scholarly journals Results of early versus standard silicone stent removal following external dacryocystorhinostomy under local anesthesia

2020 ◽  
Vol 17 (3) ◽  
pp. 263-272
Author(s):  
Ben Limbu ◽  
Benjamin Sim ◽  
Mohan K. Shrestha ◽  
Geoffrey Tabin ◽  
Rohit Saiju
Keyword(s):  
Statistical Difference ◽  
Financial Burden ◽  
Controlled Trial ◽  
Silicone Tube ◽  
Number Of Patients ◽  
Tube Removal ◽  
Silicone Stent ◽  
External Dacryocystorhinostomy ◽  
Lost To Follow Up

Introduction: Many patients in Nepal travel vast distances to have their surgeries in Kathmandu. They often remain close by until their follow-up visit for their silicone tube removal, which contributes to a large financial burden on them and their families. Hence, reducing the time for which silicone tubes remain in situ following external dacryocystorhinostomy (DCR) provides significant benefits to patients. Furthermore, this is the first comparative study which has successfully demonstrated the earliest timeframe for which silicone tubes can be removed following DCR in the medical literature. Methods: A randomized controlled trial consisting of 144 patients was designed to compare patient outcomes after early (2 weeks postoperatively) versus standard (6 weeks postoperatively) removal of silicone stents. The success of their procedures was determined when patients were assessed both symptomatically and anatomically at their 6-month follow-up. Results: The surgical success in both groups was high at 97.8% collectively in both groups and there were only a small number of patients who were lost to follow-up (5 patients) at 6 months. There was no statistical difference at removing silicone stents at 2 or 6 weeks postoperatively. Conclusion: These results were consistent with our pilot study, which showed no statistical difference in long-term success following silicone tube removal at 2 and 6 weeks.

scholarly journals Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

2019 ◽  
Vol 11 (1) ◽  
pp. 24-28
Author(s):  
Ben Limbu ◽  
Hannah S Lyons ◽  
Mohan Krishna Shrestha ◽  
Geoffrey C Tabin ◽  
Rohit Saiju
Keyword(s):  
Success Rate ◽  
Financial Burden ◽  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Complication Rates ◽  
Tube Removal ◽  
Significant Difference ◽  
Silicone Stent ◽  
Group A ◽  
Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

Documenting Patients’ and Providers’ Preferences When Proposing a Randomized Controlled Trial: A Qualitative Exploration

2021 ◽  
Author(s):  
Devesh Oberoi ◽  
Cynthia Kwok ◽  
Yong Li ◽  
Cindy Railton ◽  
Susan Horsman ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Study Design ◽  
Controlled Trial ◽  
Primary Care Providers ◽  
Referral Letter ◽  
Care Providers ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Follow Up Care

Abstract Background With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we sought to explore patients’ and OPs’ reactions to our proposed recruitment methods. Methods We used a qualitative study design with content analysis, and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial. Results OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers. Conclusion OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials.

Manganese and Lipoflavonoid Plus® to Treat Tinnitus: A Randomized Controlled Trial

2016 ◽  
Vol 27 (08) ◽  
pp. 661-668 ◽  
Author(s):  
Eveling Rojas-Roncancio ◽  
Richard Tyler ◽  
Hyung-Jin Jun ◽  
Tang-Chuan Wang ◽  
Haihong Ji ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Data Collection And Analysis ◽  
Loudness Match ◽  
Minimal Masking Level ◽  
Lost To Follow Up ◽  
To Receive

Background: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. Purpose: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus® to treat their tinnitus. Research Design: Randomized controlled trial. Study Sample: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus® for 6 months, or Lipoflavonoid Plus® only (as the control). Data Collection and Analysis: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. Results: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. Conclusions: We were not able to conclude that either manganese or Lipoflavonoid Plus® is an effective treatment for tinnitus.

