scholarly journals ANATOMICAL MODELING OF FETUS AND NEWBORN PALM STRUCTURES

2020 ◽  
Vol 19 (3) ◽  
pp. 42-47
Author(s):  
O. Slobodian
Keyword(s):  
Clinical Practice ◽  
Surgical Treatment ◽  
Gestational Age ◽  
Morphometric Parameters ◽  
Anatomical Modeling ◽  
Inflammatory Processes ◽  
Palmar Aponeurosis ◽  
Over Time

Numerous anomalies manifested in clinical practice, in most cases, can be explained only on the basis of clarifying the origin and interaction of organs and structures, which over time acquire their characteristic forms, having studied their unusual topography and deeply understanding the corresponding embryonic phenomena. A detailed study of the anatomy of the hand is necessary for a correct under-standing of the pathways of the spread of purulent-inflammatory processes and the development of rational methods of surgical treatment. The prognostication models created to foresee standard morphometric parameters of a palm within a perinatal ontogenesis period are: for the length of a palm = β0+ 0.042 х parietal-calcaneal lengths of a fetus, where β0:= 3.587 during the 4th month of gestation; 5.562 = 5th month; 4.071 = 6th month; 4.840 = 7th month; 6.881 = 8th month; 5.624 = 9th month; 5.448 = 10th month; 5.765 = neonates; for the width of a palm = β0+ 0.038 х parietal-calcaneal length of a fetus, where β0= 2,887 for the 4th month of fetal age; 4.341 = 5th month; 2.638 = 6th month; 3.324 = 7th month; 3.548 = 8th month; 1.714 = 9th month; 1.814 = 10th month; 3.231 = neonates. The proposed models of standard morphometric parameters of a palmar aponeurosis in the perinatal ontogenesis period are the following: for its length – the length of a palmar aponeurosis = β0+ 0.022 х parietal-calcaneal length of a fetus, where β0= 3.531 for the 4th month of the gestational age; 6.532 = 5th month; 6.851 = 6th month; 6.526 = 7th month; 7.583 = 8th month; 7.044 = 9th month; 6.964 = 10th month; 7.968 = neonates; for the width – the width of a palmar aponeurosis = β0+ 0.018 х parietal-calcaneal length of a fetus, where β0= 2.624 within the 4th month of a fetus age; 5.431 = 5th age; 3.701 = 6th age; 4.233 = 7th age; 4.121 = 8th month; 3.602 = 9th age; 3.956 = 10th month; 4.881 = neonates.

scholarly journals P34 Characteristics, diagnosis and management of Cushing’s disease - A systematic review and meta-analysis

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Chan Hee Koh ◽  
Danyal Z Khan ◽  
Ronneil Digpal ◽  
Hugo Layard Horsfall ◽  
Hani J Marcus ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cushing’S Disease ◽  
Meta Analysis ◽  
A Priori ◽  
Pituitary Surgery ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
Diagnosis And Management ◽  
Over Time

Abstract Introduction The clinical practice and research in the diagnosis and management of Cushing’s disease remains heterogeneous and challenging to this day. We sought to establish the characteristics of Cushing’s disease, and the trends in diagnosis, management and reporting in this field. Methods Searches of PubMed and Embase were conducted. Study protocol was registered a-priori. Random-effects analyses were conducted to establish numerical estimates. Results Our screening returned 159 papers. The average age of adult patients with Cushing’s disease was 39.3, and 13.6 for children. The male:female ratio was 1:3. 8% of patients had undergone previous transsphenoidal resection. The ratio of macroadenomas: microadenomas:imaging-undetectable adenomas was 18:53:29. The most commonly reported preoperative biochemical investigations were serum cortisol (average 26.4µg/dL) and ACTH (77.5pg/dL). Postoperative cortisol was most frequently used to define remission (74.8%), most commonly with threshold of 5µg/dL (44.8%). Average remission rates were 77.8% with recurrence rate of 13.9%. Median follow-up was 38 months. Majority of papers reported age (81.9%) and sex (79.4%). Only 56.6% reported whether their patients had previous pituitary surgery. 45.3% reported whether their adenomas were macroadenoma, microadenoma or undetectable. Only 24.1% reported preoperative cortisol, and this did not improve over time. 60.4% reported numerical thresholds for cortisol in defining remission, and this improved significantly over time (p = 0.004). Visual inspection of bubbleplots showed increasing preference for threshold of 5µg/dL. 70.4% reported the length of follow up. Conclusion We quantified the characteristics of Cushing’s disease, and analysed the trends in investigation and reporting. This review may help to inform future efforts in forming guidelines for research and clinical practice.

scholarly journals Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Åsa Kettis ◽  
Hanna Fagerlind ◽  
Jan-Erik Frödin ◽  
Bengt Glimelius ◽  
Lena Ring
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Significant Difference ◽  
Patient Reported ◽  
Health Related Qol ◽  
Health Related ◽  
Secondary Outcomes ◽  
The Impact ◽  
Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

scholarly journals Embryology of Spinal Dysraphism and its Relationship to Surgical Treatment

