scholarly journals Long-term functional outcomes after bladder exstrophy repair: A single, low-volume centre experience

2016 ◽  
Vol 10 (3-4) ◽  
pp. 94 ◽  
Author(s):  
Ossamah Alsowayan ◽  
John Paul Capolicchio ◽  
Roman Jednak ◽  
Mohamed El-Sherbiny
Keyword(s):  
Primary Repair ◽  
Bladder Exstrophy ◽  
High Volume ◽  
Bladder Capacity ◽  
Urinary Continence ◽  
Number Of Patients ◽  
Bladder Neck Reconstruction ◽  
Low Volume ◽  
Continence Rate ◽  
The Cost

Introduction: In this study, we present our experience managing bladder exstrophy (BE) in a low-volume centre over 24 years.Methods: Charts of patients with BE between 1990 and 2014 were retrospectively reviewed. Patients with BE closure and ≥5 years followup were included. BE closure was carried out in the first two days of life using either complete primary repair (CPRE) or modernstaged repair (MSRE). Daytime urinary continence (UC) was evaluated by the age of five years. Patients were considered continent if completely dry for ≥3 hours using no or one pad/day. Incontinent patients with bladder capacity (BC) ≥100 ml underwent bladder neck reconstruction (BNR) and bilateral ureteric reimplantation(BUR), while patients with BC <100ml underwent simultaneous augmentation cystoplasty (ACP).Results: Sixteen (16) patients met our inclusion criteria with a mean followup time of 18±5 years. Ten (10) underwent CPRE, while six underwent MSRE. Four surgeons were involved in patients’  management. Two surgeons had previous experience in BE surgery while working in other institutions. Complications included dehiscence in five patients, vesicocutanous fistula in three and breakthrough UTI in eight. Continence was achieved in 15/16 patients: two after BE closure only, seven with BNR, and six who required ACP and BNR.Conclusions: Despite the small number of patients and the reterospective nature of the study, some observations are noteworthy. Although continence rate post-primary BE closure was initially low, it rose to 93.8% after auxiliary continence procedures. This might be at the cost of urethral voiding, which was achieved in 60% of patients. Our small cohort did not show clear advantage of CPRE vs. MSRE. Our outcomes may not be different from high-volume centres due to the fact that two exstrophy-experienced surgeons performed most primary or subsequent surgeries. For this reason, we recommend assigning designated centres for BE repair for both new and repeat cases.

The Cost of Implementation of the Clinical Laboratory Improvement Amendments of 1988—The Example of Pediatric Office-Based Cholesterol Screening

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 230-234
Author(s):  
Andrew M. Tershakovec ◽  
S. Diane Brannon ◽  
Michael J. Bennett ◽  
Barbara M. Shannon
Keyword(s):  
Proficiency Testing ◽  
Laboratory Testing ◽  
Clinical Laboratory ◽  
High Volume ◽  
Chemistry Laboratory ◽  
Screening Process ◽  
Cholesterol Screening ◽  
Low Volume ◽  
The Cost ◽  
Clinical Laboratory Improvement Amendments

Objective. To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. Methods. Four-to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. Results. In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. Conclusions. Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.

scholarly journals Cost and Impact of Dried Blood Spot Versus Plasma Separation Card for Scale-up of Viral Load Testing in Resource-limited Settings

2019 ◽  
Author(s):  
Brooke E Nichols ◽  
Sarah J Girdwood ◽  
Aaron Shibemba ◽  
Sharper Sikota ◽  
Christopher J Gill ◽  
...  
Keyword(s):  
Viral Load ◽  
Scale Up ◽  
High Volume ◽  
Dried Blood Spots ◽  
Correct Result ◽  
Load Testing ◽  
Plasma Separation ◽  
Resource Limited ◽  
Low Volume ◽  
The Cost

Abstract Background Routine plasma viral load (VL) testing is recommended for monitoring human immunodeficiency virus–infected patients on antiretroviral therapy. In Zambia, VL scale-up is limited due to logistical obstacles around plasma specimen collection, storage, and transport to centralized laboratories. Dried blood spots (DBSs) could circumvent many logistical challenges at the cost of increased misclassification. Recently, plasma separation cards (PSCs) have become available and, though more expensive, have lower total misclassification than DBSs. Methods Using a geospatial model created for optimizing VL utilization in Zambia, we estimated the short-term cost of uptake/correct VL result using either DBSs or PSCs to increase VL access on equipment available in-country. Five scenarios were modeled: (1) plasma only (status quo); (2) plasma at high-volume sites, DBS at low-volume sites; (3) plasma at high-volume sites, PSC at low-volume sites; (4) PSC only; (5) DBS only. Results Scenario 1 resulted in 795 342 correct results due to limited patient access. When allowing for full and partial adoption of dried specimens, access increases by 19%, with scenario 3 producing the greatest number of correct results expected (929 857). The average cost per correct VL result was lowest in the plasma + DBS scenario at $30.90 compared to $31.62 in our plasma + PSC scenario. The cost per correct result of using dried specimens only was dominated in the incremental analysis, due primarily to fewer correct results. Conclusions Adopting the partial use of dried specimens will help achieve improved VL access for patients at the lowest cost per correct result.