Why are patients lost to follow-up in a gynecologic oncology clinic?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17571-e17571 ◽  
Author(s):  
V. C. Garcia ◽  
A. M. Manalo ◽  
J. B. Toral ◽  
M. L. Siasu
Keyword(s):  
Educational Attainment ◽  
Marital Status ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Cancer Type ◽  
Monthly Income ◽  
Family Commitment ◽  
Number Of Patients ◽  
Lost To Follow Up

e17571 Background: The aim of this study is to investigate why patients are lost to follow-up in a gynecologic oncology clinic. Methods: Patients who had been lost to follow up previously, and eventually followed up between April and August 2007 were given a consent form and questionnaire to answer. An approximately equal number of patients who were not lost to follow-up were given the same questionnaire as controls. The first part of the questionnaire included the age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation and monthly income. The second part asked directly the reason why they were lost to follow-up. Data were recorded in a computerized database via Microsoft Excel. Descriptive statistics were presented in mean, median, standard deviation, minimum, maximum and frequencies. Differences between patients who failed to follow-up (LF) and their controls (NLF) with respect to demographics, disease and treatment characteristics were assessed by an x2 test or independent t test, depending on the variable. SPSS version 15 was used to perform all analyses. A p < 0.05 was considered significant. Results: There were 50 patients who were not lost and 52 patients who were lost to follow-up. The demographic characteristics between these two groups; i.e., age, marital status, location, diagnosis/type of gynecologic cancer, type of intervention, educational attainment, occupation, and monthly income of patients were all not statistically significant. The most common reason why patients were lost to follow-up was they had no money. Other reasons included: symptoms became better or problems resolved, the follow up was at an inconvenient time and I had family commitment. Conclusions: Patients expressed that the main reason for not following-up was the lack of funds. The majority in these respondents lived below the minimum salary wages. No significant financial relationships to disclose.

scholarly journals Lost to follow up and clinical outcomes of HIV adult patients on antiretroviral therapy in care and treatment centres in Tanga City, north-eastern Tanzania

2012 ◽  
Vol 14 (4) ◽  
Author(s):  
Williams H. Makunde ◽  
Filbert Francis ◽  
Bruno P. Mmbando ◽  
Mathias L. Kamugisha ◽  
Acleus M. Rutta ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Scaling Up ◽  
Regional Hospital ◽  
Crucial Aspect ◽  
Number Of Patients ◽  
North Eastern ◽  
Patient Documentation ◽  
Care And Treatment ◽  
Lost To Follow Up

Scaling up of Antiretroviral (ARV) drugs is crucial and should be a perpetual venture in developing countries in-order to increase the survival period of HIV/AIDS individuals. In Tanzania, information on the rate of patients considered as lost to follow up during treatment with ARVs is scarce. The objective of this study was to determine the rate of lost to follow up and treatment outcome among patients attending two care and treatment clinics (CTCs) in Tanga City in north-eastern Tanzania. A descriptive observational study was carried out on cohorts from Tanga AIDS Working Group and Bombo Regional Hospital. The total number of patients identified as “lost to follow up” were 89 of which 14 (15.7%) died. Among those who died, 3 (21.4%) died between the second week and 3 months after ARV initiation. Of those still alive (84.3%; 75/89), 25% (19/75) were still on ARVs, whereas 47 (62.7%) self transferred to other CTCs. Proper patient documentation with actual residence address is a crucial aspect for adherence. Similarly, frequent prompt tracing of patient should be part of any drug interventional programme linking   facility and communities.

scholarly journals P1010EFFECTS OF SGLT2 INHIBITORS ON DIABETIC NEPHROPATHY: PODOCYTURIA ON FOCUS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Serbay Ozkan ◽  
Halil İbrahim Saygi ◽  
Ozge Polat Korkmaz ◽  
Emre Durcan ◽  
Ahmet Murt ◽  
...  
Keyword(s):  
Diabetic Nephropathy ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Statistical Difference ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Immunocytochemical Staining ◽  
Control Group ◽  
Number Of Patients

