scholarly journals Efficacy of an adrenaline auto-injector diary for patients allergic to foods or insect stings

2021 ◽  
Author(s):  
Taku Oishi ◽  
Kouhei Hagino ◽  
Hajime Kuroiwa ◽  
Mikiya Fujieda
Keyword(s):  
Primary Endpoint ◽  
Anterolateral Thigh ◽  
One Year ◽  
Auto Injector ◽  
Insect Stings

Background: Adrenaline auto-injectors (AAIs) are not used correctly by patients and their caregivers because of a lack of training. The aim of this study was to determine how to help patients maintain proper use of AAIs. Methods: Patients prescribed AAIs or their caregivers were recruited. At enrollment, they were asked to demonstrate use of a ‘trainer’ device, and they were given a calendar as a diary. They were asked to mark the days they practice for a year. After one year, their performance was re-evaluated. Their skills were evaluated in five steps that consisted of a) how to hold the AAI, b) removing the cap, c) selecting the mid-anterolateral thigh as the correct site of injection, d) holding firmly in place for 5 seconds, and e) massaging after injection. The primary endpoint was the percentage of participants that correctly used the AAI one year after enrollment. Results: A total of 102 participants were enrolled. At enrollment, of the 82 participants who had previous AAI prescriptions, 38 (46.3%) used it correctly. Except for evaluation items d) and e), 55 of 82 (67.1%) used it correctly. Ninety-seven participants could be confirmed after one year, and 81 of them (83.5%) used the AAI correctly. Conclusion: Distributing the diary was effective in maintaining AAI skill. It is thought that the diary helped participants maintain their motivation to practice using the AAI.

scholarly journals Revisited Anterolateral Thigh Free Flaps For Reconstructive Microsurgery : One Year Evaluation

1970 ◽  
Vol 1 (2) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Siti Handayani ◽  
Shelly Madona Djaprie
Keyword(s):  
Soft Tissue ◽  
Free Flaps ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Wide Range ◽  
Reconstructive Microsurgery ◽  
One Year ◽  
Tissue Defects

Extensive soft tissue defects present a dif!cult problem to the plastic surgeon as they are usually associated with exposed important structures such as vessels, nerves, tendons, joint cavity or bone. Reconstruction of soft tissue defects have a wide range of therapeutic options. We reconstructed soft tissue defect in many areas using free anterolateral thigh flap (ALTF). From Februari 2009 - 2010, 9 cases of soft tissue defects in the face, neck, leg and foot of various etiologic factors were admitted to the plastic and reconstructive surgery unit, Cipto Mangunkusumo general hospital. Trauma is the commonest cause of soft tissue defects of the lower extremity, followed by tumours. The cruris was the commonest site (4 cases, 44,4%). Flap success rate was 66,67 %. Failure was reported 1 cases in this study due to vein compromise. In our hospital, we are quite familiar with Anterolateral thigh flap (ALTF) even though the case is limited. Anterolateral thigh flap (ALTF) is used for reconstruction of various simple and complex soft tissue defects, for big and small defects with cavity (orbita).

P1018Evolution of atrioventricular conduction disorders after TAVI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Irles ◽  
F Salerno ◽  
R Cassagneau ◽  
R Eschallier ◽  
C Maupain ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Primary Endpoint ◽  
Univariate Analysis ◽  
P Value ◽  
Conduction Disorders ◽  
Av Conduction ◽  
One Year ◽  
The One ◽  
Valve Implantation

