• Title/Summary/Keyword: Retrospective approach

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Comparative study of ambulatory versus inpatient laparoscopic cholecystectomy in Thailand: Assessing effectiveness and safety with a propensity score matched analysis

  • Nattawut Keeratibharat;Sirada Patcharanarumol;Sarinya Puranapanya;Supat Phupaibul;Nattaporn Khomweerawong;Jirapa Chansangrat
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.28 no.3
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    • pp.381-387
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    • 2024
  • Backgrounds/Aims: Ambulatory laparoscopic cholecystectomy (LC) is increasingly recognized for its advantages over the inpatient approach, which advantages include cost-effectiveness and faster recovery. However, its acceptance is limited by patient concerns regarding safety, and the potential for postoperative complications. The study aims to compare the operative and postoperative outcomes of ambulatory LC versus inpatient LC, specifically addressing patient hesitations related to early discharge. Methods: In a retrospective analysis, patients who underwent LC were divided into ambulatory or inpatient groups based on American Society of Anesthesiologists (ASA) classification, age, and the availability of postoperative care. Propensity score matching was utilized to ensure comparability between the groups. Data collection focused on demographic information, perioperative data, and postoperative follow-up results to identify the safety of both approaches. Results: The study included a cohort of 220 patients undergoing LC, of which 48 in each group matched post-propensity score matching. The matched analysis indicated that ambulatory LC patients seem to experience shorter operative times and reduced blood loss, but these differences were not statistically significant (35 minutes vs. 46 minutes, p-value = 0.18; and 8.5 mL vs. 23 mL, p-value = 0.14, respectively). There were no significant differences in complication rates or readmission frequencies, compared to the inpatient cohort. Conclusions: Ambulatory LC does not compromise safety or efficacy, compared to traditional inpatient procedures. The findings suggest that ambulatory LC could be more widely adopted, with appropriate patient education and selection criteria, to alleviate concerns and increase patient acceptance.

Routine 6-Week Outpatient Radiography and Visit in Patients with Conservatively Treated Multiple Rib Fractures: Valuable or a Waste of Resources?

  • Felix Peuker;Thomas Philip Bosch;Roderick Marijn Houwert;Ruben Joost Hoepelman;Menco Johannes Sophius Niemeyer;Mark van Baal;Fabrizio Minervini;Frank Johannes Paulus Beeres;Bryan Joost Marinus van de Wall
    • Journal of Chest Surgery
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    • v.57 no.5
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    • pp.430-439
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    • 2024
  • Background: This study investigated the incidence and clinical consequences of abnormal radiological and clinical findings during routinely performed 6-week outpatient visits in patients treated conservatively for multiple (3 or more) rib fractures. Methods: A retrospective analysis was conducted among patients with multiple rib fractures treated conservatively between 2018 and 2021 (Opvent database). The primary outcome was the incidence of abnormalities on chest X-ray (CXR) and their clinical consequences, which were categorized as requiring intervention or additional clinical/radiological examination. The secondary focus was the incidence of deviation from standard treatment in response to the findings (clinical or radiological) at the routine 6-week outpatient visit. Results: In total, 364 patients were included, of whom 246 had a 6-week visit with CXR. The median age was 57 years (interquartile range, 46-70 years) and the median Injury Severity Score was 17 (interquartile range, 13-22). Forty-six abnormalities (18.7%) were found on CXR. These abnormalities resulted in additional outpatient visits in 4 patients (1.5%) and in chest drain insertion in 2 (0.8%). Only 2 patients (0.8%) with an abnormality on CXR presented without symptoms. None of the 118 patients who had visits without CXR experienced problems. Conclusion: Routine 6-week outpatient visits for patients with conservatively treated multiple rib fractures infrequently revealed abnormalities requiring treatment modifications. It may be questioned whether the 6-week outpatient visit is even necessary. Instead, a more targeted approach could be adopted, providing follow-up to high-risk or high-demand patients only, or offering guidance on recognizing warning signs and providing aftercare through a smartphone application.

