Patient-Telemonitoring After Revascularization Procedures in the Lower Extremities

2022 ◽  
pp. 207-219
Author(s):  
Roman Gumzej ◽  
Lidija Fošnarič
Keyword(s):  
Medical Equipment ◽  
Clinical Pathways ◽  
Waiting Times ◽  
Lower Extremities ◽  
Security Issues ◽  
Multidisciplinary Cooperation ◽  
Authentication And Authorization ◽  
Specialist Treatment ◽  
Revascularization Procedures

Multidisciplinary cooperation of participating healthcare professionals, use of common standards in diagnostics, and clinical pathways in the treatment of vascular patients should provide for a higher-quality clinical practice. Using telemedicine, a more efficient way of obtaining specialist treatment is achievable. However, its introduction may raise safety and security issues, which originate from its enabling information technology. In this chapter, a model of patient-telemonitoring after revascularization procedures in the lower extremities is presented. A protocol for proper authentication and authorization to access medical equipment and patient medical records has been introduced. The associated clinical study has shown that most post-operative follow-up examinations can successfully be performed by trained nurses. Hence, improvements to healthcare logistics, mainly due to shortening waiting times for specialist treatment and the reduction of follow-up examinations on the secondary healthcare level, can be achieved using telemedicine.

scholarly journals Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience

2021 ◽  
pp. 219256822098827
Author(s):  
Giorgio Lofrese ◽  
Alba Scerrati ◽  
Massimo Balsano ◽  
Roberto Bassani ◽  
Michele Cappuccio ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Waiting Times ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Surgical Strategies ◽  
Bone Removal ◽  
Mild Dysphagia

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( P = 0.12) to the burr ( P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( P = 0.15). Use of curved chisel reduced the surgical times ( P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( P = 0.04) and shorter waiting times for surgery ( P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

scholarly journals A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

2016 ◽  
Vol 7 ◽  
pp. JCM.S39766 ◽  
Author(s):  
Noriko Satoh-Asahara ◽  
Hiroto Ito ◽  
Tomoyuki Akashi ◽  
Hajime Yamakage ◽  
Kazuhiko Kotani ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Diabetes Care ◽  
Clinical Pathways ◽  
Coping Resources ◽  
Care Providers ◽  
Depression Care ◽  
Patients With Diabetes ◽  
And Coping ◽  
Levels Of Integration

Purpose Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. Method We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. Results Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. Conclusion A new PHR may be suitable for comorbid patients with diabetes and depression.

scholarly journals Mid-term follow-up of 183 arterial myocardial revascularization procedures

1997 ◽  
Vol 11 (1) ◽  
pp. 140-148 ◽  
Author(s):  
Carlo Antona ◽  
Marco Zanobini ◽  
Attilio A Lotto ◽  
Alessandro Parolari ◽  
Francesco Alamanni ◽  
...  
Keyword(s):  
Myocardial Revascularization ◽  
Revascularization Procedures

RENAL AMYLOIDOSIS RESULTING FROM A CHRONICALLY INFECTED BURN

PEDIATRICS ◽  
1963 ◽  
Vol 32 (5) ◽  
pp. 888-894
Author(s):  
Saul Hoffman ◽  
Bernard E. Simon ◽  
Robert A. Fischel ◽  
Donald Gribetz
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Clinical Improvement ◽  
Short Duration ◽  
Unusual Case ◽  
White Male ◽  
Lower Extremities ◽  
Renal Amyloidosis ◽  
One Year

An interesting and unusual case of an 11-year-old white male with chronically infected burns of his lower extremities who developed amyloidosis and the nephrotic syndrome is reported. The case is considered from the following aspects: (1) the rarity of amyloidosis in burns, (2) the short duration between the onset of the primary disease and the amyloidosis, (3) the age of the patient, and (4) the striking clinical improvement of the renal manifestations after the treatment of the burn. The treatment of the burns, using homografts, and the importance of renal biopsy in the diagnosis and follow-up are also discussed. Addendum: A third renal biopsy was performed in August, 1963, about one year following the second one. The amount of amyloid seen in the glomeruli did not seem to have diminished.

scholarly journals Reasons patients leave their nearest healthcare service to attend Karen Park Clinic, Pretoria North

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Agnes T. Masango- Makgobela ◽  
Indiran Govender ◽  
John V. Ndimande
Keyword(s):  
Healthcare Provider ◽  
Waiting Time ◽  
Healthcare Service ◽  
Waiting Times ◽  
Healthcare Providers ◽  
Descriptive Study ◽  
Staff Attitudes ◽  
Quality Service ◽  
Cross Sectional

