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1.
J Grad Med Educ ; 16(1): 59-63, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38304599

ABSTRACT

Background Internal medicine residents frequently experience distressing clinical events; critical event debriefing is one tool to help mitigate their effects. Objective To evaluate the effectiveness of a 1-hour workshop teaching residents a novel, efficient approach to leading a team debrief after emotionally charged clinical events. Methods An internal needs assessment identified time and confidence as debriefing barriers. In response, we created the STREAM (Structured, Timely, Reflection, tEAM-based) framework, a 15-minute structured approach to leading a debrief. Senior residents participated in a 1-hour workshop on the first day of an inpatient medicine rotation to learn the STREAM framework. To evaluate learning outcomes, participants completed the same survey immediately before and after the session, and at the end of their 4-week rotation. Senior residents at another site who did not complete the workshop also evaluated their comfort leading debriefs. Results Fifty out of 65 senior residents (77%) participated in the workshop. After the workshop, participants felt more prepared to lead debriefs, learned a structured format for debriefing, and felt they had enough time to lead debriefs. Thirty-four of 50 (68%) workshop participants and 20 of 41 (49%) comparison residents completed the end-of-rotation survey. Senior residents who participated in the workshop were more likely than nonparticipants to report feeling prepared to lead debriefs. Conclusions A brief workshop is an effective method for teaching a framework for leading a team debrief.


Subject(s)
Internship and Residency , Humans , Curriculum , Education, Medical, Graduate/methods , Learning , Surveys and Questionnaires
2.
MedEdPORTAL ; 17: 11074, 2021 01 25.
Article in English | MEDLINE | ID: mdl-33511271

ABSTRACT

Introduction: The AAMC has recognized the importance of effective teamwork and collaboration. One core Entrustable Professional Activity emphasizes creating a climate of mutual respect and trust and prioritizing team needs over personal needs, which leads to safe, timely, effective, efficient, and equitable patient care. Relationship conflicts, specifically, are associated with decreased productivity, complex information processing, and work satisfaction. Given the prevalence of conflict and its impact on health care workers, the lack of conflict resolution curricula in undergraduate medical education is surprising. We developed a curriculum formally introducing these skills and allowing practice in a simulated environment before students entered residency. Methods: Fourth-year medical students completed a conflict resolution exercise in a mandatory transition-to-residency course. Students completed online prework including reflection on teamwork and information on conflict resolution styles, participated in a simulated conflict with a standardized patient acting as a nurse, and afterward completed a self-evaluation with video review by the students' assigned coach and feedback on the session. Results: We collected complete responses from 108 students. We evaluated the curriculum for feasibility and acceptability by faculty and students. Most students agreed with faculty on their entrustment and milestone levels. Students found that the session prompted self-reflection and was a good review of conflict resolution. The standardized patient and faculty feedback was found to be the most useful by the students. Discussion: We successfully implemented a simulated but realistic conflict resolution exercise. Students found the exercise helpful in their preparation for residency.


Subject(s)
Education, Medical, Undergraduate , Students, Medical , Communication , Curriculum , Humans , Negotiating
3.
MedEdPORTAL ; 16: 10897, 2020 05 15.
Article in English | MEDLINE | ID: mdl-32656318

ABSTRACT

Introduction: Early formal instruction in procedural skills may increase the frequency with which residents perform procedures in the clinical setting. This workshop trained internal medicine residents in ultrasound skills and manual skills required to perform procedures common on medicine wards and required for board eligibility. Methods: Since 2016, our internal medicine residency program has executed three annual half-day workshops for interns during orientation, before clinical duties began. Prior to the workshop, we directed interns to relevant educational resources in the form of online modules and videos. At the workshop, trainees rotated in small groups through facilitated stations to learn basics of procedural ultrasound and to practice manual tasks performed during paracentesis, thoracentesis, lumbar puncture, and peripheral intravenous catheter placement. We administered questionnaires before and immediately after the workshop and used Wilcoxon signed rank tests to compare self-assessed independence and confidence. Results: Two hundred four interns with little prior procedural training participated in the workshop. Most participants (85%) indicated that orientation was the best timing for this training experience when compared to later options. Confidence and independence increased for ultrasound-marked thoracentesis, paracentesis, and peripheral intravenous catheters and for lumbar puncture without ultrasound. Discussion: This internal medicine intern orientation workshop on procedures and procedural ultrasound was well received and increased participants' confidence and sense of independence. This publication contains materials needed to reproduce the training experience.


