scholarly journals EPIDURAL ANAESTHESIA

2010 ◽  
Vol 17 (02) ◽  
pp. 318-324
Author(s):  
AZMAT RIAZ ◽  
HAMID SAEED MALIK ◽  
BILAL YASIN
Keyword(s):  
Patient Satisfaction ◽  
Epidural Anaesthesia ◽  
Knee Arthroscopy ◽  
Single Shot ◽  
Care Hospital ◽  
Day Case ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objectives: To compare the benefits and adverse effects of three different drug combinations when used for single-shot epidural anaesthesia for day-case arthroscopy. Design of Study: Prospective, random, double-blind study. Setting: A 250 bedded secondary care hospital. Period: From October 2005 to Feb 2007. Material and Methods: We studied 75 adult male patients, aged between 23 to 63 years, weight <100 kg, ASA physical status I or II undergoing elective knee arthroscopy as day-case procedure. Patients were randomly divided into three groups ( 25 patients in each group) and single-shot epidural anaesthesia was performed using a total of 20 ml epidural lignocaine 2% (Group 1) bupivacaine 0.5% (Group 2) or a mixture containing lignocaine 2% and bupivacaine 0.5%, 10 ml each (Group 3). Results: Time to achieve maximum height (in minutes) was similar in group-1 and group-3 (10±4 and 11±2), but it was significantly longer in group-2 (20±3). Block time was comparable in group-2 and 3 (130±25 and 118±37) but it was significantly shorter in group-1 (60±20). Post-operative discharge time was longest in the group-2, and comparable in group-1 and 3.The incidence of complications like bradycardia, hypotension, nausea and vomiting were more in group-2 and less in group-1 and group-3. Inadequate anaesthesia was more in group-1 and least in other two groups.Four patients of group-1 needed rescue analgesia and two from same group needed general anaesthesia as compared to none in group-2 and group-3. In 4-point patient satisfaction scale, maximum patients from Group-3 rated it perfect while most patients from group-1 were not satisfied with the quality of anaesthesia. Conclusions: The results of our study show that a 50-50 mixture of lignocaine and bupivacaine withfentanyl 50 μg when used for single-shot epidural anaesthesia for day case knee arthroscopy, provides better quality of analgesia, with fewer incidences of side effects and more patient satisfaction as compared to lignocaine or bupivacaine alone.

scholarly journals A Comparison of Dexmedetomidine Sedation With and Without Midazolam for Dental Implant Surgery

2012 ◽  
Vol 59 (2) ◽  
pp. 62-68 ◽  
Author(s):  
Ryo Wakita ◽  
Hikaru Kohase ◽  
Haruhisa Fukayama
Keyword(s):  
Patient Satisfaction ◽  
Amnesic Effect ◽  
Group 4 ◽  
Combined Use ◽  
Group 3 ◽  
Group 2 ◽  
Arousal Response ◽  
Dental Implant Surgery ◽  
Group 1

Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three subjects were randomly divided into 4 groups. In group 1, MDZ (0.02 mg/kg) was administered intravenously, followed by a dose of 0.01 mg/kg every 45 minutes. After the first dose of MDZ, preloading with DEX (2 µg/kg/h for 10 minutes) was started and maintained with a dosage of 0.5 µg/kg/h. In group 2, MDZ was infused in the same manner as in group 1, followed by preloading with DEX (1 µg/kg/h for 10 minutes) and maintenance (0.3 µg/kg/h). In group 3, MDZ was infused 0.03 mg/kg, and a dose of 0.01 mg/kg was given every 30 minutes; DEX was administered at the same as in group 2. In group 4, DEX was infused using the same method as in group 1 without MDZ. The sedation levels, amnesia, and patient satisfaction were also investigated. Group 2 had a lower sedation level and a poor evaluation during the first half of the operation. Group 4 did not exhibit an amnesic effect at the beginning of the operation. An evaluation of the degree of patient satisfaction did not reveal any differences among the groups. Optimal sedation was achieved through the combined use of MDZ (0.02 mg/kg with the addition of 0.01 mg/kg every 45 minutes) and DEX (2 µg/kg/h for 10 minutes followed by 0.5 µg/kg/h).