Abstract Background and Aims Sodium-glucose co-transporter 2 (SGLT2) inhibitors which are a class of oral anti-diabetic drugs are being used in the treatment of type 2 diabetes (T2D). Basically these drugs reduce blood glucose by blocking glucose reabsorption of primary sodium-coupled glucose transporter in the proximal tubules. Diabetic nephropathy (DN) is a progressive disease with the pathology of glomerular filtration barrier damage and loss of podocytes. In this respect, podocyturia which is the case characterized with presence of podocytes in urine have recently been considered to be a candidate marker for glomerular damage. Therefore, we aimed to investigate effects of SGLT2 inhibitors on glomerulus through the evaluation of podocyturia in DN patients. Method Our study population was composed of two T2D patient groups; one of which received SGLT2 inhibitor (SGLT2 group) and the other one is control which did not received. Patients with T2D for at least 5 years, diagnosed with DN and having microalbuminuria &gt;30 mg/day, glomerular filtration rate (GFR) &gt;60 ml/min and HbA1c&lt; 8.5 were involved. In addition, all patients had received angiotensin converting enzyme inhibitor or angiotension receptor blocker for at least 6 months. Nephrologic parameters of patients were monitored before and 3rd and 6th month of follow up period. Patients’ age, sex, diabetes duration and HbA1c value were obtained from medical charts. GFR was calculated using the abbreviated MDRD formula. Microalbuminuria was measured in 24 hour urine. Number of podocytes in the urine was determined by immunocytochemical staining of two different markers as podocalyxin (podx) and synaptopodin (synp). Statistical analyses were carried out using Statistical Package for the Social Sciences version (SPSS) 24.0 and statistical significance was set as p&lt;0.05. Results We evaluated a total of 29 patients (mean age: 57.59 ± 9.66). The number of patients for SGLT2 and control groups are 18 (mean age: 54.89 ± 7.73) and 11 (mean age: 62.00 ± 11.60) respectively. Between these two groups, there was no statistical difference with respect to durations of diabetes (p=0.875) and HbA1c (p=0.05) values except for age (p=0.023) in which control group is statistically higher than the SGLT receiving group. Among the patients receiving SGLT2 inhibitor, podocyturia and microalbuminuria (mca) levels in the 6th month of follow up period were statistically lower than the initial ones [p=0.039 (synp), p=0.016 (podx) and p=0.011 (mca) respectively] while there was no statistical difference for creatinine clearance rate between the initial and follow up period (p:0.371 and ;p=0.111) (Figure-1). For control group, although podocyturia was significantly reduced in the 6th month of follow up period [p=0.013 (synp) and p:0.005 (podx)], microalbuminuria (p=0.263) in addition to creatinine clearance (p:0.214; p=0.173) did not change significantly (p=0.263). Furthermore, while there was no significant difference for initial microalbuminuria level between the control and SGLT2 groups (p=0.353); in the 3rd and 6th month follow up period, microalbuminuria was significantly lower than the control group accordingly (p=0.011 and p=0.015 respectively). Conclusion According to our preliminary results; patients receiving SGLT2 inhibitors had better microalbuminuria levels than the ones did not and this parameter was correlated with podocyturia. However, even though microalbuminuria of the control group did not change during the follow up period, podocyturia was found out as reduced in the 6th month of follow up period. This discrepancy in the podocyturia level could be resulted from lower number of patients in control so that there is need for evaluation of more patients to emphasize podocyte protective effect of SGLT2 inhibitors.

scholarly journals Conservative treatment versus elective repair of umbilical hernia in patients with liver cirrhosis and ascites: results of a randomized controlled trial (CRUCIAL trial)

2020 ◽  
Author(s):  
B. de Goede ◽  
M. M. J. van Rooijen ◽  
B. J. H. van Kempen ◽  
W. G. Polak ◽  
R. A. de Man ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Liver Cirrhosis ◽  
Conservative Treatment ◽  
Umbilical Hernia ◽  
Controlled Trial ◽  
Number Of Patients ◽  
Umbilical Hernia Repair ◽  
Elective Repair