Assessment of ultrasound-guided intercostal nerve block for acute herpes zoster and its' possible prophylaxis for postherpetic neuralgia: a retrospective and case-controlled trial

  • Xiuhua Li;Rong Yuan;Yanwei Yang;Zhenlong Qin;Runqiao Fu
    • The Korean Journal of Pain
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    • v.37 no.4
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    • pp.343-353
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    • 2024
  • Background: This study aimed to compare the intercostal nerve block (ICNB) and thoracic paravertebral block (TPVB) for acute herpes zoster-associated pain (ZAP) and possible prophylaxis for post-herpetic neuralgia (PHN). Methods: This study enrolled 128 patients with ZAP. Their records were stratified into standard antiviral treatment (AVT) plus US-guided TPVB (the TPVB group), AVT plus US-guided ICNB (the ICNB group) or AVT alone (the control group). Herpes zoster (HZ)-related burden of illness (HZ-BOI) within the post-procedural 30 days was defined as the primary endpoint, determined by a composite of pain severity and follow-up duration. Procedure time, rescue analgesic requirement, PHN incidence, health-related quality of life and side effects were also recorded. Results: Significantly lower HZ-BOI-AUC30 was reported in the TPVB and ICNB groups as compared to the control group, with a mean difference of 57.5 (P < 0.001) and 40.3 (P = 0.003), respectively. However, there was no difference between the TPVB and ICNB groups (P = 0.978). Both TPVB and ICNB reported significantly greater improvements in PHN incidence, EQ-5D-3L scores and rescue analgesic requirements during follow-up, as opposed to the control AVT. Shorter procedure time was observed in ICNB as compared to TPVB (16.47 ± 3.39 vs. 11.69 ± 2.58, P < 0.001). Conclusions: Both US-guided TPVBs and ICNBs were effective for ZAP, and accounted for possible prophylaxis for PHN, as compared to AVT alone. The ICNB approach could be recommended as an alternative to conventional TPVB with a better consumed procedure time and side effect profile.

Learning Curve of the Direct Anterior Approach for Hip Arthroplasty (직접전방 접근법을 통한 인공 고관절 치환술의 학습곡선)

  • Ham, Dong Hun;Chung, Woo Chull;Choi, Byeong Yeol;Choi, Jong Eun
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.2
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    • pp.143-153
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    • 2020
  • Purpose: To evaluate the timing of the improvement in surgical skills of the direct anterior approach for hip arthroplasty through an analysis of the clinical features and learning curve in 58 cases. Materials and Methods: From November 2016 to November 2018, 58 patients, who were divided into an early half and late half, and underwent hip arthroplasty by the direct anterior approach, were enrolled in this retrospective study. The operation time and complications (fracture, lateral femoral cutaneous nerve injury, heterotopic ossification, infection, and dislocation) were assessed using a chi-square test, paired t-test, and cumulative sum (CUSUM) test. Results: The mean operation times in total hip arthroplasty (26 cases) and bipolar hemi-arthroplasty were 132.1 minutes and 79.7 minutes, respectively, demonstrating a significant difference between the two groups. CUSUM analysis based on the results revealed breakthrough points of the operation time, decreasing to less than the mean operation time because of the 16th case in total hip arthroplasty and 14th case in bipolar hemiarthroplasty. Complications were encountered in the early phase and late phase: five cases of fractures in the early phase, no case in the late phase; eight and two cases of lateral femoral cutaneous nerve injury, respectively; three and two cases of heterotopic ossification, respectively; and one case of dislocation, one case of infection and three cases of others in the early phase. The CUSUM chart for the fracture rate during operation in the early phase revealed the following: five cases fracture (17.2%) in the early phase and no case in the late phase (0%). This highlights the learning curve and the need for monitoring the inadequacy of operation based on the complications. Conclusion: Hip arthroplasty performed by the direct anterior approach based on an anatomical understanding makes it difficult to observe the surgical field and requires a learning curve of at least 30 cases.

