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1.
Medicine (Baltimore) ; 98(44): e17757, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689833

RESUMO

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.


Assuntos
Cateteres de Demora/normas , Protocolos Clínicos , Neoplasias/enfermagem , Dispositivos de Acesso Vascular/normas , Adulto , Idoso , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Trombose/etiologia , Dispositivos de Acesso Vascular/efeitos adversos
2.
Br J Nurs ; 28(18): 1170-1174, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597070

RESUMO

BACKGROUND: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. AIM: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). METHOD: an observational service evaluation. FINDINGS: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. CONCLUSION: securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.


Assuntos
Nutrição Enteral/instrumentação , Falha de Equipamento/estatística & dados numéricos , Unidades de Terapia Intensiva , Intubação Gastrointestinal/instrumentação , Nutrição Enteral/métodos , Humanos , Intubação Gastrointestinal/métodos
3.
J Clin Nurs ; 28(23-24): 4488-4495, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31410906

RESUMO

AIMS AND OBJECTIVES: To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. BACKGROUND: Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. DESIGN: Prospective, observational study. We have complied with the STROBE checklist of items. METHODS: This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. RESULTS: A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. CONCLUSIONS: The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. RELEVANCE TO CLINICAL PRACTICE: The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Adulto , Cateterismo Periférico/enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
4.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(4): 303-306, 2019 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-31460728

RESUMO

OBJECTIVE: To explore the high-risk fault risk of CT simulator and the main causes of the risk, and to put forward effective risk management strategies. METHODS: The failure mode and effect analysis method was used to identify and control the operational fault risk of CT simulator. RESULTS: 5 major fault components, 8 fault failure models and 17 failure causes were analyzed. The top 5 failure causes are:anode target surface burn caused by direct scanning without warming up the tube (590.4), tube failure (518.2), burnout of joints caused by aging of high voltage cables (424.2), motor carbon brush wear (304.8) and belt break (296.4). CONCLUSIONS: The failure mode and effect analysis method can effectively identify the risk of equipment failure, and thus specifically formulate risk management and control measures to ensure the normal operation of equipment and the safety of doctors and patients.


Assuntos
Falha de Equipamento , Gestão de Riscos , Tomografia Computadorizada por Raios X , Falha de Equipamento/estatística & dados numéricos , Humanos , Gestão de Riscos/métodos , Tomografia Computadorizada por Raios X/normas
5.
Isr Med Assoc J ; 21(6): 399-403, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280509

RESUMO

BACKGROUND: Hysterectomy is common in the management of symptomatic uterine prolapse. Vaginal wall repair is often necessary, for which vaginal mesh remains a popular option. OBJECTIVES: To evaluate the risk of mesh erosion following mesh-augmented vaginal prolapse repair, with or without concomitant vaginal hysterectomy. METHODS: This retrospective cohort comprised 70 women who underwent vaginal mesh-augmented pelvic organ prolapse repair from 2007 to 2010. Of the participants, 36 (51.4%) had a vaginal hysterectomy concomitant to the anterior and/or posterior vaginal mesh repair (hysterectomy group) and 34 (48.6%) underwent mesh repair without vaginal hysterectomy (no hysterectomy group). RESULTS: There were no inter-group differences in age, parity, menopausal state, hormonal use, or presenting symptoms. Previous prolapse repair surgery was much more common in the no hysterectomy group (29.4% vs. 5.5%, P = 0.01). Eleven patients (32.3%) in the no hysterectomy group had previously undergone hysterectomy. Anterior mesh repair was performed in 77.7% and 67.6% of hysterectomy and no hysterectomy patients, respectively. Posterior mesh repair was performed in 27.7% and 44.1%, respectively. One patient in the hysterectomy group underwent immediate removal of mesh due to infection. Surgically treated mesh erosion (limited local excision) occurred in three patients (8.3%) in the hysterectomy group (3, 16, and 18 months following surgery) and in two patients (5.8%) in the no hysterectomy group at 6 months following surgery (P = 0.67). CONCLUSIONS: Vaginal mesh-augmentation concomitant with vaginal hysterectomy for pelvic organ prolapse repair does not carry an increased risk of erosion.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Histerectomia Vaginal , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco
6.
Urology ; 131: 125-129, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31158353

