Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 9: Effect of ventricular catheter entry point and position

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 72-76 ◽  
Author(s):  
Joanna Kemp ◽  
Ann Marie Flannery ◽  
Mandeep S. Tamber ◽  
Ann-Christine Duhaime
Keyword(s):  
Full Text ◽  
Entry Point ◽  
Ventricular Catheter ◽  
Class Iii ◽  
Entry Site ◽  
Csf Shunts ◽  
Pediatric Hydrocephalus ◽  
Entry Points ◽  
Shunt Survival ◽  
The Impact

Object The objective of this guideline was to answer the following question: Do the entry point and position of the ventricular catheter have an effect on shunt function and survival? Methods Both the US National Library of Medicine/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been delineated a priori were then examined, and data were abstracted and compiled in evidentiary tables. Results The search yielded 184 abstracts, which were screened for potential relevance to the clinical question of the effect of ventricular catheter entry site on shunt survival. An initial review of the abstracts identified 14 papers that met the inclusion criteria, and these were recalled for full-text review. After review of these articles, only 4 were noted to be relevant for an analysis of the impact of entry point on shunt survival; an additional paper was retrieved during the review of full-text articles and was included as evidence to support the recommendation. The evidence included 1 Class II paper and 4 Class III papers. An evidentiary table was created including the relevant articles. Conclusion Recommendation: There is insufficient evidence to recommend the occipital versus frontal point of entry for the ventricular catheter; therefore, both entry points are options for the treatment of pediatric hydrocephalus. Strength of Recommendation: Level III, unclear degree of clinical certainty.

scholarly journals Iodine content of salt 2 years after the introduction of the universal salt iodisation legislation in Lesotho

2005 ◽  
Vol 93 (6) ◽  
pp. 917-922
Author(s):  
Masekonyela Linono Damane Sebotsa ◽  
Andre Dannhauser ◽  
Pieter L. Jooste ◽  
Gina Joubert
Keyword(s):  
Iodine Content ◽  
Entry Point ◽  
Iodised Salt ◽  
Ecological Zones ◽  
Household Level ◽  
Entry Level ◽  
Entry Points ◽  
Almost All ◽  
The Impact ◽  
Point Level

The aim of the present study was to assess the impact of the universal salt iodisation legislation on I levels of salt at household, retail and entry level in Lesotho. We used a multistage proportion to population size method to select thirty-one clusters from all the districts and ecological zones of Lesotho. In each cluster, thirty households were randomly selected and salt samples were collected. Six salt samples from two randomly selected retailers in each cluster, and a total of 107 salt samples from all the commercial entry points in the country were also collected. Lesotho does not produce salt and it imports almost all its salt from South Africa. The salt samples were analysed using the iodometric titration method. The median I concentration of salt was 36.2 ppm at entry point, 37·3 ppm at retail level and 38·5 ppm at household level. At household level only 1·6 % used non-iodised salt and 86·9 % used adequately iodised salt. Of all salt collected at household level, 20·4 % was coarse salt, which was significantly less well iodised than fine salt. The study demonstrates a major achievement in the availability of iodised salt as well as household use of adequately iodised salt. Under-iodisation of coarse salt and non-uniformity of salt iodisation at the production site were observed. Therefore, there is a need for enforcement of the salt iodisation legislation especially at entry-point level to ensure that only iodised salt enters the country. During enforcement more emphasis should be given to iodisation of coarse salt.

scholarly journals Standardization of cerebrospinal fluid shunt valves in pediatric hydrocephalus: an analysis of cost, operative time, length of stay, and shunt failure

2021 ◽  
pp. 1-6
Author(s):  
Jessica Berns ◽  
Blake Priddy ◽  
Ahmed Belal ◽  
R. Dianne Seibold ◽  
Kristin Zieles ◽  
...  
Keyword(s):  
Operative Time ◽  
Cost Effective ◽  
Shunt Failure ◽  
Csf Shunts ◽  
Shunt Valve ◽  
Distal Catheter ◽  
Pediatric Hydrocephalus ◽  
Programmable Valve ◽  
Surgical Cost ◽  
The Impact