Subject(s)
Internship and Residency , Clinical Competence , Education, Medical, Graduate , Humans , Teaching Materials , Ultrasonography
4.
Am J Transplant ; 20(7): 1885-1890, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32330356

ABSTRACT

With the rapidly expanding pandemic of SARS-CoV-2, there is concern that solid organ transplant recipients will be particularly vulnerable to infection and may experience a more severe clinical course. We report four cases of COVID-19 in solid organ transplant recipients including recipients of kidney, liver, lung, and heart transplants. We describe each patient's medical history including transplantation history, their clinical presentation and workup, and their course from diagnosis to either hospital discharge or to improvement in symptoms. These reports demonstrate a range of symptoms, clinical severity, and disease course in solid organ transplant recipients with COVID-19, including two hospitalized patients and two patients managed entirely in the outpatient setting.


Subject(s)
Coronavirus Infections/complications , Immunosuppression Therapy/methods , Pneumonia, Viral/complications , Transplant Recipients , Aged , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , End Stage Liver Disease/complications , End Stage Liver Disease/surgery , Female , Heart Failure/complications , Heart Failure/surgery , Heart Transplantation , Hospitalization , Humans , Immunosuppression Therapy/adverse effects , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Transplantation , Lung Diseases/complications , Lung Diseases/surgery , Lung Transplantation , Male , Middle Aged , Outpatients , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , United States/epidemiology , Vulnerable Populations , Washington
5.
Open Forum Infect Dis ; 6(11): ofz465, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31777756

ABSTRACT

We describe a case of acute liver failure and myopericarditis due to herpes simplex virus-1 (HSV-1) in an immunocompetent adult. We estimate that, at the height of viremia, the patient contained a quantity of HSV-1 virions approaching that of human cells. The patient recovered with acyclovir that was dose-adjusted for neurotoxicity and developed a vigorous anti-HSV-1 T-cell response.

6.
Int J Technol Assess Health Care ; 31(5): 289-96, 2015 Jan.
Article in English | MEDLINE | ID: mdl-26715372

ABSTRACT

OBJECTIVES: Although the clinical benefits of endovenous thermal ablation are widely recognized, few studies have evaluated the health economic implications of different treatments. This study compares 6-month clinical outcomes and cost-effectiveness of endovenous laser ablation (EVLA) compared with radiofrequency ablation (RFA) in the setting of a randomized clinical trial. METHODS: Patients with symptomatic primary varicose veins were randomized to EVLA or RFA and followed up for 6 months to evaluate clinical improvements, health related quality of life (HRQOL) and cost-effectiveness. RESULTS: A total of 131 patients were randomized, of which 110 attended 6-month follow-up (EVLA n = 54; RFA n = 56). Improvements in quality of life (AVVQ and SF-12v2) and Venous Clinical Severity Scores (VCSS) achieved at 6 weeks were maintained at 6 months, with no significant difference detected between treatment groups. There were no differences in treatment failure rates. There were small differences in favor of EVLA in terms of costs and 6-month HRQOL but these were not statistically significant. However, RFA is associated with less pain at up to 10 days. CONCLUSIONS: EVLA and RFA result in comparable and significant gains in quality of life and clinical improvements at 6 months, compared with baseline values. EVLA is more likely to be cost-effective than RFA but absolute differences in costs and HRQOL are small.