Background: Many patients move from one healthcare provider or facility to another, disturbing the continuity that enhances holistic patient care.Objectives: To investigate the reasons given by patients for attending Karen Park Clinic rather than the clinic nearest to their homes.Methods: A cross-sectional descriptive study was conducted during 2010. Three hundred and fifty patients attending Karen Park Clinic were given questionnaires to complete, with the following variables: place of residence; previous attendance at the clinic nearest their home; services available at their nearest clinic; and their willingness to attend their nearest clinic in future.Results: Respondents were from Soshanguve (153; 43.7%), Mabopane (92; 26.3%), Garankuwa (29; 8.3%) and Hebron (20; 5.7%) and most were women (271; 77.4%) aged 26–45 (177; 50.6%). Eighty per cent (281) of the patients had visited their nearest clinic previously and 54 of these (19.2%) said they would not return. The reasons for this were: long waiting time (88; 25.1%); long queues (84; 24%); rude staff (60; 17%); and no medication (39; 11.1%).Conclusion: The majority of patients who had attended their nearest clinic were adamant that they would not return. It is necessary to reduce waiting times, thus reducing long queues. This can be achieved by having adequate, satisfied healthcare providers to render a quality service and by organising training for management. Patients can thus be redirected to their nearest clinic and the health centre’s capacity can be increased by procuring adequate drugs. There is a need to follow up on patients’ complaints about staff attitudes.

SEC adopts regulation systems compliance and integrity

2015 ◽  
Vol 16 (3) ◽  
pp. 4-14 ◽  
Author(s):  
James Burns ◽  
Georgia Bullitt ◽  
Howard Kramer ◽  
Jack Habert ◽  
James Doench
Keyword(s):  
Cyber Security ◽  
Financial Services ◽  
Periodic Review ◽  
Content Type ◽  
Security Issues ◽  
Market Participants ◽  
Investment Companies ◽  
Policies And Procedures ◽  
Investment Advisers

Purpose – To explain the requirements of Regulation Systems Compliance and Integrity (“Regulation SCI”) and the new responsibilities of organizations defined as “SCI entities.” Design/methodology/approach – Explains the purpose of Regulation SCI, the responsibilities of SCI entities, systems covered by the rules (“SCI systems”), and specific obligations of SCI entities, including the establishment and periodic review of policies and procedures, compliance with the Exchange Act, designation of “responsible SCI personnel,” appropriate corrective action in response to “SCI events,” notification of systems changes, annual “SCI reviews,” business continuity and disaster recovery testing, and recordkeeping and filing. Discusses future implications for SCI Entities and other market participants. Findings – Regulation SCI launches a broad and extensive overlay of rules and guidance to address systems capacity and integrity issues that have increasingly affected the securities markets. The adoption of this regulation suggests that there will continue to be increased scrutiny by the SEC, FINRA and other regulators of the automated systems and related policies and procedures of all market participants. Practical implications – SCI entities will need to devote considerable attention and resources not just to prevent incidents where possible, but also to establish systems for ensuring thorough compliance and well-documented and reasonable follow-up actions where necessary. All market professionals – including broker-dealers, investment advisers, pension funds and investment companies – should study the new regulation and consider adopting appropriate policies and procedures to address operating as well as cyber security issues with respect to their own critical operating technology. Originality/value – Practical guidance from experienced financial services lawyers.

scholarly journals Tracheal surgery

2016 ◽  
Vol 73 (3) ◽  
Author(s):  
A. D'Andrilli ◽  
E.A. Rendina ◽  
F. Venuta
Keyword(s):  
Surgical Resection ◽  
Surgical Techniques ◽  
Treatment Modalities ◽  
Malignant Neoplasms ◽  
New Techniques ◽  
Multidisciplinary Cooperation ◽  
Post Traumatic ◽  
Post Intubation ◽  
Near Future

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.

scholarly journals NEXT AND LONG-TERM RESULTS OF X-RAY ENDOVASCULAR INTERVENTIONS IN TREATMENT OF CHRONIC CRITICAL ATHERODIABETIC ISCHEMIA OF LOWER EXTREMITIES

2020 ◽  
Vol 18 (6) ◽  
pp. 710-715
Author(s):  
N. N. Ioskevich ◽  
◽  
L. F. Vasilchuk ◽  
P. E. Vankovich ◽  
S. P. Antonenko ◽  
...  
Keyword(s):  
Lower Limb ◽  
Type I Diabetes ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Type I ◽  
Critical Ischemia ◽  
Lower Limb Ischemia ◽  
X Ray ◽  
Endovascular Interventions