scholarly journals A retrospective analysis of early experience with modified complete primary repair of exstrophy bladder (CPRE) in neonates and children

2013 ◽  
Vol 46 (03) ◽  
pp. 549-554 ◽  
Author(s):  
Santosh B. Kurbet ◽  
Gowda P. Prashanth ◽  
Mahantesh V. Patil ◽  
Shivaji Mane
Keyword(s):  
Quality Of Life ◽  
Primary Repair ◽  
Bladder Exstrophy ◽  
Psychosocial Impact ◽  
Quality Of Life Inventory ◽  
Pedsql 4.0 ◽  
Continence Rate ◽  
Good Cosmesis

ABSTRACT Objective: To study the problems faced during the surgery and follow-up of modified complete primary repair of exstrophy (CPRE) technique. Initial experience with CPRE and its short- and long-term outcomes with respect to continence status and psychosocial impact are reported. Materials and Methods: A retrospective review of the hospital case records from March 2008 to September 2012 was performed. Data of patients with bladder exstrophy managed by a single paediatric surgeon using modified CPRE technique were analysed. Quality of life and psychosocial impact of the surgery were assessed using Pediatric Quality of Life Inventory (PedsQL 4.0) and compared with those of typical peers. Results: Eight children (age 4 days-12 years) underwent CPRE using modified Mitchell′s technique. Two patients (25%) experienced early postoperative complications, with infection and fistula developing in one each. All the patients were doing well on follow-up, with variable continence rates and good cosmesis. Mean duration of follow-up was 18.5 months (range 6 months-4 years). Five out of seven (71%) children were continent or partially continent. One case was lost to follow-up. PedsQL scores were comparable with those of age-matched peers in all domains except the social functioning domain in 8-12 years age group (83.53 ± 9.70 vs. 77.86 ± 10.22, P < 0.05). Conclusion: Our preliminary results with modified CPRE in neonates and children have been encouraging. No major complications were observed. Continence rate was satisfactory and cosmetic results were good. Though the technique is being practiced at several Indian centres, there is a paucity of comprehensive Indian data on CPRE.

scholarly journals Prognostic Value of the LATITUDE and CHAARTED Risk Criteria for Predicting the Survival of Men with Bone Metastatic Hormone-Naïve Prostate Cancer Treated with Combined Androgen Blockade Therapy: Real-World Data from a Japanese Multi-Institutional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Takashi Kawahara ◽  
Shuko Yoneyama ◽  
Yoshio Ohno ◽  
Junpei Iizuka ◽  
Yasunobu Hashimoto ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
High Volume ◽  
Low Risk ◽  
Free Survival ◽  
Combined Androgen Blockade ◽  
Number Of Patients ◽  
High Risk Disease ◽  
Low Volume ◽  
Androgen Blockade

Background. The CHAARTED and LATITUDE trials demonstrated a prolonged overall survival (OS) for metastatic hormone-naïve prostate cancer (mHNPC) patients who receive up-front docetaxel or abiraterone acetate. These studies used their own risk criteria: CHAARTED trial defines high- and low-volume diseases and LATITUDE trial targeting a high-risk disease. The present study explored whether or not the CHAARTED and LATITUDE criteria were useful for predicting the outcome in Japanese bone mHNPC patients, including elderly patients (≥70 years). Methods. A total of 532 mHNPC patients diagnosed from 2004 to 2014 in multithird referral cancer centers were enrolled in this study. All patients had bone metastasis and received combined androgen blockade treatment as an initial hormonal therapy. Results. The number of patients with CHAARTED low-volume and high-volume diseases was 178 (33.5%) and 354 (66.5%), respectively. On the contrary, the number of patients with LATITUDE low-risk and high-risk diseases was 157 (29.5%) and 375 (70.5%), respectively. A total of 307 (57.7%) patients were defined as having both CHAARTED high-volume and LATITUDE high-risk disease. The median castration-resistant prostate cancer- (CRPC-) free survival was 12.5 months for the CHAARTED high volume, 56.9 months for the CHAARTED low volume, 13.6 months for the LATITUDE high risk, and 37.3 months for the LATITUDE low risk, respectively. The OS was 50.1 months in patients with CHAARTED high-volume disease, 95.1 months in patients with CHAARTED low-volume disease, 54.0 months in patients with LATITUDE high-risk disease, and 92.7 months in patients with LATITUDE low-risk disease, respectively. This trend was also observed in elderly (≥70 years old) patients. Conclusions. The patients with CHAARTED high-volume disease or LATITUDE high-risk disease showed a shorter CRPC-free survival and a shorter OS than those in the CHAARTED low-volume disease group or in the LATITUDE low-risk group among Asian Japanese bone metastatic HNPC patients.