RESUMO

OBJECTIVE: To introduce a quality improvement initiative tracking robotic instrument failures on a per case basis. It is imperative to understand rates of failure, financial implications of failures, and identify factors suggesting common mechanisms of failure. MATERIALS AND METHODS: Starting in January 1, 2014 a quality reporting system for failed robotic equipment began. Staff was instructed to submit an incident report when a robotic instrument failed and the instrument returned to central processing. Instruments were then returned to the manufacturer (Intuitive Surgical Inc, Sunnyvale, CA) for analysis and reimbursement. Results of failure analysis by the manufacturer, including reimbursement rates, were recorded and correlated with the procedure and surgical specialty. RESULTS: A total of 3935 robotic cases were performed during the study period with a reported instrument failure incidence of 6.2% (247 total instruments). Etiology of instrument failure was as follows: tip or wrist (46.9%), cable (30.0%), unknown (12.6%), control housing (5.3%), and shaft (3.2%). Highest instrument failure incidence was seen in colorectal surgery cases at 4.0%, Urology had the lowest at 2.7%. Manufacturer reimbursement rate was 57.9%; the most common reason for denial being mishandling/misuse of equipment, determined by manufacturer analysis. CONCLUSION: Herein, we have demonstrated that improved process flow of reporting is necessary to better track incidence and etiology of instrument failures. Cost savings comes from improved training of not only surgeons but operating room and central processing staff in handling equipment to prevent high rates of reimbursement denial.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/normas , Humanos
7.
Aerosp Med Hum Perform ; 90(7): 637-642, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31227038

RESUMO

INTRODUCTION: Despite the large number of U.S. military members who conduct parachuting operations, its inherent safety risks, and the introduction of a new military parachute in 2010, little has been published in the last decade on U.S. military parachute fatalities.METHODS: Parachute fatality investigative records maintained by the U.S. Army Combat Readiness Center were reviewed for U.S. Army fatalities resulting from military parachuting operations from January 1, 2010, through December 31, 2015. De-identified data on cases were collected, including causes, lethal injuries, and demographic, environmental, and missional factors. A descriptive analysis was performed.RESULTS: There were 13 cases which met study inclusion criteria. Most occurred during static-line operations and were jumps from a C-17 aircraft using a T-11 parachute. The two most common assigned accident codes were "improper or abnormal exit" and "unstable or improper body position," which combined accounted for 33% of cases. Also noteworthy at 11% each were "entanglement," "parachute malfunction," and "dragged on the drop zone," and at 6% each were "static line injury," "lost or stolen air," and "drop zone hazard." In 69% of cases blunt force trauma was the cause of death.DISCUSSION: Incident factors included human actions, equipment failure, and the environment. Death from blunt force trauma upon impact with the ground as the most frequent lethal injury was expected for parachute operations. This descriptive study provides awareness to military leaders of circumstances in which fatalities occur. Future investigations should include data on the total number of jumps to provide a more comprehensive analysis of risk.Johnson ES, Gaydos SJ, Pavelites JJ, Kotwal RS, Houk JE. U.S. Army parachute mishap fatalities: 2010-2015. Aerosp Med Hum Perform. 2019; 90(7):637-642.


Assuntos
Acidentes Aeronáuticos/mortalidade , Medicina Aeroespacial/estatística & dados numéricos , Aviação/estatística & dados numéricos , Militares/estatística & dados numéricos , Acidentes Aeronáuticos/prevenção & controle , Adulto , Aviação/instrumentação , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
8.
Anaesthesia ; 74(7): 891-895, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31069798

RESUMO

Tracheal intubation with a double-lumen tube can be more challenging than with a single-lumen tube. A bougie can be used to facilitate intubation. Case reports have described fragment shearing from bougies when they are removed from the tube after intubation. These fragments have the potential to cause harm. It has even been suggested that bougies and double-lumen tubes should not be used together. We conducted a benchtop trial to investigate factors that influence the risk of shearing. We investigated three brands of double-lumen tube (each in three sizes and both lateralities) and four brands of bougie. We simulated one intubation and 29 further insertions/removals of bougie with every bougie-double-lumen tube combination. We inspected the inside of the tube for evidence of shearing after first, tenth and thirtieth removals. We found that brand of bougie, brand of double-lumen tube and size of double-lumen tube (but not its laterality) all influenced the degree of shearing. Certain bougie-double-lumen tube combinations produced a particularly high degree of shearing, so these should be avoided.