Aseptic Humeral Nonunion: What Went Wrong? What to Do? A Retrospective Analysis of 20 Cases

  • Kim, Jinil;Cho, Jae-Woo;Cho, Won-Tae;Cho, Jun-Min;Kim, Namryeol;Kim, Hak Jun;Oh, Jong-Keon;Kim, Jin-Kak
    • Journal of Trauma and Injury
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    • v.29 no.4
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    • pp.129-138
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    • 2016
  • Purpose: Due to recent advances in internal fixation techniques, instrumentation and orthopedic implants there is an increasing number of humeral shaft fracture treated operatively. As a consequence, an increased number nonunion after operative fixation are being referred to our center. The aim of this study is to report the common error during osteosynthesis that may have led to nonunion and present a systematic analytical approach for the management of aseptic humeral shaft nonunion. Methods: In between January 2007 to December 2013, 20 patients with humeral shaft nonunion after operative procedure were treated according to our treatment algorithm. We could analysis x-rays of 12 patients from initial treatment to nonunion. In a subgroup of 12 patients the initial operative procedure were analyzed to determine the error that may have caused nonunion. The following questions were used to examine the cases: 1) Was the fracture biology preserved during the procedure? 2) Does the implant construct have enough stability to allow fracture healing? Results: In 19 out of 20 patients have showed radiographic evidence of union on follow up. One patient has to undergo reoperation because of the technical error with bone graft placement but eventually healed. There were 2 cases wherein the treatment algorithm was not followed. All patients had problems with mechanical stability, and in 13 patients had biologic problems. In the analysis of the initial operative fixation, only one of 12 patients had biologic problems. Conclusion: In our analysis, the common preventable error made during operative fixation of humeral shaft fracture is failure to provide adequate stability for bony union to occur. And with these cases we have demonstrated a systematic analytic management approach that may be used to prevent surgeons from reproducing the same fault and reduce the need for bone grafting.

A Study on Seeking an Alternative Approach to the Remedy for Breach of the Duty of Disclosure in English Marine Insurance Law (영국 해상보험법에서 고지의무 위반에 대한 구제의 대안에 관한 연구)

  • Shin, Gun-Hoon
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.24
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    • pp.25-49
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    • 2004
  • English contract law has traditionally taken the view that it is not the duty of the parties to a contract to give information voluntarily to each other. In English law, one of the principal distinctions between insurance contract law and general contract law is the existence of the duty of disclosure in insurance law. This article is, therefore, designed to analyse the scope or extent of the duty of disclosure and the remedy for breach of the duty in English marine insurance law. The main purpose of this article is also to seek the alternative remedy for the breach. The results of analysis are as following : First, the scope of the duty of disclosure is closely related to the test of materiality and the concept of a hypothetical prudent insurer. The assured is required to disclose only material circumstances subject to MIA 1906, s. 18(1). The test of materiality, which had caused a great deal of debate in English courts over 30 years, was finally settled by the House of Lords in Pan Atlantic and the House of Lords rejected the 'decisive influence' test and the 'increased risk' test, and the decision of the House of Lords is thought to accept the 'mere influence' test in subsequent case by the Court of Appeal. Secondly, an actual insurer is, in order to avoid contract, required to provide proof that he is induced to enter into the contract by reason of the non-disclosure of the assured. But this subjective test of actual inducement is somewhat meaningless in sense that English court takes the test of materiality as a starting point and assumes the presumption of inducement even in case of no clear proof on the inducement. Finally, MIA 1906, s. 18 provides expressly for the remedy of avoidance of the contract for breach of the duty of disclosure. This means rescission or retrospective avoidance of the entire contract, and the remedy is based upon a fairly crude 'all-or-nothing' approach. The remedy of rescission is too draconian from the point of view of the assured, because he can be deprived of all cover despite he is innocent perfectly. An inadvertent breach from an innocent mistake is as fatal as wilful concealment. What is, therefore, needed in English marine insurance law with respect to remedy for the breach is to introduce a more sophisticated or proportionate remedy ascertaining degrees of fault.