Staged Male Bladder Exstrophy Repair

2019 ◽  
Author(s):  
Timothy S. Baumgartner ◽  
John P. Gearhart
Keyword(s):  
Bladder Exstrophy ◽  
Pelvic Osteotomy ◽  
Postoperative Management ◽  
Urinary Continence ◽  
Antireflux Procedure ◽  
Surgical Interventions ◽  
Urethral Closure ◽  
Bladder Neck Reconstruction ◽  
Selection For ◽  
Primary Bladder

This chapter details the latest surgical advances and outcomes in the modern surgical management of male classic bladder exstrophy to include patient selection for closure, operative considerations, newborn primary bladder and posterior urethral closure, early epispadias repair, bladder neck reconstruction with an antireflux procedure, and postoperative management. It highlights how to achieve the primary objectives of (1) a secure abdominal closure, (2) reconstruction of a functional and cosmetically acceptable penis, and (3) urinary continence with the preservation of renal function. In addition, it addresses the most common pitfalls and challenges encountered when accomplishing each of the major surgical interventions. This review contains 3 figures, 5 tables, and 47 references. Key Words: Congenital defect, Bladder exstrophy, Epispadias, Reconstruction, Urinary Continence, Magnetic Resonance Imaging, Pain management, Pelvic osteotomy

Association of tumor burden with the eligibility of upfront therapy in patients with castration-naive prostate cancer: A multicenter retrospective study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 107-107
Author(s):  
Hiromichi Iwamura ◽  
Shingo Hatakeyama ◽  
Shintaro Narita ◽  
Toshihiko Sakurai ◽  
Sadafumi Kawamura ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Deep Learning ◽  
Cox Regression ◽  
High Volume ◽  
Progression Rate ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Number Of Patients ◽  
Low Volume ◽  
Upfront Therapy

107 Background: Although several large-scale studies reported a robust benefit of upfront therapy for mHNPC, not all patients with mHNPC experienced mCRPC progression. As there is a concern for overtreatment in patients with low-risk/volume disease, we aimed to identify potential candidates for upfront therapy in patients with metastatic hormone-naïve prostate cancer (mHNPC). Methods: We retrospectively evaluated 679 patients with mHNPC who were initially treated with conventional androgen deprivation therapy. We defined the patients with progression to metastatic castration-resistant prostate cancer (mCRPC) as potential candidates for upfront therapy. To estimate the suitable candidate for upfront therapy, we retrospectively compared mCRPC progression rate, mCRPC-free survival, and overall survival (OS) after castration-resistance (OS-CR) between the low- and high-volume disease groups. Furthermore, we tried to develop a novel prediction model using deep learning algorithm. Results: The number of patients with mCRPC progression (potential candidates for upfront therapy) was 119 (52%) and 319 (71%) in the low- and high-volume disease groups. The mCRPC progression rate and CRPC-free survival were significantly worse in high-volume disease group ( P < 0.01), but no difference was found for OS-CR. Multivariate Cox regression analysis showed no significant association between tumor volume and OS-CR (HR 1.14, P=0.52). The deep learning model showed not high accuracy of mCRPC prediction (AUC 0.66). Conclusions: Approximately a half of patients with low-volume disease had progression to mCRPC. As the OS-CR in the patients with low-volume disease showed poor prognosis as well as those with high-volume disease, upfront therapy may be needed for a half of patients with low-volume disease.

scholarly journals Utilisation of laboratory services by health workers in a district hospital in Malawi

2009 ◽  
Vol 62 (10) ◽  
pp. 935-938 ◽  
Author(s):  
S O Mepham ◽  
S Bertel Squire ◽  
L Chisuwo ◽  
J Kandulu ◽  
I Bates
Keyword(s):  
Laboratory Tests ◽  
Health Workers ◽  
District Hospital ◽  
Cost Effective ◽  
High Volume ◽  
Resource Poor Setting ◽  
Laboratory Services ◽  
Low Volume ◽  
Effective Use ◽  
The Cost