Assuntos
Remoção de Dispositivo/métodos , Falha de Equipamento/estatística & dados numéricos , Intubação Intratraqueal/instrumentação , Desenho de Equipamento , Manequins
9.
World Neurosurg ; 128: e329-e333, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028985

RESUMO

OBJECTIVE: To investigate malfunctioning of ventriculoperitoneal shunt (VPS) valves in patients with brain tumors compared with patients with VPS for nontumoral etiologies to identify risk factors for shunt malfunction. METHODS: Medical charts of all adult patients who underwent VPS surgery for hydrocephalus between 2011 and 2016 were reviewed. Incidence and risk factors for revision surgery due to valve malfunction were identified in patients with brain tumors (group A) and patients without brain tumors (group B). RESULTS: Group A comprised 89 patients, and group B comprised 164 patients. The median follow-up time was 17 months for the entire cohort (9.4 months for group A vs. 25 months for group B, P < 0.001). VPS revision was performed in 60 patients (23.7%); 11 revisions involved valve failures necessitating valve replacement. Valve failures were significantly more common in group A (10 group A patients vs. 1 group B patient, P < 0.001). The distal or proximal shunt revision rate for reasons other than the valve was similar for both groups. Group A patients had a significantly higher cerebrospinal fluid protein level (44.5 mg/dL vs. 27.79 mg/dL, P < 0.05), and patients with valve failure had a 3-fold higher cerebrospinal fluid protein level compared with group A patients who experienced any type of shunt failure (96.3 mg/dL vs. 30.6 mg/dL, P < 0.05). CONCLUSIONS: Shunt malfunction occurred mainly in patients with brain tumors and high cerebrospinal fluid protein levels. These patients are at high risk of valve failure and should be closely observed for emergent valve revision.


Assuntos
Neoplasias Encefálicas/complicações , Falha de Equipamento/estatística & dados numéricos , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/secundário , Estudos de Casos e Controles , Estudos de Coortes , Traumatismos Craniocerebrais/complicações , Feminino , Glioma/complicações , Humanos , Hidrocefalia/etiologia , Hidrocefalia de Pressão Normal/cirurgia , Linfoma/complicações , Masculino , Neoplasias Meníngeas/complicações , Meningioma/complicações , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo
10.
Int Heart J ; 60(2): 318-326, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30745538

RESUMO

Implantable cardioverter-defibrillators (ICDs) improve survival in patients who are at risk of sudden death. However, inappropriate therapy is commonly given to ICD recipients, and this situation may be associated with an increased risk of death. This study aimed to construct a risk stratification scheme by using decision tree analysis in patients who received inappropriate ICD therapy.Mortality was calculated from a retrospective data analysis of a multicenter cohort involving 417 ICD recipients. Inappropriate therapy was defined as therapy for nonventricular arrhythmias, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation/flutter, oversensing, and lead failure. Inappropriate therapy included antitachycardia pacing, cardioversion, and defibrillation. The prognostic factors were identified by a Cox proportional hazards regression analysis, and we constructed a decision tree.During an average follow-up of 5.2 years, 48 patients (12%) had all-cause death. A multivariate Cox hazard model revealed that the age (hazard ratio [HR] 1.06, P < 0.001), ln B-type natriuretic peptide (BNP) (HR 1.47, P = 0.02), nonsinus rhythm at implantation (HR 2.70, P < 0.05), and inappropriate therapy occurring during sedentary/awake conditions (HR 3.51, P = 0.001) correlated with an increased risk of mortality. An inappropriate therapy due to abnormal sensing (HR 0.16, P = 0.04) decreased the risk of mortality. Furthermore, a decision tree analysis stratified the patients well by using 4 covariates: BNP, activity at the time of inappropriate therapy, mechanism of inappropriate therapy, and baseline rhythm at ICD implantation (log-rank test, P < 0.0001).We identified the predictors of mortality in inappropriate ICD therapy recipients and constructed a risk stratification scheme by using decision tree analysis.


