Impact of drainage technique on pediatric pyeloplasty: Comparative analysis of externalized uretero-pyelostomy versus double-J internal stents

Introduction: Pediatric pyeloplasty with double J (DJ) stent drainage requires manipulation of the uretero-vesical junction (UVJ) and a second anesthetic for removal. Externalized uretero-pyelostomy (EUP) stents avoid these issues. We report outcomes of laparoscopic and open pyeloplasty with EUP compared to DJ stents in children.Methods: We retrospectively reviewed 76 consecutive children who underwent pyeloplasty for ureteropelvic junction (UPJ) obstruction over a 1-year period by 5 pediatric urologists at a single institution. The exclusion criteria included patients with concomitant urological procedures, other urinary drainage strategies, “stentless” pyeloplasty or patients without follow-up data. Based on surgeon preference, 24 patients had a EUP stent and 38 had a DJ stent placed.Results: The mean follow-up was 23.8 ± 10.9 months and 21.1 ± 11.1 months for the EUP and DJ stent groups, respectively (p = 0.32). The mean age was 40 ± 54 months and 80 ± 78 months for the EUP and DJ groups, respectively (p = 0.04). The EUP group had a greater proportion of open pyeloplasties (n = 17, 71%) versus the DJ group (n = 16, 42%; p = 0.04). There were no statistically significant differences in operative time, length of stay, and overall complication rate between groups. Complications were divided by timing of complication (intraoperative, before and after 3 months) and according to the Clavien Classification system. There were no statistically significant differences between these subgroups. The limitations of this study include small sample size, potential selection bias, and heterogeneity between both study groups.Conclusions: Pyeloplasty using EUP stents does not incur prolonged operative time, longer length of stay or higher complication rate when compared to DJ stents. Within the limitations of this study, EUP stents may be a safe alternative to DJ stents.

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A long wait: barriers to discharge for long length of stay patients

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-135815 ◽

2018 ◽

Vol 94 (1116) ◽

pp. 546-550 ◽

Cited By ~ 3

Author(s):

Emma Jane Zhao ◽

Apurva Yeluru ◽

Lakshman Manjunath ◽

Lei Ray Zhong ◽

Hsiao-Tieh Hsu ◽

...

Keyword(s):

Length Of Stay ◽

Chart Review ◽

Small Sample Size ◽

Tertiary Care ◽

Small Sample ◽

Care Hospital ◽

Healthcare Staff ◽

Care Capacity ◽

Improve Cost

IntroductionReducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine.MethodsWe conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge.ResultsDischarge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay.ConclusionTogether with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.

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Implementation of a novel prehospital advance directive protocol in southeastern Ontario

CJEM ◽

10.1017/s148180350001513x ◽

2007 ◽

Vol 9 (04) ◽

pp. 250-259 ◽

Cited By ~ 4

Author(s):

Rose P. Mengual ◽

Michael J. Feldman ◽

Gord R. Jones

Keyword(s):

Prospective Observational Study ◽

Small Sample Size ◽

Small Sample ◽

Decision Makers ◽

Prehospital Setting ◽

Do Not Resuscitate ◽

Surrogate Decision Makers ◽

The Mean ◽

Surrogate Decision

ABSTRACTIntroduction:Do not resuscitate (DNR) orders are commonly accepted in most health care settings, but are less widely recognized in the prehospital setting. We describe the implementation of and satisfaction with a prehospital DNR protocol that allows paramedics to honour verbal and non-standard written DNR requests.Methods:This prospective observational study reviewed all cardiac arrests in southeastern Ontario between March 1, 2003 and September 31, 2005. Following a verbal or non-standard written DNR request, paramedics completed a questionnaire and a follow-up structured telephone interview was conducted with surrogate decision makers (SDMs).Results:There were 1890 cardiac arrests during the study period, of which 86 met our inclusion criteria. Paramedic surveys were available for 82 cases (95%), and surrogate decision makers (SDMs) were successfully contacted in 50 (58%) of them. Two SDMs declined to be interviewed. The mean patient age was 72.7 (standard deviation 13.8) years and 65% were male. Sixty-three (73%) of DNR requests were verbal, and 23 (27%) were written. The mean paramedic comfort was rated 4.9 on a 5-point Likert scale (with 5 being “very comfortable” ) (95% confidence interval [CI] 4.9–5.0). The mean SDM comfort was rated by paramedics as 4.9 (95% CI 4.8 –4.9). SDMs reported comfort in withholding CPR in 47 of 48 cases (98%), and with paramedic care in all cases. One SDM stated that although it was consistent with the patient's wishes, she was uncomfortable having to make the DNR request.Conclusions:Satisfaction with this novel prehospital DNR protocol was uniformly high among paramedic and SDM respondents. It appears that such a protocol is feasible and acceptable for the prehospital setting. Our conclusions are limited by a small sample size, the lack of a comparison group, and limited follow-up.