Aims:To identify priorities for improving effective use of laboratory services in a district hospital in Malawi.Methods:A prospective observational study of clinician–patient interactions to analyse laboratory test requesting practices and utilisation of laboratory results. The proportion of tests that was appropriately ordered, processed and ultimately influenced clinical management was used to assess effectiveness of utilisation.Results:420 clinical consultations between health professionals and patients were observed. 92% of tests were ordered appropriately, 84% were processed by the laboratory and 64% of results influenced patient management. 73–79% of high-volume tests (haemoglobin, microscopy for malaria and tuberculosis) and 32% of low-volume tests influenced management.Conclusions:25% of commonly requested laboratory tests were not utilised effectively; because of the high volume, interventions to improve their use are likely to be cost effective. Although 68% of low-volume tests were not used efficiently, the cost of providing support for these tests in a resource-poor setting needs to be balanced against their clinical usefulness. In contrast to published information, this study shows significant under-requesting of laboratory tests that were available. Measures to increase appropriate test requests will have implications for clinician education as well as laboratory space, budgets and staffing levels.

scholarly journals Use of Pinolene or Other Spray Adjuvants with Iprodione for Improved Control of Sclerotinia Blight on Peanut1

1991 ◽  
Vol 18 (2) ◽  
pp. 97-101
Author(s):  
F. D. Smith ◽  
P. M. Phipps ◽  
R. J. Stipes
Keyword(s):  
Disease Incidence ◽  
High Volume ◽  
On Demand ◽  
Sclerotinia Blight ◽  
Additional Testing ◽  
Acetic Acid Buffer ◽  
The Mean ◽  
Low Volume ◽  
The Cost ◽  
Spray Adjuvants

Abstract Various spray adjuvants were evaluated in 1985 and 1986 with iprodione (Rovral®) for improved control of Sclerotinia blight of peanut, caused by Sclerotinia minor (Jagger) Kohn. Treatments were applied three times on demand, using high-volume nozzles to deliver 335 L/ha or low-volume nozzles to deliver 140 L/ha. Acetic acid, Buffer P.S.®, Chem Wert Plus®, hydrochloric acid, pinolene (Nu-Film-17®), SoyOil 937® and Spray-Aide® were tested with iprodione in 1985, and ChemWett Plus®, pinolene and Spray-Aide® were chosen for additional trials in 1986. Treatments of iprodione at 1.12 kg/ha with pinolene at 0.42% in low-volume sprays and 0.18% (v/v) in high-volume sprays produced the greatest yield of peanut during both years. Additional testing of iprodione with pinolene used only high-volume sprays, and these treatments were applied on demand: three times in 1987 and twice in 1988, 1989 and 1990. Yield and value of peanut over the 6-yr period of high-volume treatments were increased significantly (P = 0.05) by iprodione with pinolene, compared to iprodione alone. The addition of pinolene increased the mean yield by 348 kg/ha and value of peanut by $291/ha. The cost of using pinolene as an adjuvant averaged $6.95/ha each year. Disease incidence was 12% lower in plots treated with iprodione and pinolene, compared to iprodione alone, but this difference was not significant over the period.

scholarly journals P280 Sodium picosulfate low-volume and split-dosed bowel preparation facilitates endoscopic monitoring of patients with inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S291-S292
Author(s):  
K Fasoulas ◽  
A Katsimpeli ◽  
P Kevrekidou ◽  
N Kafalis ◽  
E Stergiou ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Preparation ◽  
Bowel Disease ◽  
High Volume ◽  
Cancer Surveillance ◽  
Number Of Patients ◽  
Sodium Picosulfate ◽  
Inflammatory Bowel ◽  
Low Volume ◽  
Split Dosing