OBJECTIVECSF shunts are the most common procedures performed in the pediatric neurosurgical population. Despite attempts in multiple studies, a superior shunt valve has never been shown. Because of this, the authors aim was to examine the impact of shunt valve standardization at their institution to determine if there is a difference in surgical cost, operative time, or short-term postoperative shunt failure.METHODSA retrospective analysis at the authors’ institution was performed for all new CSF diversion shunts, as well as shunt revisions requiring a new valve, or a new valve and at least a new proximal or distal catheter over a 1-year period (January 1, 2016, to December 31, 2016). After a period of transition, neurosurgeons were encouraged to use only one type of fixed-differential-pressure valve and one type of programmable valve when performing shunt surgeries. These patients who underwent “standardized” shunt surgery over a 1-year period (January 1, 2018, to December 31, 2018) were then compared to patients in the prestandardization epoch. All patients were followed for a 12-month period after surgery. Demographic information, surgical cost, operative time, and postoperative shunt failure data were collected in all patients in the study.RESULTSThe authors analyzed 87 shunt surgeries in patients prior to standardization and 94 shunt surgeries in patients after standardization. The rate of violation of the standardized shunt valve policy after implementation was 5.3% (5 of 94 procedures). When comparing the prestandardization group to those who received the standardized valve, operative costs were less ($1821.04 vs $1333.75, p = 0.0034). There was no difference in operative times between groups (78 minutes vs 81 minutes, p = 0.5501). There was no difference in total number of shunt failures between the two groups at 12 months after surgery (p = 0.0859). The rate of postoperative infection was consistent with the literature at 8%.CONCLUSIONSIn accordance with quality improvement principles, the reduction of unexplained clinical variance invariably leads to a decrease in cost and, more importantly, increased value. In this study, the implementation of a standardized shunt valve decreased operative cost. There were no differences in postoperative shunt failures at 12 months after surgery and no differences in length of surgery. Standardizing shunt valves in the treatment of pediatric hydrocephalus seems to be cost-effective and safe.

A Computed Tomography-Based Localizer to Determine the Entry Site of the Ventricular End of a Parietal Ventriculoperitoneal Shunt

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons162-ons167
Author(s):  
Hrishikesh Sarkar ◽  
Sumit Thakar ◽  
Samson Sujith Kumar ◽  
Ranjith K. Moorthy ◽  
Vedantam Rajshekhar
Keyword(s):  
Computed Tomography ◽  
Ventriculoperitoneal Shunt ◽  
Entry Point ◽  
Burr Hole ◽  
Reference Plane ◽  
Ventricular Catheter ◽  
Entry Site ◽  
Independent Observer ◽  
Group A ◽  
Group B

Abstract BACKGROUND: One of the major principles of shunt insertion into the brain involves choosing an entry site that avoids eloquent cortex. OBJECTIVE: We describe a novel tool to accurately locate the burr hole for insertion of the ventricular end of a catheter during parietal ventriculoperitoneal shunt surgery. METHODS: Computed tomography (CT)-based measurements in 2 dimensions were used to mark the entry point with the help of an indigenously designed Vellore burr hole localizer (VL). Patients underwent surgery with either the conventional method to localize the burr hole (Keen point; group A; n = 28) or the VL (group B; n = 28). An independent observer determined the accuracy of shunt placement on postoperative CT scans. The VL is designed with a fixed horizontal arm that can be aligned with the CT or magnetic resonance reference plane and a vertical arm with a flexible sliding horizontal arm that is attached to it with an adjustable screw. By manipulating the flexible arm along the contour of the skull and using the scale provided on both the vertical and horizontal arms, we can mark the burr hole site for placement of a parietal ventriculoperitoneal shunt. RESULTS: Overall accuracy in group A was 32.1%, whereas in group B, an accuracy of 82.1% could be achieved (P < .01). CONCLUSION: Placement of a burr hole guided by the VL increases the accuracy of the desired entry point of the ventricular catheter.

scholarly journals Ventricular catheter entry site and not catheter tip location predicts shunt survival: a secondary analysis of 3 large pediatric hydrocephalus studies