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Circle nephrostomy tube revisited

Canadian Urological Association Journal ◽

10.5489/cuaj.3596 ◽

2016 ◽

Vol 10 (7-8) ◽

pp. 223

Author(s):

Yasser A. Noureldin ◽

Christian Diab ◽

David Valenti ◽

Sero Andonian

Keyword(s):

Lower Cost ◽

Small Sample Size ◽

Cost Savings ◽

Small Sample ◽

Nephrostomy Tube ◽

Urinary Leakage ◽

Urinary Drainage ◽

Risk Patients ◽

Indwelling Time ◽

The Mean

Introduction: There are few options for patients requiring chronic urinary drainage using nephrostomy tubes. Although circle nephrostomy tube (CNT) was invented in 1954, it is rarely used. Its advantages include longer indwelling time such that it is changed semi-annually when compared with the standard nephrostomy tube (SNT), which is changed monthly. However, there are no studies comparing indwelling times and costs with these two tubes. The aim of the present study was to compare CNT with SNT in terms of frequency of tube changes, reasons for earlier tube changes, and associated costs.Methods: Patients who had CNT inserted between 2009 and 2015 were reviewed. The indications for chronic indwelling nephrostomy tubes were tabulated. The frequency of tube changes was compared between CNT and SNT in the same patients. Furthermore, costs associated with insertion and exchange of CNT and SNT were analyzed.Results: Seven patients with mean age of 71.9 ± 7.6 years (range 43‒96) had a total of 36 CNT changes. The mean number of CNT changes was four (range 2‒5) at a mean interval of 168.3 ± 15.6 days (range 120‒231). All patients had SNT prior to converting to CNT. When compared with the mean interval for SNT changes, the mean interval for CNT changes was significantly longer (44.8 ± 19.4 vs. 168.3 ± 41.3 days; p=0.028). Tube blockage and urinary leakage were the most common reasons for earlier than scheduled CNT changes. In our centre, CNT insertion and exchange cost $1965.48 and $923.96 compared with $1450.43 and $803.81 for SNT, respectively. There was an estimated cost savings of $46 861.10 (range $87 414.30 –$40 553.20) for the whole cohort by switching from SNTs to CNTs.Conclusions: Despite the small sample size as the main limitation, this study confirms that CNTs are associated with significantly fewer changes and lower cost when compared with SNTs for poorsurgical- risk patients requiring chronic NTs.

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Early promising result of bicompartmental knee replacement in middle-aged patients

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491719848758 ◽

2019 ◽

Vol 26 (2) ◽

pp. 85-88

Author(s):

Bruce Yan Ho Tang ◽

Chi Nok Cheung ◽

Hon For Tsui ◽

Hok Leung Wong

Keyword(s):

Length Of Stay ◽

Knee Replacement ◽

Operative Time ◽

Knee Score ◽

Middle Aged ◽

Aged Patients ◽

Incision Length ◽

The Mean ◽

Hemoglobin Drop

Introduction: Partial knee replacement (PKR) is one of the treatment options in middle-aged patients with less extensive knee osteoarthritis, with unicompartmental knee replacement (UKR) most commonly done for medial osteoarthritis. There are numerous advantages like bone/ligament preserving and faster recovery. However, the indications of UKR remain controversial, as most patients have some patellofemoral joint (PFJ) osteoarthritis. We performed modular bicruciate-retaining bicompartmental knee replacement (BKR) in this group of patients and compared the outcome with total knee replacement (TKR). Materials and Methods: From 2016 to 2017, 14 BKR were performed in patients with medial and PFJ osteoarthritis. They were retrospectively compared with 14 TKR performed in patients with similar age and severity. The incision length, operative time, blood loss (in terms of hemoglobin drop), and length of stay were recorded. Pre- and postoperative range of motion and Knee Society knee score at 1-year follow-up were compared. Results: The mean incision length for BKR was shorter than TKR (130.1 vs. 185.1 mm), but the mean operative time was also longer (152.6 vs. 88.1 min). There was also less mean hemoglobin drop (1.8 vs. 2.6 g/dL) and shorter length of stay (7.4 vs. 9.2 days). The mean postoperative function score is better in BKR group (90.4 vs. 77.5), and the mean postoperative knee score (87.2 vs 88.9) and flexion (115.7° vs. 111.4°) were similar for both groups. Discussion: In selected patients, BKR is a good alternative to TKR. It preserves advantages of UKR while also tackle the PFJ which is the most controversial aspect of UKR. The early clinical outcome in our study is promising. However, there is a learning curve. Longer follow-up is necessary to study on the performance and survivorship as compared with UKR and TKR.

