 23 hours/day for the first three months, and nap time brace application for rest of the duration of study.Results: In 36 of 38 feet on the brace the correction was maintained(94.7% effective). In two patients(feet) there was worsening of the Pirani score after brace application and recurrence was seen. The reason for failure was found to be non compliance. The correlation between noncompliance and recurrence was significant(p <0.001) using Fischer Exact Test. Pirani score improved significantly in compliant group with significant worsening noted in noncompliant group. There were no other brace related complications.Conclusions: The significant correlation between noncompliance and recurrence shows that Steenbeek FAB is effective in maintaining correction and can be a cost-effective alternative to the more costly braces, for use in developing countries.

Effective Pharmacist led interventional strategies to improve outcomes in hypertensive patients: a narrative review

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Samra Bashir ◽  
Akash Syed
Keyword(s):  
Pharmaceutical Care ◽  
Cost Effective ◽  
Pharmacist Intervention ◽  
Care Plan ◽  
Hypertensive Patients ◽  
Disease Outcomes ◽  
Cost Effective Alternative ◽  
The Impact

The role of pharmacist intervention as a cost-effective alternative to physician in disease management is increasingly been recognized. Studies have demonstrated that pharmaceutical care can improve drug therapy as well as patient satisfaction in chronic health conditions including cardiovascular diseases. This study is aimed to review and outline a comprehensive pharmaceutical care plan from the randomized controlled trials previously conducted to assess the impact of pharmacist-managed care on disease outcomes in hypertensive patients. Compared with usual care, the pharmaceutical intervention involved patient evaluation, patient education and counselling, medication review and management, patient monitoring and follow-up, and feedback to the primary physician as major strategies.

MANAGEMENT OF IDIOPATHIC CONGENITAL CLUBFOOT USING PONSETI METHOD

2021 ◽  
pp. 38-39
Author(s):  
Chunchesh MD Chunchesh MD ◽  
Vani Ahuja ◽  
Kiran S Mahapure
Keyword(s):  
Cost Effective ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Idiopathic Clubfoot ◽  
Congenital Talipes Equinovarus ◽  
Cost Effective Treatment ◽  
Pediatric Orthopaedics ◽  
Talipes Equinovarus ◽  
Main Factor

Introduction: Idiopathic congenital talipes equinovarus is a complex deformity that is difcult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in pediatric orthopaedics. Most orthopedists agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short-term follow up of 30 patients treated by the Ponseti method at our institute to assess the efcacy of the treatment modality. Methodology: 30 patients underwent Ponseti method for a period of 2 years, patients were followed up regularly at weekly intervals. The severity of foot deformities was graded as per Pirani's scoring system. Results: The Ponseti method is a safe and cost-effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. Non-compliance with orthotics has been widely reported to be the main factor causing failure of the technique. At the end of study good results were obtained in 28 patients. 2 patients developed recurrence of the deformity due to non-compliance of the use of Orthotics.

scholarly journals Caregiver’s Recall of Stroke Discharge Education Exceeds Patients and Is Associated With Greater Satisfaction

2019 ◽  
Vol 7 (5) ◽  
pp. 796-800
Author(s):  
Caleb J Heiberger ◽  
Clayton Busch ◽  
John Chandler ◽  
Kevin Rance ◽  
Brett Montieth ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Categorical Data ◽  
Stroke Patients ◽  
Exact Test ◽  
Perceived Utility ◽  
Time Periods ◽  
Fischer Exact Test ◽  
Over Time ◽  
Discharge Education

Stroke survivors and their caregivers report not receiving enough information at discharge. To identify strengths and weaknesses of stroke discharge education, we delivered questionnaires that assessed patient and caregiver recall, perceived utility, and satisfaction at discharge as well as 1- and 3-month follow-up. Categorical data of responses were compared between time periods using Fischer exact test. Recall significantly differed between discharge (86%) and 1-month follow-up (54%, P < .05), but not discharge and 3-month follow-up (69%). Patient perceived utility at both 1 month (69%) and 3 months (64%) was lower than at discharge (92%, P < .05). Patient satisfaction was lower at 1 month (69%) and 3 months (54%) than discharge (92%, P < .05). Caregiver recall declined from discharge (81%) to 1 month (65%) but improved from 1 to 3 months (82%, P < .05). Caregiver satisfaction and perceived utility remained positive through the study. The results suggest stroke patients and their caregivers suffer from education recall failure over time that is associated with worse satisfaction and perceived utility by patients. Reinforcement at 1 month may improve caregiver recall. We conclude that education for caregivers may be more reliably reinforced, suggesting a role in continued patient education.