Analysis of the quality of early diagnostics of cardiovascular diseases in students of educational institutions of Khabarovsk (according to the data of preventive examinations)

2020 ◽  
pp. 13-16
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Sinus Tachycardia ◽  
Blood Pressure Level ◽  
Educational Institutions ◽  
Conduction Disturbances ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

To identify the prevalence of early pathology of cardiovascular diseases, a survey of 400 200 girls) in the age group 15 and 17 years old was conducted as a part of routine medical of the level of blood pressure (BP) was carried out, with the calculation of the average level pressure on the basis of three separate measurements estimated by percentile tables for a registration of a standard resting ECG in 12 leads. According to the results of the survey, into 3 groups: with an increase in blood pressure above 95 ‰ (group 1 – 16 people), which recorded in males (p<0,05); Group 2 (67 people) – adolescents with a normal blood pressure level and group 3 of adolescents with a decrease in blood pressure below 5 ‰ changes in the form of rhythm and conduction disturbances were noted in almost every a predominance of sinus tachycardia in the first group. In the third group of adolescents, form of ectopic rhythm and pacemaker migration were significantly more frequently only 78 % of adolescents were referred for consultation and in-depth examination by a pediatric cardiologist.

scholarly journals Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study)

Pituitary ◽  
2021 ◽  
Author(s):  
Muhammad Fahad Arshad ◽  
Oluwafunto Ogunleye ◽  
Richard Ross ◽  
Miguel Debono
Keyword(s):  
Quality Of Life ◽  
Medical Treatment ◽  
Physical Component Score ◽  
Healthy Controls ◽  
Component Score ◽  
Post Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = − 4.9, 95% CI − 10.9 to 1.2; p = 0.12; mental component score MD = − 3.0, 95% CI − 10.5 to 4.4; p = 0.44], or FSS (MD = − 0.004, 95% CI − 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = − 8.3, 95% CI − 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. Conclusions Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.

Development and Validation of the Questionnaire of Satisfaction with Perioperative Anesthetic Care for General and Regional Anesthesia in Taiwanese Patients

2011 ◽  
Vol 114 (5) ◽  
pp. 1064-1075 ◽  
Author(s):  
Wui-Chiu Mui ◽  
Chia-Ming Chang ◽  
Kong-Fah Cheng ◽  
Tak-Yu Lee ◽  
Kwok-On Ng ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Patient Satisfaction ◽  
Regional Anesthesia ◽  
Anesthetic Care ◽  
Anesthesia Group ◽  
Confounding Variables ◽  
Group 3 ◽  
Group 2 ◽  
Nomological Validity ◽  
Group 1

Background To fulfill the increasing demand of service quality improvement in recent years, it is imperative to develop a proper instrument to evaluate patient satisfaction with perioperative anesthetic care for many institutes in Taiwan. Methods We used a six-factor 32-item pilot questionnaire developed in our previous study as our starting point in this study. Exploratory factor analysis of the pilot questionnaire for factor structure generation was performed in general anesthesia patients (group 1, n = 320) and resulted in the generation of the Patient Satisfaction with Perioperative Anesthetic Care questionnaire (PSPACq). Confirmatory factor analysis of the PSPACq in general anesthesia (group 2, n = 565) and regional anesthesia (group 3, n = 225) patients was performed for validation and cross-validation of the PSPACq model, respectively. The confounding variables and the patient loyalty effects on PSPACq scores were analyzed to evaluate the nomological validity of the PSPACq. Result Exploratory factor analysis of the pilot questionnaire in group 1 resulted in the development of the PSPACq (a seven-factor 30-item model). The standardized coefficients and indexes for the assessment of fit of the PSPACq model in group 2 (validation) and group 3 (cross-validation) patients revealed a well-fitting model. The results of the loyalty scores and confounding variables support the nomological validity of the PSPACq. Conclusions A valid and reliable questionnaire (PSPACq) with Taiwanese culture characteristics was developed and is suitable for testing of patient satisfaction with perioperative anesthesia care for patients receiving general or regional anesthesia for their surgery.