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Punch Incision versus Elliptical Excision for Epidermal Inclusion Cysts: Systematic Review and Meta-Analysis

Surgeries ◽

10.3390/surgeries2030033 ◽

2021 ◽

Vol 2 (3) ◽

pp. 335-346

Author(s):

Kengo Mukuda ◽

Jun Watanabe

Keyword(s):

Operative Time ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Postoperative Wound ◽

Randomized Controlled ◽

Clinical Registries ◽

The Mean ◽

Wound Length ◽

Review Manager

Punch incision is an alternative to elliptical excision for treating epidermal inclusion cysts, but its efficacy has not been systematically reviewed. This study assessed the efficacy and safety of punch incision versus elliptical excision for epidermal inclusion cysts. Randomized controlled trials published through January 2021 that evaluated the performance of punch incision versus elliptical excision on epidermal inclusion cysts were identified through electronic databases and clinical registries. Version 2 of the Cochrane risk-of-bias tool for randomized trials tool was used. Review Manager software was used for the meta-analysis. Two trials (100 participants) were identified. The primary outcomes were recurrence rate (risk ratio, 2.40; 95% confidence interval [CI], 0.37–15.60 [favoring elliptical excision]), mean operative time (mean difference [MD], −5.28; 95% CI, −12.72 to 2.16 [favoring punch incision]), and mean postoperative wound length (MD, −11.67; 95% CI, −20.59 to −2.76 [favoring punch incision]). The evidence was low to moderate due to the small sample size and its considerable heterogeneity. The use of punch incision shortened the mean postoperative wound length and had comparable safety to that of elliptical excision.

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Assessing Biomarkers of Breast Cancer Risk in Underserved Women in a Midwestern County

Journal of Primary Care & Community Health ◽

10.1177/21501327211017792 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110177

Author(s):

Marla A. DeWitt ◽

Ivana T. Croghan ◽

Celine M. Vachon ◽

Thomas D. Thacher ◽

Marcia R. Venegas Pont ◽

...

Keyword(s):

Vitamin D ◽

Mammographic Density ◽

Small Sample Size ◽

Vitamin D Insufficiency ◽

Screening Mammography ◽

Small Sample ◽

Vitamin D Status ◽

Small Pilot Study ◽

Unexpected Findings

Objective: The primary aim of this study was to evaluate the feasibility of collecting risk factor information and accessing digitized mammographic data in a medically marginalized population. A secondary aim was to examine the association between vitamin D status and mammographic density. Methods: Breast-screening examinations were provided for age-appropriate patients, and a referral for no-cost screening mammography was offered. Study participants were asked to undergo 25-hydroxyvitamin D testing at mammography and 1-year follow-up. Results: Of 62 women approached, 35 (56%) consented to participate. Of 32 participants who had baseline mammography, the median mammographic density measured by VolparaDensity (Volpara Solutions Limited) was 5.7%. After 1 year, 9 women obtained follow-up mammograms, with a median density of 5.7%. Vitamin D status was measured for 31 participants at baseline and 13 participants in the following year. Insufficient vitamin D status (<30 ng/mL) was noted in 77% at each time point. Mammographic density was not significantly correlated with vitamin D status ( P = .06). Conclusions: On the basis of this small pilot study, vitamin D insufficiency is common in this study population. Owing to the small sample size, an association between vitamin D insufficiency and breast density was not clear. Additional unexpected findings included substantial barriers in initial access to care and longitudinal follow-up in this population. Further study of these issues is needed.

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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

BioMed Research International ◽

10.1155/2019/1491796 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Yangjing Lin ◽

Jin Cao ◽

Changgui Zhang ◽

Liu Yang ◽

Xiaojun Duan

Keyword(s):

Achilles Tendon ◽

Recurrence Rate ◽

Operative Time ◽

Achilles Tendon Rupture ◽

Tendon Lengthening ◽

Group A ◽

Achilles Tendon Lengthening ◽

The Mean ◽

Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

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Stillbirth Rate and Weight at Birth of Quintuplets in Japan

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000002841 ◽

1989 ◽

Vol 38 (1-2) ◽

pp. 65-69 ◽

Cited By ~ 6

Author(s):

Yoko Imaizumi

Keyword(s):

Sample Size ◽

Birth Order ◽

Gestational Age ◽

Size Effects ◽

Maternal Age ◽

Small Sample Size ◽

Small Sample ◽

Stillbirth Rate ◽

The Mean

AbstractNation-wide data in Japan on births and prenatal deaths of 16 sets of quintuplets during 1974-1985 were analysed. Among the 16 sets, 3 sets were liveborn, 8 were stillborn, and 5 were mixed, with a stillbirth rate of 0.64 (51/80). Effects of sex, maternal age and birth order on the stillbirth rate were not considered because of the small sample size. Effects of gestational age and birthweight on stillbirth rate were also examined. The mean weight of the 40 quintuplet individuals was 1,048 g.

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