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Laparoscopic Retroperitoneal Nephroureterectomy is a Safe and Adherent Modality for Obese Patients with Upper Urinary Tract Urothelial Carcinoma

  • Matsumoto, Kazumasa;Hirayama, Takahiro;Kobayashi, Kentaro;Hirano, Syuhei;Nishi, Morihiro;Ishii, Daisuke;Tabata, Ken-ichi;Fujita, Tetsuo;Iwamura, Masatugu
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3223-3227
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    • 2015
  • Objective: We evaluated the association of body mass index (BMI) with perioperative outcomes in patients who underwent laparoscopic or open radical nephroureterectomy. Materials and Methods: This retrospective single-center study included 113 patients who had been diagnosed with upper urinary tract cancer from January 1998 to June 2013 and were treated with laparoscopic nephroureterectomy (Lap group, n=60) or open nephroureterectomy (Open group, n=53). Laparoscopic nephroureterectomy was performed via a retroperitoneal approach following an open partial cystectomy. The two surgical groups were stratified into a normal-BMI group (<25) and a high-BMI group ($BMI{\geq}25$). The high-BMI group included 27 patients: 13 in the Lap group and 14 in the Open group. Results: Estimated blood loss (EBL) in the Lap group was much lower than that in the Open group irrespective of BMI (p<0.01). Operative time was significantly prolonged in normal-BMI patients in the Lap group compared to those in the Open group (p=0.03), but there was no difference in operative time between the Open and Lap groups among the high-BMI patients. Multivariate logistic regression analysis of the data for all the cohorts revealed that the open procedure was a significant risk factor for high EBL (p<0.0001, hazard ratio 8.02). Normal BMI was an independent predictor for low EBL (p=0.01, hazard ratio 0.25). There was no significant risk factor for operative time in multivariate analysis. There were no differences in blood transfusion rates or adverse event rates between the two surgical groups. Conclusions: Laparoscopic radical nephroureterectomy via a retroperitoneal approach can be safely performed with significantly reduced EBL even in obese patients with upper urinary tract cancer.

The Impact of M&L Psychotherapy on the Growth and Development of a Socially Disadvantaged Adolescent with Anxiety Disorders - Quantitative and Qualitative Analysis of a Single Case (M&L 심리치료가 불안장애를 가진 취약계층 청소년의 건강한 성장에 미치는 영향 - 단일증례의 양적, 질적 분석)

  • Jae-Wook Shin;Haegue Shin;Min-Joo Lee;Dong-Uk Kim;Hyo-Weon Suh;Hyung Won Kang
    • Journal of Oriental Neuropsychiatry
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    • v.35 no.1
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    • pp.115-140
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    • 2024
  • Objectives: This study investigates the impact of M&L psychotherapy on an adolescent with anxiety disorders transitioning into adulthood, using a retrospective mixed-method approach. Methods: An adolescent with Diagnostic Statistical Manual of Mental Disorders (DSM)-5-diagnosed anxiety disorders underwent combined treatment with M&L psychotherapy and complex Korean medicine therapy over a period of approximately two years. Patient records tracked the diagnosis, treatments, and progress. In-depth interviews were also conducted. The study used a convergent parallel mixed-method approach, integrating quantitative analysis from psychological assessments, including the State-Trait Anxiety Inventory (STAI-X), the Core Seven Emotions Inventory-short form (CSEI-s), and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), with qualitative analyses of traditional Korean medicine counseling session notes, interviews, and other qualitative psychological assessments. Results: State anxiety decreased from 40 to 36, and trait anxiety decreased from 42 to 34. MMPI-2 L scale scores decreased slightly to 64T, whereas S scale scores increased to 62T, and FRS scores decreased to 70T from an initial score of 78T. Qualitative analysis revealed an increase in the MMPI-2 Es scale, identified as "subjectivity." Joy (喜) emerged as the highest emotional profile score in the CSEI-S. Scores for anger (怒), thought (思), fear (恐), and fright (驚) decreased, indicating improved negative emotions. Qualitatively, expressions of determination to "move forward" and "strengthen the mind" were noted, suggesting enhanced "lower danjeon (下丹田)." Conclusions: Integrating traditional Korean medicine treatment with M&L psychotherapy for a vulnerable adolescent with anxiety disorders demonstrated efficacy. Further research is warranted to substantiate the effectiveness of M&L psychotherapy and advocate for its wider adoption in mainstream practice.