Abstract Background The concept of Treat to Target and Tight Control relies heavily on bowel mucosa assessment. This implies that multiple endoscopies should be performed for any patient with moderate to severe inflammatory bowel disease (IBD). Improving patient tolerance of bowel preparation is important as we stride for frequent endoscopic monitoring. We aimed to compare low-volume (2 litres) Sodium Picosulfate (Pico) and high-volume (4 litres) Polyethylene Glycol (PEG) bowel preparation regimens, as well as split dosing, in terms of tolerance, efficacy and safety. Methods We included all adult IBD patients of our IBD clinic who underwent colonoscopy in the last 2 years for the sole purpose of mucosal healing assessment. We excluded patients with an indication of cancer surveillance, acute severe colitis, bowel strictures with obstructive symptoms, and patients with renal or liver failure. We used a Visual Analog Scale (VAS) assessed by patients to evaluate tolerance, and Boston Bowel Preparation Scale (BBPS) assessed by physicians to evaluate efficacy. Results A total of 139 patients were included in the study: 70 (50,4%) male patients, 86 (61,8%) with Crohn’s disease and 53 (38,2%) with ulcerative colitis, with a mean age of 46,14 years (range 17–74) and mean disease duration of 10.12 years. We included 21 patients (15.1%) with a previous ileocecal resection. Low-volume Pico preparation was received by 48 (34,5%) patients. High-volume PEG preparation was received by 91 (65,5%) patients. Split dosed preparation was received by 49 (35.2%) patients. Low-volume Pico preparation was significantly better tolerated than high-volume PEG preparation (VAS 81,75 vs. 65,69, p &lt; 0,001) without a negative impact on bowel preparation quality (BBPS 7,65 vs. 7,32, p = 0.237). Split dosing did not improve tolerance (VAS 74,96 vs. 67,75, p = 0.221) but it improved the quality of the preparation (BBPS 7,94 vs. 7.13, p = 0,002). No meaningful differences were observed in terms of isolated aphthous ulcers (0% vs. 4%, p = 0,325). Complete intake of preparation was significantly higher in the low-volume Pico group (94,7% vs. 74,7%, p = 0,002). Complete colonoscopy was achieved in all patients. No serious adverse events related to the bowel preparation were reported. Patients in the low-volume Pico group were slightly younger (42,54 vs. 48,03 years, p = 0,034) and more likely to have had surgery (25% vs. 9,9%, p = 0,018). Conclusion Although this was a single-centre non-randomised study with a relatively small number of patients, it clearly demonstrated that low-volume PICO split dosed bowel preparation is superior for IBD patients scoped to check for endoscopic remission, as it improves tolerance and quality without compromising efficacy. Further evidence from randomised studies is needed.

scholarly journals Effect of High-Volume Injectate in Lumbar Transforaminal Epidural Steroid Injections: A Randomized, Active Control Trial

2015 ◽  
Vol 6;18 (6;11) ◽  
pp. E519-E525
Author(s):  
Hahck Soo Park
Keyword(s):  
Pain Relief ◽  
Active Control ◽  
High Volume ◽  
Radicular Pain ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Number Of Patients ◽  
Significant Difference ◽  
Low Volume ◽  
Epidural Steroid

Background: There have been many studies proving the effectiveness of lumbar transforaminal epidural steroid injections (TFESIs) for the treatment of radicular pain. Dexamethasone has been suggested as an alternative to particulate steroids. However, no controlled trials have investigated the effect of different injected volumes for a same dose of dexamethasone. Objective: To compare the effects of a high-volume injectate with those of a low-volume injectate using the same dose of dexamethasone for 2 groups in lumbar TFESI. Study Design: A prospective, randomized, active control trial. Setting: The outpatient clinic of a single academic medical center. Methods: A total of 66 patients were randomized to receive lumbar transforaminal epidural dexamethasone injections with either a low-volume injectate (3mL, N = 30) or a high-volume injectate (8mL, N = 32). The primary outcome measures for this study were the incidence of the patients achieving meaningful pain relief and a reduction on the Visual Analogue Scale (VAS, range 0 – 100) at 4 weeks after the procedure. The definition of “meaningful pain relief” was ≥ 50% from baseline. The secondary outcomes included the Roland-Morris Disability Questionnaire (RMDQ, range 0 – 24) score and adverse effects. The outcomes were assessed 4 weeks after the procedure. Results: Four weeks after the procedure, in the DL8 group, the incidence of achieving meaningful pain relief was higher compared with DL3 group (19, 59.4% vs. 9, 30%, P = 0.024). Both groups demonstrated a significant improvement in their VAS and RMDQ scores (P < 0.05). The VAS of the high-volume injectate group (DL8) was significantly lower than that of the low-volume injectate group (DL3) (33.3 ± 25 vs. 46.3 ± 25, P = 0.036). There was no significant difference in the RMDQ score between the 2 groups. Limitations: We enrolled a small number of patients and did not assess the long-term outcomes. Conclusions: Injectate at a volume of 8 mL was more effective than injectate at a volume of 3 mL for radicular pain in a lumbar transforaminal steroid injection, although both of the injectates contained the same dose of dexamethasone. Key words: Dexamethasone, disc herniation, epidural injection, lumbar, radiculopathy

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