Subject(s)
Laser Therapy/economics , Laser Therapy/methods , Varicose Veins/radiotherapy , Varicose Veins/surgery , Adult , Aged , Cost-Benefit Analysis , Female , Humans , Low-Level Light Therapy/economics , Low-Level Light Therapy/methods , Male , Middle Aged , Models, Economic , Patient Satisfaction , Quality of Life , Treatment Outcome
7.
Ann Surg ; 261(4): 654-61, 2015 Apr.
Article in English | MEDLINE | ID: mdl-24950277

ABSTRACT

OBJECTIVE: A randomized clinical trial assessing the difference in quality of life and clinical outcomes between delayed and simultaneous phlebectomies in the context of endovenous truncal vein ablation. BACKGROUND: Endovenous ablation has replaced open surgery as the treatment of choice for truncal varicose veins. Timing of varicosity treatment is controversial with delayed and simultaneous pathways having studies advocating their benefits. A previous small randomized study has shown improved outcomes for simultaneous treatment. METHODS: Patients undergoing local anesthetic endovenous thermal ablation were randomized to either simultaneous phlebectomy or delayed varicosity treatment. Patients were reviewed at 6 weeks, 6 months, and 1 year with clinical and quality of life scores completed, and were assessed at 6 weeks for need for further varicosity intervention, which was completed with either ultrasound-guided foam sclerotherapy or local anesthetic phlebectomy. Duplex ultrasound assessment of the treated trunk was completed at 6 months. RESULTS: 101 patients were successfully recruited and treated out of 221 suitable patients from a screened population of 393. Patients in the simultaneous group (n = 51) showed a significantly improved Venous Clinical Severity Score at all time points, 36% of the delayed group required further treatment compared with 2% of the simultaneous group (P < 0.001). There were no deep vein thromboses, with 1 superfificial venous thrombosis in each group. CONCLUSIONS: Combined endovenous ablation and phlebectomy delivers improved clinical outcomes and a reduced need for further procedures, as well as early quality of life improvements.


Subject(s)
Ambulatory Surgical Procedures/methods , Catheter Ablation/methods , Endovascular Procedures/methods , Quality of Life , Varicose Veins/psychology , Varicose Veins/therapy , Female , Follow-Up Studies , Humans , Laser Therapy/methods , Male , Middle Aged , Sclerotherapy/methods , Surveys and Questionnaires , Treatment Outcome , Ultrasonography , Varicose Veins/diagnostic imaging
8.
Am J Obstet Gynecol ; 210(2): 160.e1-160.e11, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24176895

ABSTRACT

OBJECTIVE: The purpose of this study was to compare the survival of women with endometrial cancer managed by robotic- and laparoscopic-assisted surgery. STUDY DESIGN: This was a retrospective study conducted at 2 academic centers. Primary outcomes were overall survival, disease-free survival (DFS), and disease recurrence. RESULTS: From 2003 through 2010, 415 women met the study criteria. A total of 183 women had robotic and 232 women had laparoscopic-assisted surgery. Both groups were comparable in age, body mass index, comorbid conditions, histology, surgical stage, tumor grade, total nodes retrieved, and adjuvant therapy. With a median follow-up of 38 months (range, 4-61 months) for the robotic and 58 months (range, 4-118 months) for the traditional laparoscopic group, there were no significant differences in survival (3-year survival 93.3% and 93.6%), DFS (3-year DFS 83.3% and 88.4%), and tumor recurrence (14.8% and 12.1%) for robotic and laparoscopic groups, respectively. Univariate and multivariate analysis showed that surgery is not an independent prognostic factor of survival. CONCLUSION: Robotic-assisted surgery yields equivalent oncologic outcomes when compared to traditional laparoscopic surgery for endometrial adenocarcinoma.


Subject(s)
Endometrial Neoplasms/surgery , Laparoscopy , Neoplasm Staging/methods , Robotics , Adult , Aged , Aged, 80 and over , Endometrial Neoplasms/mortality , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Retrospective Studies , Survival Analysis
9.
Med Clin North Am ; 97(4): 737-57, xii, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23809723

ABSTRACT

Antimicrobial resistance of urinary pathogens is increasing. Most urinary tract infections (UTIs) should still be treated empirically. However, patients with recurrence or other risk factors for resistance may benefit from urine culture. Patients with recurrent UTI often resort to antibiotic prevention, a risky proposition in terms of resistance. Non-antimicrobial preventative methods should be considered first. If preventative antibiotics must be used, postcoital patient-initiated protocols are effective and reduce overall antibiotic exposure compared with continuous prophylaxis. Consider referring patients for urologic evaluation when at risk for complicated UTIs or when recurrence continues despite conservative interventions.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Urinary Tract Infections/drug therapy , Humans , Inappropriate Prescribing/prevention & control , Life Style , Risk Factors , Secondary Prevention/methods , Urinary Tract Infections/diagnosis , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & control
10.
J Vasc Surg ; 57(3): 860-8, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23343668