Background. The treatment of chronic critical ischemia of the lower extremities with their combined atherodiabetic lesion is one of the far from the resolved problems of modern surgery. Aim of the study. Analysis of the results of X-ray endovascular interventions in patients with critical lower limb ischemia due to atherodiabetic lesions of the femoral-popliteal-tibial segment. Material and methods. We analyzed the results of REVS in 60 patients with diabetes mellitus with critical ischemia of the lower extremities due to infra-anginal atherosclerotic occlusions with a follow-up period of up to 5 years from the moment of the manipulation. Results. The total shelf life of the lower limb after REVV was 492.4 ± 10.1 days. Out of 26 amputations performed, balloon angioplasty was performed in 18 cases and stenting in 8 cases. In individuals with type I diabetes, the duration of painless period was 415.4 ± 5.1 days, and the total shelf life of the leg was 465.4 ± 4.3 days. In type II diabetes, these indicators were, respectively, 181.4 ± 4.4 days and 317.8 ± 6.7 days. In the group of patients with type I diabetes, the lower limb was saved in 55.6% of cases (in 20 out of 36 patients), and in type II diabetes - in 58.3% (in 14 out of 24 people). Conclusions. The presence of simultaneously obliterating atherosclerosis and diabetes mellitus in patients leads to a combined atherodiabetic lesion of the arterial bed, including infra-anginal arteries. X-ray endovascular interventions (balloon angioplasty and stenting) on the arterial femoral-popliteal-tibial segment are a rather effective method of eliminating chronic critical lower limb ischemia, which allows preserving the lower limb in 56.7% patients with a follow-up period of up to 5 years from the date of surgery. Improving the results of X-ray endovascular interventions in case of chronic critical atherodiabetic lower limb ischemia requires a comprehensive study of the possible causes of occlusions of reconstructed arterial segments (blood coagulation potential, non-optimal processes in the intervention zone).

scholarly journals The diagnosis and management of adult ADHD in HMP Elmley, a Category B remand prison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S90-S90
Author(s):  
Kathleen McCurdy ◽  
Nosa Igbinomwanhia
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Physical Health ◽  
Attention Deficit ◽  
Prison Population ◽  
Waiting Times ◽  
Adhd Medication ◽  
Diagnosis And Management ◽  
Hyperactivity Disorder ◽  
Initial Appointment

AimsAttention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder in young adult prisoners. This audit aimed to identify how many residents are prescribed medication treatment for ADHD in HMP Elmley and whether those seen by the prison psychiatrists have been managed in line with NICE guidelines. We also audited waiting times and time to follow-up appointments. This was done with the overall aim to identify potential areas for development.MethodWe performed a spot audit of all residents in HMP Elmley who were prescribed ADHD medication on 4th November 2019, using their electronic patient records. Appointments with the psychiatrists were then subdivided into initial assessments and follow-up appointments for the purpose of analysis. Performance was measured against NICE Guideline [NG87]: Attention deficit hyperactivity disorder: diagnosis and management. We also calculated the waiting times for initial appointment and follow-up appointment.ResultWe found that 33 of residents were on ADHD medication at the time of the audit, approximately 3% of the prison population. 64% of those had a pre-existing diagnosis and 36% had been given a new diagnosis at HMP Elmley. Of those newly diagnosed 100% had undergone a Diagnostic Interview for Adults in ADHD (DIVA) assessment for diagnosis.Baseline physical health checks had been performed in 68% of patients prior to starting medication and a cardiovascular examination had occurred in 9%. At follow-up 100% of patients had their physical observations and weight checked and their symptoms reviewed.91% of patients were started on methylphenidate or lisdexamfetamine as first line treatment, with the rest started on atomoxetine and the reason for this documented.100% patients were offered general psychological support.There was a mean 22 day wait for an initial appointment (range 0-65) and a mean 20 day wait from starting medication to a psychiatric follow-up appointment (range 8-37)ConclusionThe number of residents treated for ADHD in HMP Elmley is relatively low (3%) compared to the estimated prevalence in prison population.The key areas for improvement are in baseline cardiovascular examinations and physical health evaluations. The waiting time between initial psychiatric appointment and follow-up is another area where improvement is needed and this will form the basis of a quality improvement project.Future steps include setting up a specific ADHD clinic with an allocated nurse practitioner to support, producing a template for ADHD assessments and follow-ups, producing a local policy on ADHD and developing specific resources for ADHD psychoeducation.

scholarly journals EP.WE.727Upper GI Surgery Clinic Referrals; Can We Improve the Patient Experience?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Mohamed Abouelazayem ◽  
Raluca Belchita
Keyword(s):  
Patient Experience ◽  
Waiting Time ◽  
Waiting Times ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Post Discharge ◽  
Average Waiting Time ◽  
Upper Gi

Abstract Aim To review the new referrals to the Upper GI surgery clinic for appropriateness, investigations requested, and waiting times and to identify potential pathways to reduce waiting times and improve the patient experience. Method Patients who attended the UGI clinic over 2 months period were identified. Data were collected from GP referrals and Electronic Patient Records. Follow up, post-discharge appointments, and Did Not Attends were excluded. Data collected included time from referral to first clinic, symptoms, investigations requested, suitability for a pathway, and appropriateness of referral. A first clinic outcome was concluded from reading the GP referral, there were 5 outcomes to choose from; direct to another specialty, discharge back to GP, clinic, surgery, pre-investigate and clinic. Results 147 referrals were analysed. The average waiting time from referral to the first clinic was 51 days (range 7-119 days). 73% of the referrals were GP referrals and 27% from other specialties. The most common referral was for gallstones and the most common 2 outcomes were Pre-investigate and surgery. Conclusion Most of the investigations and outcomes suggested from the project were the same as those from clinic letters. The following pathways can be developed to cut waiting times and costs for the trust:

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