Assuntos
Arritmias Cardíacas , Morte Súbita Cardíaca , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Idoso , Arritmias Cardíacas/classificação , Arritmias Cardíacas/complicações , Arritmias Cardíacas/mortalidade , Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Árvores de Decisões , Desfibriladores Implantáveis/estatística & dados numéricos , Cardioversão Elétrica/instrumentação , Cardioversão Elétrica/métodos , Análise de Falha de Equipamento/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Análise de Sobrevida
11.
Surg Infect (Larchmt) ; 20(4): 286-291, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30735109

RESUMO

Background: Glove perforation is common during surgery. Surgical gloves are used as personal protective equipment to reduce infection risks from bloodborne pathogens for both the surgical team and patients. This research was conducted to determine the perforation rates of gloves worn in open abdominal surgery performed in a general surgery department and the risk factors affecting perforation. Methods: This research was designed as an observational prospective cohort study including 70 open abdominal operations. There were four members of the surgical team (surgeon, first assistant, second assistant, and scrub nurse). A total of 280 (70 × 4) pairs of gloves in 70 consecutive open abdominal procedures were included in this study. A total of 140 unused gloves were tested as control group to assess perforations and pre-existing leaks. After the operation, all gloves were checked for water impermeability using the EN455-1 method and the presence or absence of a puncture hole was recorded. Results: Glove perforation was detected in 54.3% of operations. The rate of perforation in all gloves was 10.7%, of which 78% unnoticed by the surgical team during surgical procedure. It was determined that the puncture in the gloves was mostly on the non-dominant hand (left). For the left-hand glove, the highest number of holes was observed on the index finger (21.1%) and palm/dorsum of the hand (21.1%). The risk of glove perforation was 5.8 times greater for surgeons compared with the other team members, and operation time of 61 minutes or longer increased the risk of perforation by 12.77 times. Conclusions: Glove perforation rates are high in open abdominal surgery. The highest number of perforations occurred in the non-dominant hand (left) has a high rate of perforation in surgeons and long operations. It may be beneficial for surgical team members to change gloves at certain intervals during surgery or use indicator glove systems.


Assuntos
Cavidade Abdominal/cirurgia , Falha de Equipamento/estatística & dados numéricos , Luvas Cirúrgicas , Procedimentos Cirúrgicos Operatórios/métodos , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco
12.
Medicine (Baltimore) ; 98(3): e14179, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30653165

RESUMO

Although endoscopic ultrasound (EUS)-guided transmural drainage of pancreatic fluid collections with metal stents is generally preferred over plastic stents, its superiority among different types of metal stents has not yet been well studied. We conducted this study to compare clinical outcomes and complications of a novel self-expanding biflanged metal stent (BFMS) and a traditional-shaped tubular metal stent (TMS) in treating pancreatic pseudocyst (PPC).This was a retrospective analysis on consecutive patients with PPC underwent EUS-guided transmural drainage with either TMS or BFMS in a single tertiary center with expertise in management of complex biliary and pancreatic problems. The technical and functional success rate, reintervention, complications, and recurrence rate were evaluated.From September 2013 to January 2018, 125 patients (66.4% male, median age 47 years) underwent EUS-guided transmural drainage for PPC. Among them, 49 used TMS and 76 used BFMS. All patients met the inclusion criteria that cyst diameter was >6 cm or the distance between cyst and stomach wall was shorter than 1 cm. There was no difference in technical success (98% vs 97.4%, P = 1.0) or functional success rate (87.8% vs 92.1%, P = .54) using 2 types of metal stents. However, more procedure related complications occurred in TMS than in BFMS group. TMS group had a much higher migration rate than BFMS group (14.6% vs 0, P = .001), even though there was no significant difference in bleeding, infection, or death rate between 2 groups. With similar clinical outcomes, TMS group required more additional plastic stent placement than BFMS group for better drainage.TMS and BFMS placement can both be considered as methods of endoscopic transmural PPC drainage with equal efficacy, whereas BFMS could be preferred for fewer complications or less need of additional plastic stent placement.