ABSTRACT

BACKGROUND: Recurrent varicose veins (RVV) occur in 13% to 65% of patients following treatment, and remain a debilitating and costly problem. RVV were initially thought largely to be due to inadequate intervention, however, more recently neovascularization and other factors have been implicated. This review aims to provide an overview of the current understanding of the etiology and pathogenesis of RVV. METHODS: A systematic search of the PubMed database was performed using the search terms including "recurrent," "varicose veins," and "neovascularization." RESULTS: Three types of RVV have been reported, namely residual veins, true RVV, and new varicose veins, although the definitions varied between studies. RVV are attributable to causes including inadequate treatment, disease progression, and neovascularization. Using duplex ultrasonography, neovascularization has been observed in 25% to 94% of RVV. These new vessels appear in various size, number, and tortuosity, and they reconnect previously treated diseased veins to the lower limb venous circulation. Histologically, these vessels appear primitive with incomplete vein wall formation, decreased elastic component, and lack of valves and accompanying nerves. Although the rate of RVV following open surgery and endovenous treatment appears similar, neovascularization seems less common following endothermal ablation. Other causes of RVV following endovenous treatment include recanalization and opening of collaterals. CONCLUSIONS: Recurrence remains poorly understood following treatment of varicose veins. Neovascularization is an established and common cause of RVV, although other factors may contribute.


Subject(s)
Varicose Veins/etiology , Varicose Veins/pathology , Veins/pathology , Ablation Techniques/adverse effects , Diagnostic Imaging/methods , Disease Progression , Endovascular Procedures/adverse effects , Humans , Neovascularization, Pathologic , Predictive Value of Tests , Recurrence , Risk Factors , Treatment Outcome , Varicose Veins/therapy , Vascular Surgical Procedures/adverse effects , Veins/surgery
11.
J Vasc Surg ; 55(1): 243-51, 2012 Jan.
Article in English | MEDLINE | ID: mdl-21840152

ABSTRACT

BACKGROUND: Sclerotherapy has been shown to be an effective and increasingly popular therapeutic strategy for the treatment of varicose veins. However, recent reports of serious side effects, including cerebrovascular accidents (CVA) and transient ischemic attacks (TIA), as well as speech and visual disturbances, have caused serious concern regarding its use. This review evaluated the reported incidences of neurological side effects associated with the use of sclerotherapy. METHODS: A systematic search of the data bases MEDLINE, OVID Embase, and Google Scholar was undertaken by two independent reviewers. Articles reporting neurological side effects in humans following foam and liquid sclerotherapy were included; animal studies, laboratory studies, and review articles were excluded. Additional references were also obtained using the related articles function. RESULTS: The search yielded 1023 articles, of which 41 studies were found to meet the inclusion criteria. A total of 10,819 patients undergoing sclerotherapy were reviewed. There were 12 case reports of CVA with confirmatory brain imaging and nine reports of TIA. There were 97 (0.90%) reports of neurological events overall, including TIA, visual and speech disturbances, and 29 cases of reported migraine (0.27%). Symptoms occurred at times ranging from minutes to several days following sclerotherapy. Eleven patients with TIA or CVA were found to have a right to left cardiac shunt, usually a patent foramen ovale. CONCLUSIONS: Neurological side effects following sclerotherapy are a rare occurrence; however, CVA associated with the use of sclerotherapy is clearly documented. The pathologic mechanisms resulting in CVA are likely to be different to those leading to migraine and visual disturbances; however, care should be exercised in patient selection, particularly in those with known cardiac defects.