Monetary Incentives to Improve Follow-up Data Collection

1986 ◽  
Vol 58 (3) ◽  
pp. 739-742 ◽  
Author(s):  
F. Matthew Kramer ◽  
Robert W. Jeffery ◽  
Mary Kaye Snell
Keyword(s):  
Data Collection ◽  
Statistical Power ◽  
Cost Effective ◽  
Monetary Incentives ◽  
Size Estimation ◽  
Causal Inferences ◽  
Effect Size Estimation ◽  
Power Effect ◽  
Cost Effective Alternative

Loss of subjects during follow-up is a frequent occurrence in outcome research on habit disorders. This attrition may have undesirable effects on statistical power, effect-size estimation, and causal inferences. The present study investigated the effects of offering subjects a monetary incentive of $0.00, $5.00, or $15.00 as a cost effective alternative to normal follow-up procedures for attending a scheduled follow-up meeting. The results indicate that these modest incentives did not significantly enhance attendance at the follow-up visit. Suggestions for future applications of monetary incentives in follow-up data collection are provided.

scholarly journals Y Stenting in Wide-Necked Bifurcation Aneurysms: A Single-Center Experience

2022 ◽  
Author(s):  
Apratim Chatterjee ◽  
Anshu Mahajan ◽  
Vinit Banga ◽  
Piyush Ojha ◽  
Gaurav Goel
Keyword(s):  
Cost Effective ◽  
Stent Migration ◽  
Hematoma Expansion ◽  
Technical Aspects ◽  
Single Center Experience ◽  
Level Of Consciousness ◽  
Resource Poor ◽  
Wide Availability ◽  
Cost Effective Alternative

AbstractStent-assisted coiling is an endovascular means of managing wide-necked bifurcation aneurysms. In spite of the wide availability of various newer devices in managing such difficult aneurysms, the Y stenting offers a safe and cost-effective alternative to treat such cases in resource poor settings. This article provides an insight of our initial six cases of Y stent-assisted coiling along with their follow-up over a period of 6 months with no recanalization in any case. It also highlights the various technical aspects involved in such cases. One case had recurrent subdural hematoma probably due to use of antiplatelets and another patient had sudden dip in level of consciousness probably due to hematoma expansion that might also have been due to antiplatelet usage. However, none of the cases had any issues regarding stent migration, malapposition, and dissection. In our experience, Neuroform Atlas stent used for Y stenting offers a safe and technically easy alternative to various newer bifurcation devices.

scholarly journals Management of congenital talipes equino varus using Ponseti method: 3 year follow up in 166 club feet

2017 ◽  
Vol 3 (4) ◽  
pp. 775
Author(s):  
Rahul Bansal ◽  
Angad Jolly ◽  
P. B. Mohammed Farook ◽  
Idris Kamran ◽  
Syed Wahaj ◽  
...  
Keyword(s):  
Club Foot ◽  
Ponseti Method ◽  
Foot Deformities ◽  
Non Invasive ◽  
Bilateral Involvement ◽  
The Past ◽  
Pirani Score ◽  
Congenital Talipes

<p class="abstract"><strong>Background:</strong> Our aim was to study the effectiveness of Ponseti method using Pirani score in children with club foot treated over the past three years at our hospital.</p><p class="abstract"><strong>Methods:</strong> We studied 111 children with 166 idiopathic club feet who were treated at our teaching hospital between period of January 2012 and January 2017.The foot deformities were assessed using Pirani score at the time of first visit and the scores were recorded with each subsequent visit, with each casting and manipulation until correction of deformity. Tenotomy was performed on all the idiopathic club feet and continued with Steenbeek foot abduction brace (FAB) and the scores were recorded with every follow up and the progress was noted. All the relevant data in terms of treatment and demographics were recorded with dates and maintained.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total of 166 feet of 111 children was treated out of which 72 were males and 39 were females. 55 children had bilateral involvement remaining were unilateral. Mean Pirani score was 5.5 (range 4-6) when the treatment was started. On an average 5.7 casts (range 3-9) were required before preforming a tenotomy. Tenotomy was performed on all the feet (100%) with idiopathic club foot. Foot abduction orthosis was given to all the patients and 108 patients (97.3%) were compliant. Mean Pirani score after three years of treatment was 0.26. Skin complications like blister formation were seen in three children during the course of the treatment. Four patients did not follow up and defaulted. Three patients had relapse or worsening of Pirani score. The recurrence or worsening of scores is thought to be due to poor compliance while using the foot abduction brace.</p><p><strong>Conclusions:</strong> Ponseti method of treatment for CTEV is very effective, simple, non-invasive and convenient with excellent outcomes over long term with no significant complications.</p>