2020 ◽  
Vol 47 (6) ◽  
pp. 736-746
Author(s):  
Matthew E. Eagles ◽  
Nalin Gupta
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Surgical Treatment ◽  
Gestational Age ◽  
Congenital Malformations ◽  
Spinal Dysraphism ◽  
Embryological Development ◽  
Correct Treatment ◽  
Pathological Correlation ◽  
The Central Nervous System

ABSTRACT:Spinal dysraphism is an umbrella term that encompasses a number of congenital malformations that affect the central nervous system. The etiology of these conditions can be traced back to a specific defect in embryological development, with the more disabling malformations occurring at an earlier gestational age. A thorough understanding of the relevant neuroembryology is imperative for clinicians to select the correct treatment and prevent complications associated with spinal dysraphism. This paper will review the neuroembryology associated with the various forms of spinal dysraphism and provide a clinical-pathological correlation for these congenital malformations.

scholarly journals Rehabilitation Therapy Utilization in Patients with Parkinson’s Disease in Korea

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Han Gil Seo ◽  
Sang Jun Park ◽  
Jiah Seo ◽  
Seong Jun Byun ◽  
Byung-Mo Oh
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Health Insurance ◽  
Clinical Practice ◽  
Patient Characteristics ◽  
National Sample ◽  
Present Evidence ◽  
Rehabilitation Therapy ◽  
Swallowing Therapy ◽  
Over Time

Objective. Although evidence and guidelines recommend appropriate rehabilitation from the beginning of diagnosis in patients with Parkinson’s disease (PD), there is a lack of data addressing the utilization of rehabilitation therapies for these patients in practice. The aim of this study is to investigate the rate of rehabilitation therapy utilization over time in patients with PD using a nationwide cohort in Korea. Methods. Patients were identified using the registration code for PD in the program for rare, intractable disease from the National Health Insurance Service-National Sample Cohort database, which consists of 979,390 Korean residents. Data were divided into four periods: 2004–2006, 2007–2009, 2010–2012, and 2013–2015. We assessed the utilization of rehabilitation therapies and the associated patient characteristics. Results. The numbers of patients with PD were 384 in 2004, 855 in 2007, 1,023 in 2010, and 1,222 in 2013. The numbers of physiatrist visits per person were 0.58, 0.96, 1.97, and 2.91, in the respective periods. Among the patients, 35–40% had claims for physical therapy, 16–19% for occupational therapy, and 4–6% for swallowing therapy. There were no remarkable differences between these rates between the study periods. Sex, age, income, disability, and levodopa-equivalent dose were significantly associated with the utilization of rehabilitation therapy. Conclusion. This study demonstrated that the rate of rehabilitation therapy utilization did not change remarkably in patients with PD from 2004 to 2015 in Korea although the number of physiatrist visits increased dramatically. The present evidence and guidelines may have not been adequately integrated into clinical practice during the period of study. Additional efforts may be warranted to provide adequate rehabilitation therapies in clinical practice for patients with PD.

Clinical Practice Guidelines for the Surgical Treatment of Patients With Lynch Syndrome

2017 ◽  
Vol 60 (2) ◽  
pp. 137-143 ◽  
Author(s):  
Daniel O. Herzig ◽  
W. Donald Buie ◽  
Martin R. Weiser ◽  
Y. Nancy You ◽  
Janice F. Rafferty ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Surgical Treatment ◽  
Lynch Syndrome ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines

Abstract P35: The Trend of Stroke Rehabilitation Utilization Between 2014- 2019 in a Community Based Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel Uhm ◽  
Esther Olasoji ◽  
Alexis N Simpkins ◽  
Carolyn Geis ◽  
Keyword(s):  
Clinical Practice ◽  
Trend Analysis ◽  
Significant Proportion ◽  
Inpatient Rehabilitation ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Institutional Review ◽  
Ischemic Attack ◽  
Over Time

Introduction: Stroke is the leading cause of long-term disability in adults, resulting in significant impairments in motor, sensory, and/ or cognitive that often requires continued rehabilitation services, which vary from intensive acute inpatient rehabilitation to outpatient rehabilitation services. Efforts to reduce disability have advanced rapidly over the past several years. Our data analysis was undertaken to assess whether recent changes in clinical practice have impacted the proportion of stroke patients receiving inpatient versus outpatient rehabilitation over time between 2014-2019 at our institution, which serves a diverse mix of rural, suburban, and urban populations. Methods: Our Institutional Review Board approved retrospective stroke database, including adult patients discharged to receive rehabilitation services data from 2014-2019, was used for analysis. Cochran-Armitage trend analysis was used to assess for differences type of rehabilitation services used over time and regression analysis was used to identify clinical factors associated with discharge type over time. Results: A total of 3467 patients were included in the analysis, 50% woman, 1% Asian, 20% Black, 75% White, 4% undetermined race, 17% intracerebral hemorrhage, 65% ischemic stroke, 11% subarachnoid hemorrhage, 3% transient ischemic attack, 3% other cerebrovascular disease. In this community population, 65% were discharged to inpatient rehab. Trend analysis demonstrated a significant increase in the proportion of patients being discharged home with rehab services, p<.0001. In comparison to those discharged home, patients discharged to rehab were older (odds ratio (OR) 1.02, confidence interval (CI) 1.02-1.03), with a higher NIHSS (OR 1.16, CI 1.14-1.18), discharged in 2014 (OR 1.72, CI 1.23-2.39) or 2016 (OR 1.46, CI 1.05-2.05) versus 2019. There was no association with race, gender, or discharge in 2015, 2017, or 2018. Discussion: Our findings demonstrate the community impact of recent changes in clinical practice guidelines for stroke. The increasing trend of home discharges is encouraging, but the significant proportion of those still not discharged home suggests there is still more work to be done to reduce stroke associated disability in adults.