2017 ◽  
Vol 19 (2) ◽  
pp. 157-167 ◽  
Author(s):  
William E. Whitehead ◽  
Jay Riva-Cambrin ◽  
Abhaya V. Kulkarni ◽  
John C. Wellons ◽  
Curtis J. Rozzelle ◽  
...  
Keyword(s):  
Clinical Research ◽  
Interobserver Agreement ◽  
Catheter Placement ◽  
Survival Advantage ◽  
Research Network ◽  
Ventricular Catheter ◽  
Shunt Failure ◽  
Entry Site ◽  
Catheter Tip ◽  
Shunt Survival

OBJECTIVE Accurate placement of ventricular catheters may result in prolonged shunt survival, but the best target for the hole-bearing segment of the catheter has not been rigorously defined. The goal of the study was to define a target within the ventricle with the lowest risk of shunt failure. METHODS Five catheter placement variables (ventricular catheter tip location, ventricular catheter tip environment, relationship to choroid plexus, catheter tip holes within ventricle, and crosses midline) were defined, assessed for interobserver agreement, and evaluated for their effect on shunt survival in univariate and multivariate analyses. De-identified subjects from the Shunt Design Trial, the Endoscopic Shunt Insertion Trial, and a Hydrocephalus Clinical Research Network study on ultrasound-guided catheter placement were combined (n = 858 subjects, all first-time shunt insertions, all patients < 18 years old). The first postoperative brain imaging study was used to determine ventricular catheter placement for each of the catheter placement variables. RESULTS Ventricular catheter tip location, environment, catheter tip holes within the ventricle, and crosses midline all achieved sufficient interobserver agreement (κ > 0.60). In the univariate survival analysis, however, only ventricular catheter tip location was useful in distinguishing a target within the ventricle with a survival advantage (frontal horn; log-rank, p = 0.0015). None of the other catheter placement variables yielded a significant survival advantage unless they were compared with catheter tips completely not in the ventricle. Cox regression analysis was performed, examining ventricular catheter tip location with age, etiology, surgeon, decade of surgery, and catheter entry site (anterior vs posterior). Only age (p < 0.001) and entry site (p = 0.005) were associated with shunt survival; ventricular catheter tip location was not (p = 0.37). Anterior entry site lowered the risk of shunt failure compared with posterior entry site by approximately one-third (HR 0.65, 95% CI 0.51–0.83). CONCLUSIONS This analysis failed to identify an ideal target within the ventricle for the ventricular catheter tip. Unexpectedly, the choice of an anterior versus posterior catheter entry site was more important in determining shunt survival than the location of the ventricular catheter tip within the ventricle. Entry site may represent a modifiable risk factor for shunt failure, but, due to inherent limitations in study design and previous clinical research on entry site, a randomized controlled trial is necessary before treatment recommendations can be made.

scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 4: Cerebrospinal fluid shunt or endoscopic third ventriculostomy for the treatment of hydrocephalus in children

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 30-34 ◽  
Author(s):  
David D. Limbrick ◽  
Lissa C. Baird ◽  
Paul Klimo ◽  
Jay Riva-Cambrin ◽  
Ann Marie Flannery
Keyword(s):  
Systematic Review ◽  
Cerebrospinal Fluid ◽  
Endoscopic Third Ventriculostomy ◽  
Task Force ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Class Iii ◽  
Csf Shunts ◽  
Pediatric Hydrocephalus ◽  
Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature comparing CSF shunts and endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus and to make evidence-based recommendations regarding the selection of surgical technique for this condition. Methods Both the US National Library of Medicine and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words specifically chosen to identify published articles detailing the use of CSF shunts and ETV for the treatment of pediatric hydrocephalus. Articles meeting specific criteria that had been determined a priori were examined, and data were abstracted and compiled in evidentiary tables. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider treatment recommendations based on the evidence. Results Of the 122 articles identified using optimized search parameters, 52 were recalled for full-text review. One additional article, originally not retrieved in the search, was also reviewed. Fourteen articles met all study criteria and contained comparative data on CSF shunts and ETV. In total, 6 articles (1 Class II and 5 Class III) were accepted for inclusion in the evidentiary table; 8 articles were excluded for various reasons. The tabulated evidence supported the evaluation of CSF shunts versus ETV. Conclusions Cerebrospinal fluid shunts and ETV demonstrated equivalent outcomes in the clinical etiologies studied. Recommendation: Both CSF shunts and ETV are options in the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate clinical certainty.