scholarly journals Current and Future Trends in Life Sciences Training: Questionnaire Study

10.2196/15877 ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e15877
Author(s):  
William Magagna ◽  
Nicole Wang ◽  
Kyle Peck
Keyword(s):  
Emerging Technologies ◽  
Life Sciences ◽  
Continuing Professional Development ◽  
Cost Effective ◽  
Science Field ◽  
Current State ◽  
The Future ◽  
Training Professionals ◽  
The Status

Background Every year, the life science field spends billions of dollars on educational activities worldwide. The continuing professional development of employees, especially in this field, encompasses great challenges. Emerging technologies appear to offer opportunity, but relatively little research has been done on the effectiveness of pedagogies and tools that have been used in the life sciences, and even less research has been devoted to understanding the potential power of emerging options that might determine the field’s future. Objective In collaboration with the Life Sciences Trainers & Educators Network (LTEN), this study investigated the current state of the pedagogies and tools currently adopted by corporate training professionals in the life sciences as well as the professionals’ perceptions of the impacts of emerging technologies on training. Methods This study adopted a mixed methods approach that included a survey and a follow-up interview. The survey consists of 18 broad questions with 15 subquestions in each of the five specific sectors of the life sciences field. Interviews were conducted by phone and lasted approximately 40 minutes, covering 18 questions designed to follow-up on findings from the survey items. Results Both survey and interview results indicated that the professionals were not satisfied with the status quo and that training and education in this field need to change. Most of the techniques and tools currently used have been used for some time. The professionals surveyed were not satisfied with the current techniques and tools and did not find them cost-effective. In addition, the respondents pictured the future of training in this field to be more engaging and effective. Conclusions This is the first study in a series designed to better understand education and training in the life sciences on a macro level, in order to build a foundation for progress and evolution of the future landscape. Next steps involve developing strategies for how to extend this vision throughout individual organizations.

scholarly journals Inner Prepuce Preserving ‘Bird-Winged Coronal-Collar Skin ReArrangement’ Modification of Tip Urethroplasty

2020 ◽  
pp. 1-4
Author(s):  
Prabudh Goel ◽  
◽  
Jile Dar Rawat ◽  
Piyush Kumar ◽  
◽  
...  
Keyword(s):  
Ventral Surface ◽  
Control Group ◽  
Test Results ◽  
Penile Shaft ◽  
Modified Technique ◽  
Exact Test ◽  
Tubularized Incised Plate ◽  
Fischer Exact Test

Objective: To describe the ‘Bird-Winged Coronal-Collar Skin re-arrangement modification’ of the Tubularized Incised Plate (TIP) urethroplasty to preserve the inner preputial skin on the ventral surface of the penile shaft. Material and Method: Study Group: Prospective review of the results of a single surgeon with Bird-Winged Coronal-Collar skin re-arrangement modification of TIP urethroplasty (n=111; mean age 4.9 years) of distal (n=76) and mid-penile (n-35) hypospadias (mean follow-up 37 months). Control Group: Retrospective review of a single surgeon’s results of distal and mid-penile hypospadias repair with standard TIP urethroplasty (2007-11). Outcome parameters (to compare non-inferiority of the modified technique): Urethro-cutaneous fistula (UCF) at voiding trial and follow-up at 3 months, wound infection, complete dehiscence, local edema, meatal stenosis and quality of urinary stream. Statistical analysis was done with the Fischer Exact Test. Results: With this technique, the authors could provide an inner preputial cover on the ventral/ ventro-lateral aspects of distal penile shaft in all but one patient (complete dehiscence). The results of ‘bird-winged coronal-collar skin re-arrangement’ modification were not-inferior/ comparable to those of standard TIP urethroplasty. Conclusions: The modification is technically feasible and reproducible and the overall results of urethroplasty were not inferior to the standard TIPS procedure.