scholarly journals POSTFUNDOPLICATION DYSPHAGIA CAUSES SIMILAR WATER INGESTION DYNAMICS AS ACHALASIA

2016 ◽  
Vol 53 (2) ◽  
pp. 98-102 ◽  
Author(s):  
Roberto Oliveira DANTAS ◽  
Carla Manfredi SANTOS ◽  
Rachel Aguiar CASSIANI ◽  
Leda Maria Tavares ALVES ◽  
Weslania Viviane NASCIMENTO
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Chagas Disease ◽  
Water Volume ◽  
Flow Volume ◽  
Water Ingestion ◽  
Idiopathic Achalasia ◽  
One Year ◽  
Over Time

ABSTRACT Background - After surgical treatment of gastroesophageal reflux disease dysphagia is a symptom in the majority of patients, with decrease in intensity over time. However, some patients may have persistent dysphagia. Objective - The objective of this investigation was to evaluate the dynamics of water ingestion in patients with postfundoplication dysphagia compared with patients with dysphagia caused by achalasia, idiopathic or consequent to Chagas' disease, and controls. Methods - Thirty-three patients with postfundoplication dysphagia, assessed more than one year after surgery, together with 50 patients with Chagas' disease, 27 patients with idiopathic achalasia and 88 controls were all evaluated by the water swallow test. They drunk, in triplicate, 50 mL of water without breaks while being precisely timed and the number of swallows counted. Also measured was: (a) inter-swallows interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing flow - volume drunk divided by the time taken; (c) volume of each swallow - volume drunk divided by the number of swallows. Results - Patients with postfundoplication dysphagia, Chagas' disease and idiopathic achalasia took longer to ingest all the volume, had an increased number of swallows, an increase in interval between swallows, a decrease in swallowing flow and a decrease in water volume of each swallow compared with the controls. There was no difference between the three groups of patients. There was no correlation between postfundoplication time and the results. Conclusion - It was concluded that patients with postfundoplication dysphagia have similar water ingestion dynamics as patients with achalasia.

scholarly journals Patient Global Ratings of Change Did Not Adequately Reflect Change Over Time: A Clinical Cohort Study

2014 ◽  
Vol 94 (4) ◽  
pp. 534-542 ◽  
Author(s):  
John S. Schmitt ◽  
J. Haxby Abbott
Keyword(s):  
Clinical Practice ◽  
Physical Therapy ◽  
Computerized Adaptive Testing ◽  
Recall Period ◽  
Regression Analyses ◽  
Change Over Time ◽  
Study Objective ◽  
Global Ratings ◽  
Discharge Status ◽  
Over Time

BackgroundGlobal ratings of change (GROCs) are commonly used in research and clinical practice to determine which patients respond to therapy, but their validity as a criterion for change has not been firmly established. One factor related to their validity is the length of the recall period.ObjectiveThe study objective was to examine the influence of the length of the recall period on the validity of a GROC for determining true change over time in the clinical setting.DesignThis was a longitudinal, single-cohort observational study.MethodsData from the Focus on Therapeutic Outcomes clinical database were collected for 8,955 patients reporting for physical therapy treatment of a knee disorder. Computerized adaptive testing was used to assess knee functional status (FS) at the initial and final (discharge) physical therapy visits. Each patient's GROC was obtained at discharge. Correlation and linear regression analyses of knee FS and GROC, stratified by length of time between intake and discharge, were conducted.ResultsCorrelations of GROC with knee FS change scores were modest even for the shortest period of recall (0–30 days) and were slightly lower for longer recall periods. Regression analyses using knee FS to predict GROC scores revealed similar findings. Correlations of GROC with intake and discharge scores indicated a strong bias toward discharge status, with little or no influence of baseline status. Standardized regression coefficients fitted the pattern expected for a valid measure of change but confirmed the strong bias toward discharge status.LimitationsOne version of the GROC administered serially in a cohort of patients seen in clinical practice was examined.ConclusionsThese results call into question the validity of GROCs for measuring change over time in routine clinical practice.

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