Diagnosis and surgical correction of isthmocele after caesarean section

2021 ◽  
Vol 20 (3) ◽  
pp. 56-62
Author(s):  
N.S. Mikhaelyan ◽  
◽  
D.V. Bryunin ◽  
I.D. Khokhlova ◽  
T.A. Dzhibladze ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Surgical Correction ◽  
Postoperative Rehabilitation ◽  
Double Row ◽  
Anatomical Structures ◽  
Group 3 ◽  
Group 2 ◽  
Uterine Scar ◽  
Group 1

Objective. To compare the efficacy of different methods of surgical correction of isthmocele after caesarean section. Patients and methods. The study included 56 patients aged 29–41 years, who were divided into three groups: group 1 (n = 16) – patients who underwent surgical laparoscopy with suturing the uterine wound with single-row separate muscularmuscular sutures; group 2 (n = 23) – patients after repair of the uterus with a double-row continuous seromuscular and muscular-muscular suture performed by laparoscopy; group 3 (n = 17) consisted of patients who underwent laparotomy and suturing the uterine wound with a double-row continuous suture. Results. We developed a three-stage plastic and reconstructive surgical laparotomic and laparoscopic program in case of the uterine scar incompetence, which improved the quality of life in all patients. Pregnancy occurred 9–14 months after plastic and reconstructive surgery on the uterus and resulted in timely surgical delivery in 4 (25%) patients in group 1, in 7 (30.4%) patients in group 2 and in 3 (17.6%) patients in group 3. Two (12.5%) patients in group 1 and three (13.04%) patients in group 2 were observed during pregnancy with a period of 10–28 weeks. Conclusion. The use of laparoscopy ensured better visualization of anatomical structures (vessels, nerves, ureters, bladder), which led to a decrease in intraoperative blood loss, in the risk of damage to adjacent organs and in the development of adhesions, and to accelerated postoperative rehabilitation of patients. Key words: double-row suture, istmocele, laparoscopy, metroplasty

scholarly journals Quality of Oral Anticoagulation with Vitamin K Antagonists in 'Real-World' Patients: Lessons from a Six Years Audit Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 1159-1159
Author(s):  
Fernanda Leite ◽  
Ângela Leite ◽  
Sara Ferreira ◽  
Jorge Coutinho
Keyword(s):  
Vitamin K ◽  
Therapeutic Range ◽  
Patient Population ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Recall Interval ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Introduction: Among patients receiving vitamin K antagonists (VKA) therapy, maintenance of an international normalized ratio (INR) in the therapeutic range is essential for treatment efficacy and safety. This requires regular monitoring and appropriate dose adjustment. It has been reported that anticoagulation clinics should aim for a time in therapeutic range (TTR) between 70-80% to optimize benefit and minimize the risk of adverse events. Previously (in a study between September 2006 and June 2012), we have reported that patients with longer INR recall interval (4-8 weeks) showed no decrease of monitoring quality and that it would be safe to increase time between measurements. Aim: Since actual recommendations for improving TTR include shortening INR recall interval (Lip et al. 2018) we aimed to evaluate the quality of anticoagulation monitoring after having increased time between measurements beyond the 4-8 weeks recall interval. Methodology: We retrospectively analyzed 37931 appointments of 6 consecutive years (July 2012 to July 2018) corresponding to 1587 patients that are regularly followed up at an outpatient Anticoagulation Clinic of a central hospital under anticoagulation for at least 8 weeks, using TTR determined by Rosendaal method. Patients were divided according to target INR in three groups: Group 1 with target INR 2-3, including 1430 patients corresponding to 30743 appointments with mean age 69±15 years (mean±SD), majority (46.4%) with atrial fibrillation (AF); Group 2 with target INR 2.5-3.5, including 125 patients corresponding to 5439 appointments with mean age 67±12 years, majority (85.6%) with mechanical heart valves; Group 3 with target INR 3-4, including 32 patients corresponding to 1749 appointments with mean age 62±14 years, majority (62.5%) with antiphospholipid syndrome. Descriptive statistics (mean, standard deviation, minimum, maximum, chi-square), inferential statistics (t-test, A-Nova and effect sizes) tests and correlations were performed. Results: The 1587 patient population, 50.5% male, mean age of 68±17 years and 90.1% in Group 1, showed a mortality of 18%. A point-biserial correlation was run to determine the relationship between mortality and gender, age, INR group and diagnostic. Mortality was correlated with diagnosis (57.2% with AF) (rpb = -.071, n = 1587, p = .004), male gender (60%) (rpb = -.089, n = 1587, p <.001) and age (75±12) (rpb = .175, n= 1587, p<.001) but not with INR group (rpb = -.017, n = 1587, p = .499). Indeed, between groups mortality was not different [Χ2(2)=.492; p=.782; φ=.018] nor mean age [F(2, 1584)=2.588; p=.078; η2=.003], but gender distribution was unequal [Χ2(2)= 10.815; p=.004; φ=.083] with male predominating in Group 1 (51.9%) and female in Group 2 (60.8%) and 3 (65.6%). Patients in Group 1, corresponding to 90.1% of the total population, had TTR of 72%, patients in Group 2 had TTR of 69% and patients in Group 3 had TTR of 60%. Comparatively to the previous study (2006-2012), we noticed a significant decrease in patient population / appointments size (2087/ 61988) (p <.001) with a decrease of TTR in Group 1 (1927 patients) (83%) and Group 2 (120 patients) (74%) but a TTR increase in Group 3 (40 patients) (54%) (p <.001). Conclusions and Discussion: More than 90% of the population under VKA treatment showed effective TTR which may infer safety in increasing INR recall interval. The TTR decrease with a smaller population may be explained by the introduction of direct oral anticoagulants in patients with less comorbidities. The increase of TTR in patients with higher INR target suggests a better management of patients under VKA therapy that is actually the only choice for challenging patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Single sitting multimodality management of hemorrhoid