Assuntos
Drenagem/métodos , Endossonografia/métodos , Pseudocisto Pancreático/cirurgia , Stents/efeitos adversos , Ultrassonografia de Intervenção/métodos , Adulto , Idoso , Estudos de Coortes , Drenagem/efeitos adversos , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Pâncreas/patologia , Pâncreas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
World Neurosurg ; 125: e229-e235, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30684709

RESUMO

OBJECTIVE/BACKGROUND: The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure. METHODS: In the period of 2006-2015, ETV was attempted in 47 patients >6 months old with ventriculoperitoneal shunt malfunction who presented with increased ventricle size compared with the previous neuroradiological examinations; simultaneously the shunt was removed or ligated. RESULTS: The overall success rate of secondary ETV was 74% (shunt-free patients with normalized intracranial pressure and absence of symptoms attributable to hydrocephalus) in patients with a long shunt duration (up to 30 years). The number of previous shunt revision procedures (P = 0.026) and lower age (P = 0.017) correlate with the likelihood of secondary ETV failure, a score of 80 as ETV success score (calculated for both pediatric and adult patients, even if the score was meant for the pediatric population) correlates with secondary ETV success (P = 0.014). CONCLUSIONS: Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia/cirurgia , Ventriculostomia/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Criança , Pré-Escolar , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Ventriculostomia/métodos , Adulto Jovem
15.
J Arthroplasty ; 34(3): 439-445, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30503322

RESUMO

BACKGROUND: The aim of this study is to investigate complications following medial opening-wedge high tibial osteotomy using a locking plate. In addition, we aimed to compare postoperative outcomes between the complicated and the uncomplicated group. METHODS: This study enrolled 209 patients who underwent medial opening-wedge high tibial osteotomy between 2010 and 2015. Patients with a follow-up period of at least 2 years were enrolled. Medical records and radiologic data were retrospectively reviewed. The complications were assessed up to postoperative 2 years and categorized into major and minor complications. The preoperative and postoperative clinical statuses were assessed using the Western Ontario McMaster University Osteoarthritis Index. RESULTS: The mean patient age was 56.4 ± 5.9 years. Overall complication rate was 29.7%. Minor complications included undisplaced lateral hinge fracture (12.0%), hardware irritation (1.4%), displaced lateral hinge fracture (2.4%), delayed wound healing (1.9%), undisplaced lateral tibial plateau fracture (1%), and superficial wound infection (1%). Major complications were symptomatic hardware which needed hardware removal (4.8%), deep wound infection (1.9%), hardware failure with correction loss (1%), nonunion (0.5%), and early conversion to arthroplasty (0.5%). Most complications occurred intraoperatively (30.6%) and within 3 months postoperatively (40.3%). The major complication group showed a statistically higher Western Ontario McMaster University Osteoarthritis Index score than did other groups at postoperative 1 year (P = .013) and 2 years (P = .001). CONCLUSION: The overall complication rate was 29.7%. Most complications were minor. The most common complication was undisplaced lateral hinge fracture. Major complications occurred in 8.6%. The major complication group showed significantly worse clinical outcomes than did the uncomplicated and minor complication groups.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Tíbia/cirurgia , Placas Ósseas , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/instrumentação , Osteotomia/métodos , Complicações Pós-Operatórias/etiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
16.
Perit Dial Int ; 39(2): 142-146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30478139