Abstract Purpose To establish optimal management of patients with an umbilical hernia complicated by liver cirrhosis and ascites. Methods Patients with an umbilical hernia and liver cirrhosis and ascites were randomly assigned to receive either elective repair or conservative treatment. The primary endpoint was overall morbidity related to the umbilical hernia or its treatment after 24 months of follow-up. Secondary endpoints included the severity of these hernia-related complications, quality of life, and cumulative hernia recurrence rate. Results Thirty-four patients were included in the study. Sixteen patients were randomly assigned to elective repair and 18 to conservative treatment. After 24 months, 8 patients (50%) assigned to elective repair compared to 14 patients (77.8%) assigned to conservative treatment had a complication related to the umbilical hernia or its repair. A recurrent hernia was reported in 16.7% of patients who underwent repair. For the secondary endpoint, quality of life through the physical (PCS) and mental component score (MCS) showed no significant differences between groups at 12 months of follow-up (mean difference PCS 11.95, 95% CI − 0.87 to 24.77; MCS 10.04, 95% CI − 2.78 to 22.86). Conclusion This trial could not show a relevant difference in overall morbidity after 24 months of follow-up in favor of elective umbilical hernia repair, because of the limited number of patients included. However, elective repair of umbilical hernia in patients with liver cirrhosis and ascites appears feasible, nudging its implementation into daily practice further, particularly for patients experiencing complaints. Trial registration Clinicaltrials.gov, NCT01421550, on 23 August 2011.

Leap forward in the treatment of Pythium insidiosum keratitis

2018 ◽  
Vol 102 (12) ◽  
pp. 1629-1633 ◽  
Author(s):  
Bhupesh Bagga ◽  
Savitri Sharma ◽  
Sai Jeevan Madhuri Guda ◽  
Ritu Nagpal ◽  
Joveeta Joseph ◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
Disc Diffusion ◽  
Pythium Insidiosum ◽  
Exact Test ◽  
Number Of Patients ◽  
Lost To Follow Up ◽  
Diffusion Assay ◽  
Culture Positive

BackgroundPythium insidiosum is a parafungus that causes keratitis resembling fungal keratitis. This study compares outcome in a large cohort of patients with P insidiosum keratitis treated with antifungal drugs, to a pilot group treated with antibacterial antibiotics.MethodsBetween January 2014 and December 2016, 114 patients with culture positive P insidiosum keratitis were included in the study. A subset of culture isolates was tested in vitro for response to nine antibacterial antibiotics by disc diffusion and E test. Patients were treated with topical natamycin in 2014, 2015 and up until mid 2016. Thereafter, the patients received a combination of topical linezolid and topical and oral azithromycin. Therapeutic penetrating keratoplasty (TPK) was done for patients not responding to medical therapy.ResultsIn vitro disc diffusion assay showed linezolid to be most effective. The rate of TPK was significantly higher in 2015 compared with 2016 (43/45, 95.6% vs 22/32, 68.8%; p=0.002). Eighteen patients were treated with antibacterial and 14 were treated with antifungal antibiotic in 2016. One patient was lost to follow-up in each group. The rate of TPK was higher and proportion of healed ulcers was lower (p=0.21, Fisher’s exact test) in the group on antifungal therapy (TPK—11/13, 84.6%; Healed—2/13, 15.3%) compared with the group on antibacterial therapy (TPK—11/17, 64.7%; Healed—6/17, 35.2%).ConclusionsWe report favourable but not statistically significant response of P insidiosum keratitis to antibacterial agents in a pilot series of patients. Further evaluation of this strategy in larger number of patients is recommended.

scholarly journals Prostate Cancer Burden at the Uganda Cancer Institute

2016 ◽  
Vol 2 (4) ◽  
pp. 181-185 ◽  
Author(s):  
Fred Okuku ◽  
Jackson Orem ◽  
George Holoya ◽  
Chris De Boer ◽  
Cheryl L. Thompson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Stage Iv ◽  
Cord Compression ◽  
Hormonal Manipulation ◽  
Number Of Patients ◽  
Stage Iv Disease ◽  
Metastatic Sites ◽  
Lost To Follow Up

Purpose In Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking. Methods A retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed. Results Our sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up. Conclusion UCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.

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