Comparison of the Injury Mechanism, Pattern and Initial Management Approach for Orthopedic Injuries According to the Injury Severity in Moderate-to-Severe Injured Patients (중등도 이상의 손상 환자에서 손상 중증도에 따른 정형외과적 손상에 대한 수상기전, 손상유형, 초기 치료적 접근의 비교)

  • Lee, Eui-Sup;Sohn, Hoon-Sang;Kim, Younghwan;Shon, Min Soo
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.5
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    • pp.383-396
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    • 2020
  • Purpose: This study compared the injury mechanism, site, type, initial management approach of orthopedic injury, and outcomes according to the injury severity in moderate-to-severe injured patients. Materials and Methods: During 57-month, excluding the period when the authors' emergency/trauma center was not operating, from 2014 to 2019, a retrospective study was conducted on 778 patients with orthopedic injuries among patients with an Injury Severity Score (ISS)>9 scored. The patients were classified into moderate-injured group (group-1, 679) and severe-injured group (group-2, 99) according to the injury severity based on the ISS and physiologic parameters. The injury mechanism and non-orthopedic injury were evaluated. Orthopedic injuries were assessed according to the injury pattern and the number of anatomical regions and bone sites involved. The management approach for the orthopedic injuries in two groups was compared. Outcomes (hospital stay, systemic complications, and in-hospital mortality) were evaluated, and the risk factors for mortality were analyzed. Results: In group-2, the incidence of younger males, high-energy mechanisms, and accompanying injuries was significantly higher than in group-1. The number of anatomical regions and bone sites involved increased in group-2. The involvement of the pelvis, spine, and upper extremity was significantly higher in group-2, whereas group-1 was involved mainly by the lower extremities. Depending on the patient's condition, definitive or staged management for orthopedic injuries may be used. Group-1 was treated mainly with definite fixation after the physiological stabilization process, and group-2 was treated with staged management using temporary external fixation. The hospital stay was significantly longer in group-2. The overall systematic complications and in-hospital mortality was approximately 4.9% and 4.5%. A higher injury severity was associated with higher in-hospital mortality (2.9%, 15.2%; p<0.0001). Increasing age and high ISS are independent risk factors for mortality. Conclusion: A higher severity of injury was associated with a higher incidence of high-energy mechanism, younger, male, accompanying injuries, and the frequency and severity of orthopedic injuries. Severe polytrauma patients were treated mainly with a staged approach, such as external fixation. The hospital stay, systematic complications, and in-hospital mortality were significantly higher in severe-injured patients. Age and ISS are strong predictors of in-hospital mortality in polytrauma.

A RETROSPECTIVE MULTICENTER CLINICAL STUDY OF INSTALLED US II / SS II IMPLANTS AFTER MAXILLARY SINUS FLOOR ELEVATION (상악동저 거상술 후 Osstem Implant (US II / SS II)의 다기관 후향적 임상연구)

  • Kook, Min-Suk;Park, Hong-Ju;Kim, Su-Gwan;Kim, Young-Kyun;Cho, Yong-Seok;Choi, Gab-Lim;Oh, Young-Hak;Oh, Hee-Kyun
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.34 no.3
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    • pp.341-349
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    • 2008
  • Purpose: The purpose of this study was to evaluate the $Osstem^{(R)}$ implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the $Osstem^{(R)}$ implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.