Subject(s)
Nervous System Diseases/etiology , Sclerosing Solutions/adverse effects , Sclerotherapy/adverse effects , Varicose Veins/therapy , Cerebrovascular Disorders/etiology , Humans , Migraine Disorders/etiology , Risk Assessment , Risk Factors , Speech Disorders/etiology , Time Factors , Vision Disorders/etiology
12.
Curr Vasc Pharmacol ; 9(3): 333-49, 2011 May.
Article in English | MEDLINE | ID: mdl-20807188

ABSTRACT

Hypoxia-inducible factor-1 (HIF-1) is a nuclear transcription factor that is upregulated in hypoxia and co-ordinates the adaptive response to hypoxia by driving the expression of over 100 genes. In facilitating tissues to adapt to hypoxia, HIF-1 may have a role in reducing the cellular damage induced by ischaemia, such as that seen in peripheral arterial disease (PAD), or following acute ischaemic insults such as stroke and myocardial infarction. This therefore raises the possibility of HIF-1 modulation in such contexts to reduce the consequences of ischaemic injury. HIF1 has further been implicated in the pathogenesis of atherosclerosis, abdominal aortic aneurysm (AAA) formation, pulmonary hypertension and systemic hypertension associated with obstructive sleep apnoea. Through a better understanding of the role of HIF-1 in these disease processes, novel treatments which target HIF-1 pathway may be considered. This review summarises the role of HIF-1 in arterial disease, specifically its role in atherosclerosis, ischaemic heart disease, in-stent restenosis following coronary revascularisation, stroke, PAD, AAA formation, pulmonary artery hypertension and systemic hypertension. The potential for exploiting the HIF-1 signalling pathway in developing therapeutics for these conditions is discussed, including progress made so far, with attention given to studies looking into the use of prolyl-hydroxylase inhibitors.


Subject(s)
Drug Delivery Systems , Hypoxia-Inducible Factor 1/metabolism , Vascular Diseases/physiopathology , Animals , Enzyme Inhibitors/pharmacology , Humans , Ischemia/physiopathology , Procollagen-Proline Dioxygenase/antagonists & inhibitors , Signal Transduction , Vascular Diseases/drug therapy
13.
J Vasc Surg ; 53(2): 374-82, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21129895

ABSTRACT

OBJECTIVE: The wide variety of outcome measures to evaluate patients with varicose veins poses significant difficulties when comparing clinical trials. In addition, the relationship between different outcome measures is poorly understood. The aim of this study was to compare anatomical, hemodynamic, and clinical outcomes with disease-specific quality-of-life tools in patients undergoing treatment for varicose veins. METHODS: Patients undergoing treatment for symptomatic veins in a single unit were studied. Assessments included duplex ultrasonography, digital photoplethysmography, evaluation of Venous Clinical Severity Scores and CEAP scores, generic (Short Form 12 [SF12]) and disease-specific (Aberdeen Varicose Vein Questionnaire [AVVQ], and Specific Quality-of-life and Outcome Response-Venous [SQOR-V]) questionnaires. Patients were reviewed at 6 weeks when hemodynamic, clinical, and quality-of-life assessments were repeated. The relationships between these outcomes were assessed. RESULTS: The AVVQ showed a strong positive correlation with the SQOR-V (Spearman coefficient 0.702; P < .001) and weaker, but significant correlations with the SF12 physical and mental component scores and the Venous Clinical Severity Score (VCSS) (P < .001, P = .019, and P < .001, respectively, Spearman correlation). No correlations were observed between the AVVQ and photoplethysmography results (Spearman coefficient -0.042; P = .606), and weak correlations were observed with the AVVQ and anatomical reflux. At 6 weeks, functional, clinical, and hemodynamic measurements were all responsive to changes following interventions; however, correlations observed between changes in disease-specific quality-of-life and generic, clinical, and hemodynamic outcomes were weak. CONCLUSIONS: Both the AVVQ and SQOR-V questionnaire are sensitive and responsive disease-specific questionnaires, which correlate with generic and clinical outcomes to some extent. Anatomical and hemodynamic measurements correlated poorly with functional outcomes both preoperatively and following interventions.