Working at the Crossroads: A Guide for Border Crossing

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
John Mckiernan-González
Keyword(s):  
American Studies ◽  
Collaborative Work ◽  
Border Crossing ◽  
Keynote Address ◽  
Cross Border ◽  
Entry Points ◽  
Academic Labor ◽  
Boyle Heights ◽  
The University ◽  
The Impact

This article discusses the impact of George J. Sánchez’s keynote address “Working at the Crossroads” in making collaborative cross-border projects more academically legitimate in American studies and associated disciplines. The keynote and his ongoing administrative labor model the power of public collaborative work to shift research narratives. “Working at the Crossroads” demonstrated how historians can be involved—as historians—in a variety of social movements, and pointed to the ways these interactions can, and maybe should, shape research trajectories. It provided a key blueprint and key examples for doing historically informed Latina/o studies scholarship with people working outside the university. Judging by the success of Sánchez’s work with Boyle Heights and East LA, projects need to establish multiple entry points, reward participants at all levels, and connect people across generations.I then discuss how I sought to emulate George Sánchez’s proposals in my own work through partnering with labor organizations, developing biographical public art projects with students, and archiving social and cultural histories. His keynote address made a back-and-forth movement between home communities and academic labor seem easy and professionally rewarding as well as politically necessary, especially in public universities. 

A Predictive Model of the Impact of the Skidding System on Forest Soil in Severe Climatic Conditions

2020 ◽  
pp. 131-144
Author(s):  
S.E. Rudov ◽  
◽  
V.Ya. Shapiro ◽  
O.I. Grigoreva ◽  
I.V. Grigorev ◽  
...  
Keyword(s):  
Forest Soil ◽  
Warm Season ◽  
Climatic Conditions ◽  
Soil Freezing ◽  
Class Iii ◽  
Freezing And Thawing ◽  
Metal Structures ◽  
Rapid Adjustment ◽  
Soil Freezing And Thawing ◽  
The Impact

In the Russian Federation logging operations are traditionally carried out in winter. This is due to the predominance of areas with swamped and water-logged (class III and IV) soils in the forest fund, where work of forestry equipment is difficult, and sometimes impossible in the warm season. The work of logging companies in the forests of the cryolithozone, characterized by a sharply continental climate, with severe frosts in winter, is hampered by the fact that forest machines are not recommended to operate at temperatures below –40 °C due to the high probability of breaking of metal structures and hydraulic system. At the same time, in the warm season, most of the cutting areas on cryosolic soils become difficult to pass for heavy forest machines. It turns out that the convenient period for logging in the forests of the cryolithozone is quite small. This results in the need of work in the so-called off-season period, when the air temperature becomes positive, and the thawing processes of the soil top layer begin. The same applies to the logging companies not operating in the conditions of cryosolic soils, for instance, in the Leningrad, Novgorod, Pskov, Vologda regions, etc. The observed climate warming has led to a significant reduction in the sustained period of winter logging. Frequent temperature transitions around 0 °C in winter, autumn and spring necessitate to work during the off-season too, while cutting areas thaw. In bad seasonal and climatic conditions, which primarily include off-season periods in general and permafrost in particular, it is very difficult to take into account in mathematical models features of soil freezing and thawing and their effect on the destruction nature. The article shows that the development of long-term predictive models of indicators of cyclic interaction between the skidding system and forest soil in adverse climatic conditions of off-season logging operations in order to improve their reliability requires rapid adjustment of the calculated parameters based on the actual experimental data at a given step of the cycles.