Factors Associated With The Relapse In Ponseti Treated Congenital Club Foot

2021 ◽  
Author(s):  
Wei Hu ◽  
Baoyi Ke ◽  
Niansu Xiao ◽  
Sen Li ◽  
Cheng Li ◽  
...  
Keyword(s):  
Club Foot ◽  
Ethics Committee ◽  
Ponseti Method ◽  
Ethical Standards ◽  
Factors Associated ◽  
Pirani Score ◽  
Walking Age ◽  
The Mean ◽  
Hospital Ethics

Abstract Objectives. We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method.Methods. We retrospectively reviewed all children with congenital club foot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee.Results. In this study, there were 148 cases with 164 feet in total that underwent the Ponseti method. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50±2.15 months. The average initial Pirani score was 4.98±1.33, 2 and the average number of casts was 5.71±2.28 times. The mean age of mothers at birth was 25.81±2.38 years old. The walking age of children was at a mean of 14.83±1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 feet (76.4%). The average follow–up period was 7.27±1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group.Conclusion. The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

A Prospective Study of Clinical Outcomes in Laryngopharyngeal Reflux Diseases Following Treatment with Proton Pump Inhibitors in a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (28) ◽  
pp. 2538-2543
Author(s):  
Binu Raju George ◽  
Ajayan P.V ◽  
Saify Samad
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Laryngopharyngeal Reflux ◽  
Cost Effective ◽  
Reflux Symptom ◽  
P Value ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
A Prospective Study

BACKGROUND Laryngopharyngeal reflux (LPR) is found to be a common disease encountered in Otolaryngology practice. LPR presents clinically with symptoms of laryngeal irritation, frequent throat clearing, cough, and hoarseness of voice. The main diagnostic methods currently used are Fiber-optic laryngoscopy and in some centers pH monitoring. Proton pump inhibitors (PPIs) are used and found to be cost-effective and useful for the treatment of LPR. The main objective of this study was to study the effectiveness of PPIs in alleviating the symptoms assessed using Reflux Symptom Index (RSI) score and Reflux Finding Scores (RFS). METHODS A prospective study was carried out on 100 patients attending the ENT OPD of Government Medical College and Hospital, Thrissur, Kerala. Patients were evaluated for improvement in symptoms of Laryngopharyngeal reflux disease following use of proton pump inhibitors, using Reflux symptom index and Reflux finding scores using 70 degree / flexible nasopharyngolaryngoscopy. Patients with clinical findings of LPRD with RSI score > 13 and RFS score > 7 were given a standard treatment protocol followed in our ENT department using Tab. Pantoprazole 40 mg twice daily before food and the treatment response was assessed by proper follow up at 6 weeks and 12 weeks. On each follow up visit, improvement in RSI and RFS scores with Proton pump inhibitor therapy was assessed. Data collected was then tabulated and analysed. RESULTS The study was conducted in 100 patients, 59 % of whom were females and 41 % males. Mean RSI score changed from 18.9 at the beginning to 14.5 at 6 weeks of treatment and 9.0 at 12 weeks of treatment with Proton pump inhibitor. Mean RFS score changed from 10.7 at the beginning to 8.7 at 6 weeks of treatment and to 5.9 at 12 weeks of treatment. Comparison of mean Reflux Symptom Index and mean Reflux Finding Scores before and after treatment revealed improvement and the result was statistically significant (p value < 0.001). CONCLUSIONS The use of RSI and RFS scores in the assessment of PPIs at fixed intervals is cost effective and avoids time consuming and cost intensive examinations. These scores also help in early diagnosis and long term follow up of LPR patient. Fixed time interval PPI treatment significantly improved RSI and RFS scores in LPR patients. The mean RSI score changed from 18.9 at the beginning of treatment to 14.5 at 6 weeks after treatment (p value < 0.001) and 9.0 after 12 weeks of treatment; (p value < 0.001) The mean RFS score changed from 10.7 at the beginning of treatment to 8.7 at 6 weeks after treatment (p value < 0.001) and 5.9 after 12 weeks of treatment; (p value < 0.001). KEYWORDS Laryngopharyngeal Reflux, Reflux Symptom Index, Reflux Finding Score

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