Abstract Background The evolution of atrioventricular block (AVB) after Trans Aortic Valve Implantation (TAVI) is poorly understood, and indications of pacemaker (PM) implantation after TAVI not well defined. Modern PM algorithms can help studying the evolution of these AV conduction disorders after TAVI. SafeR® mode (Sorin® PM) allows to monitor precisely the AV conduction and to store AVB episodes in the PM memory as intracardiac electrograms, which can be re-read and validated afterwards. Methods From November 2015 and January 2017, all patients implanted in one of the 19 French enrolling centers with a Sorin® PM set in SafeR® mode after TAVI could be prospectively included in the study. All the PM interrogation files were centrally collected. The primary endpoint (PE) was the presence of at least one episode of high grade AVB (HG-AVB) beyond day 7 (D7) to one year after the TAVI. It could be validated either by the presence of a HG-AVB on EKG or telemetry, or by the confirmation of a HG-AVB in the PM memory files. Results 273 patients were included in the study, the PE was assessable in 197 patients. PE was validated in 74.6% patients. In univariate analysis, the use of an oversized prothesis or balloon, and all early episodes of HG-AVB (all those occurring up to D7) influence the validation of the PE. Other AV conduction disorders have no influence on the PE (Table). In multivariate analysis, only HG-AVB occurring between D2 and D7 has a significant influence on the PE. Factors influencing HG-AVB after TAVI Studied factor HG-AVB episode(s) during the one year follow up No HG-AVB episode during the one year follow up p value RBBB before TAVI (%) 41 34 0,346 Low implantation (>6mm) (%) 59 37 0,156 Use of Autoexpansive Valve (%) 62 62 0,990 Oversizing (%) 19 6 0,022 HG-AVB per TAVI (%) 56 30 0,001 HG-AVB D0-D1 (%) 53 24 0,001 HG-AVB D2-D7 (%) 68 34 0,001 New or wiser LBBB and improvement of PR interval after TAVI (%) 30 39 0,253 Influence of predefined factors on the Primary Endpoint. Conclusion The analysis of the SafeR® algorithm files in patients implanted with a PM after TAVI show a high incidence of HG-AVB during the one year follow up. In multivariate analysis, only HG-AVB occurring between D2 and D7 significantly influence the PE, confirming that AV conduction disorders occurring during the first 24 hours may spontaneously normalize. Acknowledgement/Funding Microport CRM

Encephaloduroarteriosynangiosis (EDAS) revascularization for symptomatic intracranial atherosclerotic steno-occlusive (ERSIAS) Phase-II objective performance criterion trial

2020 ◽  
pp. 174749302096725
Author(s):  
Nestor R Gonzalez ◽  
Hao Jiang ◽  
Patrick Lyden ◽  
Shlee Song ◽  
Konrad Schlick ◽  
...  
Keyword(s):  
Phase Ii ◽  
Primary Endpoint ◽  
Medical Management ◽  
Performance Criterion ◽  
Atherosclerotic Disease ◽  
Intracranial Atherosclerotic Disease ◽  
Objective Performance ◽  
Endpoint Event ◽  
One Year ◽  
Event Rates

Background Intracranial atherosclerotic disease (ICAD) is one of the most challenging stroke etiologies, with frequent recurrences despite optimized medical management. Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization method that produces extra-cranial collaterals to intracranial vessels. We present the results of a phase-II trial of EDAS in intracranial atherosclerotic disease patients. Aims To evaluate the feasibility, safety, and preliminary efficacy of EDAS in intracranial atherosclerotic disease patients. Methods ERSIAS was a prospective objective-performance-criterion trial of EDAS plus intensive medical management (IMM) in intracranial atherosclerotic disease (ICAD) patients failing medical treatment. Primary endpoint was any stroke/death within 30-days post-surgery or stroke in the territory of the qualifying artery beyond 30 days. The primary analysis compared event rates through one year with an objective-performance-criterion based on a 10% reduction from the 20% rate in the intensive medical management arm of the stenting versus aggressive medical management for preventing recurrent stroke in intracranial stenosis trial (SAMMPRIS) in patients with poor collaterals. Event rates through two years were compared with propensity-score-matched (PSM) medically treated patients from SAMMPRIS and the carotid occlusion surgery study (COSS). Results During a median follow-up of 24.5 months, 5 (9.6%) of 52 patients had a primary endpoint event. The primary endpoint rate at one year met the threshold for nonfutility and advancement to phase III (<10%). In the sensitivity analysis, primary endpoint event rate at two years was lower than in PSM controls, 9.6% versus 21.2% (p < 0.07). Overall, 86% of EDAS-plus-intensive medical management patients were functionally independent at last follow-up and 89% demonstrated neovascularization. There were two (3.8%) surgical complications and no intracranial hemorrhages. Conclusion ERSIAS phase II provides evidence of safety and strong signals of efficacy of EDAS-plus-intensive medical management, supporting advancement to a seamless phase-IIb/III trial. Clinical Trial Registration URL: https://www.clinicaltrials.gov.NCT01819597 .

scholarly journals Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy

2017 ◽  
Vol 7 (7) ◽  
pp. 631-638 ◽  
Author(s):  
Mario Iannaccone ◽  
Fabrizio D’Ascenzo ◽  
Paolo Vadalà ◽  
Stephen B Wilton ◽  
Patrizia Noussan ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
Converting Enzyme Inhibitors ◽  
Patients With Cancer ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
One Year