Subject(s)
Hemodynamics , Quality of Life , Varicose Veins/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Catheter Ablation , Female , Humans , Laser Therapy , London , Male , Middle Aged , Photoplethysmography , Predictive Value of Tests , Severity of Illness Index , Surveys and Questionnaires , Time Factors , Treatment Outcome , Ultrasonography, Doppler, Color , Varicose Veins/pathology , Varicose Veins/physiopathology , Varicose Veins/psychology , Varicose Veins/surgery , Young Adult
14.
J Endovasc Ther ; 17(3): 326-31, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20557171

ABSTRACT

PURPOSE: To report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR) of an infrarenal aortic aneurysm (AAA) and survey our surgical colleagues in the UK for their use of this bypass procedure. METHODS: A 74-year-old woman who had an EVAR complicated by renal failure secondary to malposition of the stent-graft underwent successful delayed renal revascularization with hepatorenal and splenorenal bypasses. This case prompted a literature review and preparation of an online 6-part questionnaire regarding the incidence and management of renal impairment following EVAR. The survey invitation was sent to all listed members of the Vascular Society of Great Britain and Ireland. RESULTS: Responses from 68 (10.5%) of the 650 vascular surgeons invited to participate in the survey were analyzed. The combined experience of those who completed the survey was >1500 EVAR procedures per annum. Forty percent (27/68) of the respondents had experienced a case of bilateral renal artery occlusion during EVAR. Two thirds (67%, 18/27) of these surgeons stated a preference for revascularizing the kidneys endovascularly, 7 surgeons would convert to open repair, 1 surgeon favored iliorenal bypass, and another suggested splenorenal bypass. Following intervention, 15 (56%) of 27 surgeons achieved revascularization that resulted in a return to baseline serum creatinine, 7 (26%) achieved partial recovery of the patient's serum creatinine, 3 (11%) had a patient on permanent dialysis, and 2 (7%) had patients who died (after open repair and endovascular procedure, respectively). CONCLUSION: Bilateral renal artery occlusion caused by malposition of a stent-graft is probably underreported. If revascularization of the kidneys by endovascular techniques fails, there is no consensus as to the optimal approach. Delayed revascularization should be considered if the kidneys show concentration of imaging contrast. Hepato-spleno-renal bypass, which has not heretofore been indicated for renal salvage post EVAR, can provide a good functional result in this situation.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Renal Artery Obstruction/surgery , Renal Artery/surgery , Renal Insufficiency/surgery , Splenic Artery/surgery , Aged , Anastomosis, Surgical , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Creatinine/blood , Female , Health Care Surveys , Humans , Radiography , Renal Artery/diagnostic imaging , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/etiology , Renal Artery Obstruction/mortality , Renal Dialysis , Renal Insufficiency/diagnostic imaging , Renal Insufficiency/etiology , Renal Insufficiency/mortality , Reoperation , Salvage Therapy , Saphenous Vein/transplantation , Splenic Artery/diagnostic imaging , Stents , Surveys and Questionnaires , Thrombectomy , Time Factors , Treatment Outcome , United Kingdom
15.
Vasc Endovascular Surg ; 44(4): 274-8, 2010 May.
Article in English | MEDLINE | ID: mdl-20308166

ABSTRACT

OBJECTIVE: To evaluate patient satisfaction following endothermal ablation for varicose veins (VVs). METHODS: A 12-question survey was sent to consecutive patients treated with endothermal ablation--questions related to preprocedure symptoms, recurrence, further treatments, and patient satisfaction. RESULTS: Questionnaires sent a median 12 (range 6-22) months postintervention were returned by 177 (60.0%) of 295 patients; 63 (35.6%) of 177 received treatment for recurrent VVs. Preintervention symptoms included aching (141 [79.7%] of 177), swelling (86 [48.6%] of 177), and heaviness (72 [40.7%] of 177). Improvements in preoperative symptoms were reported by 82.5% (146 of 177). Postintervention recurrence was reported by 87 (49.4%) of 177; 61 (70.1%) of 87 reported a few recurrent varicosities only. Further treatment was required by 11 (6.2%) of 177; 79 (44.6%) of 177 of patients reported no complications. The majority (151 [85.8%] of 176) were satisfied with their treatment. In all, 16 (25.4%) of 62 of patients treated for recurrent VVs were dissatisfied versus 9 (7.9%) of 114 of those with primary VVs (P = .0026). CONCLUSIONS: The majority of patients are satisfied with results following endothermal ablation. Dissatisfaction may be more likely following treatment for recurrent VVs.