2021 ◽  
Vol 8 (11) ◽  
pp. 3302
Author(s):  
Mahendra P. Singh
Keyword(s):  
Variable Number ◽  
Concomitant Treatment ◽  
Stage Management ◽  
Group 4 ◽  
Number Of Patients ◽  
Clinical Complexity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: It is usual to face clinical complexity in piles patients. They usually present with variable number of pile masses and in different grades of progression. This led to the idea of offering concomitant single stage management in our hemorrhoid patients matching to our criteria. We conducted hospital based descriptive study among the patients coming to my clinical practice falling in grade-1-3.Methods: All the patients falling in grade-1-3 and matching to our criteria were included. The study was conducted   from January 2012 to December 2020. Place of study was basically at two centres: Karamdeep medical centre, Kanpur and Mayo health care, Mohali. Total number of patients were 581. Patients having grade-4 piles and with local co-morbidities were excluded from the study. Modalities of treatment used were sclerotherapy, band ligation and hemorrhoidectomy.Results: Patients managed were divided into four groups – group 1 included patients with piles in grade-1; group-2 included patients having piles in grade-1 and 2; group-3 included patients having piles in grade-1 and 3; and group-4 included patients having piles in grade-1, 2 and 3. Total 952 pile masses were treated in 581 patients. Sclerotherapy was required in 732 (77%) masses, banding in 99 (10.3%) masses and surgery in 122 (12.7%) masses.Conclusions: Concomitant treatment policy proved to be comprehensive way to tackle pile patients of grade-1-3. Mixed and matched method using surgical and non-surgical modalities in a single sitting proved to be beneficial. 86.4% cases were cured this way. Cost of the treatment was economical with lesser complications including local mutilation and better quality of life.

Patient-reported outcomes for determining prognostic groups in veterans with stage IV solid tumors starting systemic therapy.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 48-48
Author(s):  
Victor Tsu-Shih Chang ◽  
Charles B. Scott ◽  
Melanie L. Gonzalez ◽  
Jan Einhorn ◽  
Houling Yan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Solid Tumors ◽  
Systemic Therapy ◽  
Stage Iv ◽  
Group 4 ◽  
Prognostic Groups ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

48 Background: A Recursive Partitioning Analysis (RPA) prognostic algorithm based on quality of life and symptoms predicted 4 groups with distinct median survivals in patients with metastatic solid tumors receiving chemotherapy (ASCO 2013, Abst 9567). We update our findings. Methods: The RPA algorithm is based upon Karnofsky performance status (KPS), Functional Assessment of Cancer Therapy (FACT) physical well-being (PWB) subscale, and Memorial Symptom Assessment Scale Short Form (MSAS-SF) physical symptom distress (PHYS) subscale. Starting in 2007, a convenience sample of Veterans who were prescribed systemic treatment for their cancer was enrolled in an IRB approved protocol, and completed quality of life (FACT- G) and symptom (MSAS SF) questionnaires at the first cycle of treatment. We analyzed records of patients with stage IV metastatic solid tumors enrolled through June 2013, and determined survival as of June 15, 2014. Analyses were performed with STATA 11.0. Results: There were 97 patients(pts). The median age was 64 yrs, range 27-88. Males comprised 95 (98%) pts. First line chemotherapy was given to 78 (80%) pts. The most common primary sites were lung cancer 33 (35%), prostate 17 (17%) and colon 11 (11%) pts. Median KPS was 90% range 40-100%, PWB median 23 (range 6-28), and MSAS SF median PHYS 0.76 (range 0-3.2). Overall median survival was 285 days (range 6-2,358) and 80 pts (82%) had died. There was 1 pt in group 1, 58 in group 2, 12 in group 3, and 23 in group 4. The patient in group 1 had uterine sarcoma. Median survival (days) by RPA group was 155 for group 1, 177 for group 2, 292 for group 3, and 674 for group 4 (p=.011). Conclusions: These preliminary findings suggest that this algorithm is capable of dividing patients with metastatic solid tumor who are starting systemic therapy into prognostic groups. Further development is indicated.