Background: The prevalence and outcome of patients with cancer that experience acute coronary syndrome (ACS) have to be determined. Methods and results: The BleeMACS project is a multicentre observational registry enrolling patients with acute coronary syndrome undergoing percutaneous coronary intervention worldwide in 15 hospitals. The primary endpoint was a composite event of death and re-infarction after one year of follow-up. Bleedings were the secondary endpoint. 15,401 patients were enrolled, 926 (6.4%) in the cancer group and 14,475 (93.6%) in the group of patients without cancer. Patients with cancer were older (70.8±10.3 vs. 62.8±12.1 years, P<0.001) with more severe comorbidities and presented more frequently with non-ST-segment elevation myocardial infarction compared with patients without cancer. After one year, patients with cancer more often experienced the composite endpoint (15.2% vs. 5.3%, P<0.001) and bleedings (6.5% vs. 3%, P<0.001). At multiple regression analysis the presence of cancer was the strongest independent predictor for the primary endpoint (hazard ratio (HR) 2.1, 1.8–2.5, P<0.001) and bleedings (HR 1.5, 1.1–2.1, P=0.015). Despite patients with cancer generally being undertreated, beta-blockers (relative risk (RR) 0.6, 0.4–0.9, P=0.05), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR 0.5, 0.3–0.8, P=0.02), statins (RR 0.3, 0.2–0.5, P<0.001) and dual antiplatelet therapy (RR 0.5, 0.3–0.9, P=0.05) were shown to be protective factors, while proton pump inhibitors (RR 1, 0.6–1.5, P=0.9) were neutral. Conclusion: Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).

One-year outcomes in unselected patients treated with a thin-strut, platinum-chromium, paclitaxel-eluting stent: primary endpoint results from the TAXUS Element European post-approval surveillance study (TE-PROVE)

2015 ◽  
Vol 10 (11) ◽  
pp. 1261-1266 ◽  
Author(s):  
Corrado Tamburino ◽  
Davide Capodanno ◽  
Andrejs Erglis ◽  
Ian B.A. Menown ◽  
Iván G. Horváth ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Surveillance Study ◽  
One Year

scholarly journals SP4.1.2 Appendicitis during the COVID pandemic – Are we seeing more complicated presentations?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Bianca Wadham ◽  
Tom Connolly ◽  
Phoebe Beer ◽  
Paul Ainsworth
Keyword(s):  
Statistical Analysis ◽  
Primary Endpoint ◽  
Complicated Appendicitis ◽  
Operative Approach ◽  
Exact Test ◽  
Laparoscopic Procedures ◽  
Operative Complications ◽  
Secondary Endpoints ◽  
One Year ◽  
Post Operative Complications

Abstract Aims Studies have suggested a decrease in emergency presentations of appendicitis during the COVID-pandemic along with a nationwide fall in non-COVID related presentations to A&E. We therefore hypothesised that those treated for appendicitis had later presentations resulting in increasing incidence of ‘complicated appendicitis’ and post-operative complications. Methods We retrospectively analysed all patients ≥16years, undergoing emergency appendicectomy during 3-month period of UK national lockdown (pandemic cohort). Data was compared to the same period one year previously (pre-pandemic cohort). Primary endpoint was nature of appendicitis (uncomplicated or complicated). Secondary endpoints were operative approach, LOS and post-operative complications. Statistical analysis was performed using Fisher’s Exact Test. Results A total of 31 patients (median age 35years) underwent emergency appendicectomy in the pre-pandemic cohort and 30 patients in the pandemic group (median age 37). 9/31 (29%) and 18/30 (60%) were found to have complicated appendicitis in each group respectively (p = 0.021). Open procedures took place in 2/31 pre-pandemic, and 12/29 (4 of which were converted from laparoscopic procedures) in the pandemic cohort (p = 0.002). Median LOS was 2 in each group, though the pandemic cohort had a much wider range (0-7 vs 0-25 days). Post-operative complications occurred in 1/31 and 5/30 patients respectively (p = 0.104) with 1 mortality within 30 days. Conclusions Despite overall volume and demographics of patients remaining the same, the COVID-19 pandemic has resulted in a statistically significant increase in complicated presentations of appendicitis to our hospital. Subsequently this has resulted in increasing incidence of open operations and post-operative complications.

scholarly journals Interest of treating iron deficiency, diagnosed according to hepcidin quantification, on outcomes after a prolonged ICU stay compared to standard care: a multicenter, randomized, single-blinded trial.