RESUMO

BACKGROUND: The weighted catheter has shown promising results in retrospective and randomized studies. We examined its usefulness in patients with previous failed non-weighted peritoneal dialysis (PD) catheters or previous abdominal surgery. METHODS: The insertion, start, end, and removal dates were recorded for all-type catheter insertions from 2011 to 2016. Primary and secondary failure rates were recorded, defined as failure to ever establish flow (primary) or failure after a period of successful PD (secondary). Patients were censored from analysis if PD ended due to death, transfer of care, transfer to hemodialysis, transplantation, or if the patient recovered renal function. RESULTS: There were 44 weighted, 75 non-weighted open surgical, and 143 percutaneous catheters. There was previous abdominal surgery in 29% and 6% of patients receiving surgically inserted and percutaneous catheters, respectively (p < 0.0001). Primary failure rates were 4/44 (9%), 20/75 (27%), and 26/143 (18%) in weighted, non-weighted surgical, and percutaneous catheters, respectively. There were reduced primary and secondary failure rates in the weighted (9% primary and 15% secondary) versus non-weighted surgically inserted group (27% primary and 46% secondary) (p = 0.04). There was no difference between primary (p = 0.15) and secondary (p = 0.5) failure rates between weighted and percutaneously inserted catheters. Kaplan-Meier survival analysis revealed overall increased catheter survival in the weighted group (p = 0.02). CONCLUSION: Weighted catheters were associated with increased survival and decreased failure rates compared with non-weighted surgical catheters, despite usage in patients at higher risk of catheter failure due to previous failed catheters and abdominal surgery.


Assuntos
Cateteres de Demora , Falha de Equipamento , Diálise Peritoneal/instrumentação , Falha de Equipamento/estatística & dados numéricos , Humanos , Medição de Risco , Resultado do Tratamento
17.
Prog Urol ; 29(1): 36-44, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30344105

RESUMO

INTRODUCTION AND OBJECTIVES: The periurethral adjustable balloons (PUAB) Pro-ACT™ are less invasive technique to treat non-severe forms of post-radical prostatectomy urinary incontinence (pRP-UI), like sub-urethral trans-obturator male sling. Few data of efficiency are available for their use in second line treatment after male sling failure. OBJECTIVE: To evaluate the efficiency of PUAB Pro-ACT™ (Uromedica, Inc., MN, USA) in the second line treatment for non-severe pRP-UI after male sling failure. MATERIALS AND METHODS: Single center retrospective study of patients treated with male sling (17 Advance™, 1 TOMS™) between 2009 and 2015. The continence results were evaluated by the number of pad per day and the quality of life assessment by the I-QOL questionnaire. The "cure" was defined as no pad and "improved" as decreased more than 50 % of pads use. RESULTS: Eighteen patients were included with median follow-up of 21.5 [14-44] months. Two patients (11.1 %) had a past history of pelvic radiotherapy. The median pads per day used was 2 [1-3] after male sling insertion and before Pro-ACT™ device insertion. After Pro-ACT™ device insertion, the median pads per day used was 0 [0-1], with 77.7 % of patients cured and 22.2 % improved. The median quality of life score I-QOL, was 52.2 [23.3-62.6] and 83 [31.8-97.7], respectively before and after Pro-ACT™ device insertion (P<0.001). Nine (60 %) patients rated their incontinence severity as mild, four (26.6 %) as middle and two (13.3 %) as severe, after balloon insertion. The median volume of adjustment was 3 [2-6] mL. CONCLUSIONS: The PUAB Pro-ACT™ have a significant efficiency for use after male sling failure and can be used in second line therapy. LEVEL OF EVIDENCE: 3.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Prostatectomia/efeitos adversos , Implantação de Prótese/estatística & dados numéricos , Slings Suburetrais/efeitos adversos , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Idoso , Idoso de 80 Anos ou mais , França/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , Reoperação/instrumentação , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Slings Suburetrais/estatística & dados numéricos , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/estatística & dados numéricos
18.
J Pediatr Surg ; 54(1): 165-169, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30466713