scholarly journals A new classification of foods based on the extent and purpose of their processing

2010 ◽  
Vol 26 (11) ◽  
pp. 2039-2049 ◽  
Author(s):  
Carlos Augusto Monteiro ◽  
Renata Bertazzi Levy ◽  
Rafael Moreira Claro ◽  
Inês Rugani Ribeiro de Castro ◽  
Geoffrey Cannon
Keyword(s):  
Processed Food ◽  
Industrial Processing ◽  
Daily Food ◽  
Group 3 ◽  
Group 2 ◽  
Probabilistic Sample ◽  
The Impact ◽  
Group 1

This paper describes a new food classification which assigns foodstuffs according to the extent and purpose of the industrial processing applied to them. Three main groups are defined: unprocessed or minimally processed foods (group 1), processed culinary and food industry ingredients (group 2), and ultra-processed food products (group 3). The use of this classification is illustrated by applying it to data collected in the Brazilian Household Budget Survey which was conducted in 2002/2003 through a probabilistic sample of 48,470 Brazilian households. The average daily food availability was 1,792 kcal/person being 42.5% from group 1 (mostly rice and beans and meat and milk), 37.5% from group 2 (mostly vegetable oils, sugar, and flours), and 20% from group 3 (mostly breads, biscuits, sweets, soft drinks, and sausages). The share of group 3 foods increased with income, and represented almost one third of all calories in higher income households. The impact of the replacement of group 1 foods and group 2 ingredients by group 3 products on the overall quality of the diet, eating patterns and health is discussed.

scholarly journals Increased serum interleukin-9 and interleukin-1β are associated with depression in type 2 diabetes patients

2020 ◽  
Vol 78 (5) ◽  
pp. 255-261 ◽  
Author(s):  
Prabhat VARSHNEY ◽  
Rizwana PARVEEN ◽  
Mohd Ashif KHAN ◽  
Sunil KOHLI ◽  
Nidhi B. AGARWAL
Keyword(s):  
Quality Of Life ◽  
Positive Association ◽  
Diabetic Patients ◽  
Serum Samples ◽  
Type 2 Diabetic Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

ABSTRACT Background: Co-morbid diabetes and depression are prevalent chronic conditions negatively affecting quality of life (QoL). Inflammation has been considered as an integral mechanism in patients with both diabetes and depression. Objective: The aim of the present study was to investigate depression and its association with interleukins (IL)-1β and IL-9 in type 2 diabetic patients (T2DM) and controls. The QoL in diabetic patient was also assessed. Methods: Eighty subjects were included, distributed among three groups: Group 1 - Healthy controls; Group 2 - T2DM patients without depression; Group 3 - T2DM patients with depression. Depression and QoL were assessed using Patient Health Questionnaire (PHQ-9) and The Audit of Diabetes-Dependent QoL (ADDQoL), respectively. IL-1β and IL-9 were measured in serum samples of all the patients using ELISA kit. Results: The PHQ score in the Group 3 was significantly higher as compared to Group 1. The ADDQoL scores in the Group 3 were significantly higher as compared to Group 2. Levels of IL-9 and IL-1β were elevated in Group 3, as compared to the other groups. Conclusion: This study showed positive association between depression and IL-1β, IL-9 in T2DM patients. Additionally, the diabetic patients have poorer quality of life, which is further worsened by the presence of depression. Thus, routine assessment for the presence of depression is suggested in T2DM patients.

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