2020 ◽  
Author(s):  
sigismond lasocki ◽  
Pierre ASFAR ◽  
Samir JABER ◽  
Martine FERRANDIERE ◽  
Thomas KERFORNE ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Critically Ill ◽  
Primary Endpoint ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Intravenous Iron ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
One Year

Abstract Background: Anemia is a significant problem in patients on ICU. Its commonest cause, iron deficiency (ID), is difficult to diagnosed in the context of inflammation. Hepcidin is a new marker of ID. We aimed to assess whether hepcidin levels would accurately guide treatment of ID in critically ill anemic patients after a prolonged ICU stay and affect the post-ICU outcomes. Methods: In a controlled, single-blinded, multicenter study, anemic (WHO definition) critically ill patients with an ICU stay ≥5 days were randomized when discharge was expected to either intervention by hepcidin treatment protocol or control. In the intervention arm patients were treated with intravenous iron (1g of ferric carboxymaltose) when hepcidin was <20 μg/l and with intravenous iron and erythropoietin for 20≤ hepcidin <41 μg/l. Control patients were treated according to standard care (hepcidin quantification remained blinded). Primary endpoint was the number of days spent in hospital 90 days after ICU discharge (post-ICU LOS). Secondary endpoints were day 15 anemia, day 30 fatigue, day-90 mortality and one-year survival. Results: Of 405 randomized patients, 399 were analyzed (201 in intervention and 198 in control arm). 220(55%) had ID at discharge (i.e. an hepcidin <41 μg/l). Primary endpoint was not different (medians(IQR) post-ICU LOS 33(13;90) vs 33(11;90) days for intervention and control respectively, median difference -1(-3;1) days, p=0.78). D90 mortality was significantly lower in the intervention arm (16(8%) vs 33(16.6%) deaths, absolute risk difference -8.7 (-15.1 to -2.3)%, p=0.008, OR 95%IC, 0.46, 0.22 to 0.94, p=0.035) and one-year survival was improved (p =0.0394). Conclusion: Treatment of ID diagnosed according to hepcidin levels did not reduce the post-ICU LOS, but may reduce the long-term mortality in critically ill patients about to be discharged after a prolonged stay.

Abstract 66: Predictors of Vascular Events or Death within One Year of Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hiroshi Yamagami ◽  
Nobuyuki Sakai ◽  
Yoshihiro Matsubara ◽  
Yasushi Okada ◽  
Hiroyoshi Yokoi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Primary Endpoint ◽  
Carotid Artery Stenting ◽  
Older Age ◽  
Antiplatelet Drugs ◽  
Vascular Events ◽  
Factors Affecting ◽  
Multivariate Proportional Hazard ◽  
One Year ◽  
Distal Filter

Background and Purpose: Carotid artery stenting (CAS) using distal filter protection device has been approved in April 2008 in Japan. However, factors affecting the development of vascular events and deaths after CAS have not been clarified in our country. The present study was conducted to identify the predictive factors for the development of vascular events or death after CAS. Methods: CAS was indicated for patients with at least one risk factor for carotid endarterectomy and with > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Between June 2008 and June 2010, we enrolled 949 patients who were planning to undergo elective CAS in 43 Japanese centers. Patients were followed at 30days and 12 months after stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old) followed for 1 year after stenting, primary endpoint was observed in 109 (11.7%) patients, including 18 (1.9%) deaths, 52 (5.6%) ischemic strokes, 7 (0.8%) hemorrhagic strokes, 16 (1.7%) transient ischemic attacks, 4 (0.4%) myocardial infarctions, and 11 (1.2%) serious systemic bleeding. In a multivariate proportional hazard model, older age (hazard ratio [HR], 1.24 per 5 years; 95% confidence interval [CI], 1.07 to 1.44; P=0.005), history of ischemic stroke (HR, 1.68; 95% CI, 1.10 to 2.62; P=0.015), combination of pre-procedural antiplatelet drugs (P=0.03), usage of diabetes drugs (HR, 1.93; 95% CI, 1.29 to 2.88, P=0.002), femoral artery puncture (HR,0.36; 95% CI 0.18 to 0.80; =0.015), use of guiding catheter system (HR, 1.69; 95% CI 1.08 to 2.71, P=0.021) and use of Angioguard XP in the procedure (HR, 1.92; 95% CI, 1.16 to 3.40, P=0.011) were associated with the development of vascular events or death. Conclusions: In addition to older age and medical history, selection of pre-procedural antiplatelet drugs and procedural devices can predict vascular events or death after CAS.

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