RESUMO

INTRODUCTION: Central venous catheter (CVC) fracture is a common complication. The aim of this study is to examine risk factors resulting in CVC fracture and compare outcomes of children undergoing CVC repair versus replacement. METHODS: A retrospective chart review was conducted from 2000 to 2016 for children with tunneled CVCs. Children with CVC fractures were compared to those without to identify risk factors resulting in fracture. Children with fractured CVCs were divided into repair or replacement treatment groups and outcomes compared. A logistic regression model determined independent predictors of CVC-associated bloodstream infections (CLABSI) after fracture. RESULTS: In the 236 children with CVCs, the fracture rate was 29.2%. Fractured CVCs were more common with double lumen CVC (p = 0.040) and children whose indication was total parenteral nutrition (p = 0.003). Given children often underwent multiple repairs or replacements. 98 CVC repairs and 41 replacements were analyzed. CVC replacements had longer durability than repair (181.98 vs. 98.9 days, p = 0.038). There were no differences in CLABSI incidence for repair vs. replacement (OR 0.5 CI 0.05-4.97) after controlling for other factors. CONCLUSIONS: CVC fracture is a frequent complication in children with tunneled CVCs. CVC repair has no increased incidence of CLABSI but eliminates the intraoperative and anesthetic risks of CVC replacement. TYPE OF STUDY: Retrospective cohort study. LEVEL OF EVIDENCE: Level III.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Criança , Pré-Escolar , Estudos de Coortes , Remoção de Dispositivo , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
19.
Ann Thorac Surg ; 107(2): 519-526, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30316851

RESUMO

BACKGROUND: Limited data exist on factors predicting prolonged survival in left ventricular assist device (LVAD) recipients. We sought to identify patient characteristics and complications associated with prolonged survival. METHODS: We conducted retrospective review of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database, including primary continuous-flow LVAD recipients, between May 2012 and March 2013. Patients were identified as having survived with a device in place after 3 years or not, conditional on having initially survived 6 months. Patients who received a transplant, underwent explant due to recovery, or were lost to follow-up before 3 years were excluded. Multivariate logistic regression evaluated perioperative factors and adverse events within 6 months associated with long survival. RESULTS: Of 1,116 patients who survived past the initial 6 months, 725 (65%) survived beyond 3 years. On univariate analysis, long-term survivors were significantly younger, were less likely to be white, supported for destination therapy, have diabetes, solid-organ cancer, or take amiodarone. On multivariate analysis, factors associated with increased odds of death at 3 years included diabetes, amiodarone use, and developing stroke, gastrointestinal bleeding, hemolysis, or pump thrombosis within 6 months of implantation. CONCLUSIONS: Preoperative diabetes and amiodarone use were associated with poor long-term survival in LVAD recipients. Development of early complications of stroke, gastrointestinal bleeding, hemolysis, or pump thrombosis was also associated with poor long-term survival. Early diagnosis and treatment of these complications may improve survival in LVAD recipients.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Sistema de Registros , Medição de Risco/métodos , Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
20.
Int Endod J ; 52(1): 13-18, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29985528

RESUMO

AIM: To assess the fracture incidence of instruments from single-file reciprocating systems when used by students in an endodontic graduate programme. METHODOLOGY: Dental records and periapical radiographs of patients treated by students on an endodontic graduate programme using reciprocating systems were assessed. Data on tooth type, number of treated root canals, number of fractured instruments, fragment size, angle, radius, arc length and position of root canal curvature where fractures occurred were tabulated for analysis. The risk of fracture was calculated for each group of teeth, root canal and root thirds, whilst the incidence of fractures reported for the reciprocating systems was compared using the chi-squared test at 5% significance level. RESULTS: Overall, 2056 root canals (826 teeth) from 810 patients were included. The incidence of fractured files from single-file reciprocating systems in relation to a number of instrumented canals was 0.92%. Fracture rates of 0.84% and 0.93% were found in 830 and 1226 root canals instrumented with WaveOne and Reciproc systems, respectively. No significant differences were observed between the systems. The highest fracture rate was 52.6% in the mesiobuccal root of mandibular molars. The central angle, radius and arc length of the curvature of root canals where the instruments fractured ranged from 58° to 84°, from 1.7 to 7.2 mm and from 2.4 to 7.6 mm, respectively. CONCLUSION: The use of WaveOne and Reciproc single-file reciprocating systems in an endodontic graduate programme was associated with a low incidence of instrument fractures.


Assuntos
Instrumentos Odontológicos , Educação de Pós-Graduação em Odontologia , Falha de Equipamento/estatística & dados numéricos , Preparo de Canal Radicular/instrumentação , Estudantes , Estudos Transversais , Ligas Dentárias , Desenho de Equipamento , Humanos , Incidência , Dente Molar , Estudos Retrospectivos , Preparo de Canal Radicular/métodos
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