Subject(s)
Catheter Ablation , Laser Therapy , Patient Satisfaction , Varicose Veins/surgery , Catheter Ablation/adverse effects , Female , Health Care Surveys , Humans , Laser Therapy/adverse effects , Male , Recurrence , Reoperation , Stockings, Compression , Surveys and Questionnaires , Time Factors , Treatment Outcome , Varicose Veins/complications , Vascular Surgical Procedures
16.
Vasc Endovascular Surg ; 44(3): 212-6, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20150227

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate postoperative pain following endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) and identify risk factors for increased pain. METHODS: Patients undergoing either segmental RFA (VNUS Closure Fast, VNUS Medical Technologies, San Jose, California) or EVLA (980 nm) for varicose veins completed a preoperative disease-specific quality-of-life questionnaire (Aberdeen Varicose Vein Questionnaire [AVVQ]) and a diary card recording postoperative pain, return to normal activities, and return to work. Median 3- and 10-day pain scores were calculated. RESULTS: In all, 81 patients returned diary cards (RFA = 45, EVLA = 36). Patients receiving RFA reported less postoperative pain than those receiving EVLA at 3 days (14.5 vs 25.8 mm, P = .053, Mann-Whitney U test) and 10 days (13 vs 23.3 mm, P = .014, Mann-Whitney U test) and returned to work earlier than those receiving EVLA (median 5 vs 9 days, P = .022). CONCLUSIONS: Patients treated with segmental RFA had less postoperative pain and returned to work quicker than those treated with EVLA.


Subject(s)
Catheter Ablation/adverse effects , Laser Therapy/adverse effects , Pain, Postoperative/etiology , Saphenous Vein/surgery , Varicose Veins/surgery , Adult , Aged , Analgesics/therapeutic use , Female , Humans , Laser Therapy/instrumentation , Linear Models , Male , Middle Aged , Pain Measurement , Pain, Postoperative/prevention & control , Prospective Studies , Risk Assessment , Risk Factors , Sick Leave , Surveys and Questionnaires , Time Factors , Treatment Outcome , Young Adult
17.
Br J Hosp Med (Lond) ; 70(10): 560-5, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19966700

ABSTRACT

Peripheral arterial disease is commonly caused by atherosclerosis, and symptoms depend on the location and size of the affected artery, metabolic demands on the tissue, and the presence or absence of a collateral circulation. This article reviews the current evidence for the diagnosis and management of peripheral arterial disease.


Subject(s)
Intermittent Claudication/therapy , Ischemia/therapy , Peripheral Vascular Diseases/therapy , Aged , Extremities/blood supply , Female , Humans , Intermittent Claudication/etiology , Ischemia/etiology , Male , Peripheral Vascular Diseases/classification , Peripheral Vascular Diseases/complications , Peripheral Vascular Diseases/diagnosis , Prognosis , Risk Factors
18.
J Pediatr Orthop B ; 17(5): 237-40, 2008 Sep.
Article in English | MEDLINE | ID: mdl-19471175

ABSTRACT

Although superficial pin tract infections during limb lengthening are extremely common, most settle spontaneously or with antibiotics. In contrast, deep infection around pin tracts leading to osteomyelitis and abscess formation is much less frequently observed and may need washout and curettage. We report a case of a 10-year-old boy who presented with latent abscess formation at a tibial lengthening site because of Pasteurella, a rare bacterial cause of infection usually associated with animals. To our knowledge, this is the first reported case of abscess formation within regenerate bone associated with this organism and its late presentation in previously well-healed bone is surprising.


Subject(s)
Abscess/diagnosis , Bone Lengthening/adverse effects , Osteomyelitis/diagnosis , Pasteurella Infections/diagnosis , Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Bone Lengthening/methods , Bone Regeneration/physiology , Child , Combined Modality Therapy , Curettage/methods , Drainage/methods , Follow-Up Studies , Humans , Male , Osteomyelitis/therapy , Pasteurella Infections/therapy , Radiography , Risk Assessment , Tibia/diagnostic imaging , Tibia/surgery , Time Factors , Treatment Outcome
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