Ultrasound-Guided Insertion of the Ventricular Catheter in Ventriculoperitoneal Shunt Surgery: Evaluation of Accuracy and Feasibility in a Prospective Cohort

2020 ◽  
Vol 82 (01) ◽  
pp. 009-017
Author(s):  
Severina Leu ◽  
Maria Kamenova ◽  
Luigi Mariani ◽  
Jehuda Soleman
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Perioperative Complications ◽  
Univariate Analysis ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
The Us ◽  
Evans Index ◽  
Shunt Survival

Abstract Objective Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures. The position of the proximal catheter is important for shunt survival. Shunt placement is done either without image guidance (“freehand”) according to anatomical landmarks or by use of various image-guided techniques. Studies evaluating ultrasound-guided (US-G) VPS placement are sparse. We evaluate the accuracy and feasibility of US-G VPS placement, and compare it to freehand VPS placement. Methods We prospectively collected data of consecutive patients undergoing US-G VPS placement. Thereafter, the US cohort was compared with a cohort of patients in whom VPS was inserted using the freehand technique (freehand cohort). Primary outcome was accuracy of catheter positioning, and secondary outcomes were postoperative improvement in Evans' index (EI), rates of shunt dysfunction and revision surgery, perioperative complications, as well as operation, and anesthesia times. Results We included 15 patients undergoing US-G VPS insertion. Rates of optimally placed shunts were higher in the US cohort (67 vs. 49%, p = 0.28), whereas there were no malpositioned VPS (0%) in the US cohort, compared with 10 (5.8%) in the freehand cohort (p = 0.422). None of the factors in the univariate analysis showed significant association with nonoptimal (NOC) VPS placement in the US cohort. The mean EI improvement was significantly better in the US cohort than in the freehand cohort (0.043 vs. 0.014, p = 0.035). Conclusion Based on our preliminary results, US-G VPS placement seems to be feasible, safe, and increases the rate of optimally placed catheters.

Rubber specialization vs crop diversification: the roles of perceived risks

2017 ◽  
Vol 9 (2) ◽  
pp. 188-210 ◽  
Author(s):  
Shi Min ◽  
Jikun Huang ◽  
Hermann Waibel
Keyword(s):  
Land Use ◽  
Land Tenure ◽  
Risk Perceptions ◽  
Household Wealth ◽  
Environmental Conservation ◽  
Crop Diversification ◽  
Cross Sectional Survey ◽  
Content Type ◽  
Entry Points ◽  
The Impact

Purpose The purpose of this paper is to examine the impact of farmers’ risk perceptions regarding rubber farming on their land use choices, including rubber specialization and crop diversification. Design/methodology/approach A cross-sectional survey data of some 600 smallholder rubber farmers in Xishuangbanna in Southwest China is employed. This paper develops a general conceptual framework that incorporates a subjective risk item into a model of farmers’ land use choices, thereby developing four econometric models to estimate the role of risk perceptions, and applies instrumental variables to control for the endogeneity of risk perceptions. Findings The results demonstrate that risk perceptions play an important role in smallholders’ decision-making regarding land use strategies to address potential risks in rubber farming. Smallholders with higher risk perceptions specialize in rubber farming less often and are more likely to diversify their land use, thereby contributing to local environmental conservation in terms of agrobiodiversity. The land use choices of smallholder rubber farmers are also associated with ethnicity, household wealth, off-farm employment, land tenure status, altitude and rubber farming experience. Originality/value This study contributes to a better understanding of the implications of farmers’ risk perceptions and shows entry points for improving the sustainability of rubber-based land use systems.

scholarly journals The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Miguel A. L. Nicolelis ◽  
Rafael L. G. Raimundo ◽  
Pedro S. Peixoto ◽  
Cecilia S. Andreazzi
Keyword(s):  
Mathematical Modeling ◽  
Intensive Care ◽  
Road Traffic ◽  
Geographic Spread ◽  
Boomerang Effect ◽  
Entry Points ◽  
Entire Country ◽  
Major Factors ◽  
The Impact ◽  
Care Availability

AbstractAlthough international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the “super-spreading city” of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98–99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2’s case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country’s intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a “boomerang effect” that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower.

Sign in / Sign up

Export Citation Format

Share Document