Complete Success Rate Research Articles

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

Primary aldosteronism subtype discordance between computed tomography and adrenal venous sampling.

The primary aldosteronism (PA) subtype is usually confirmed by CT and adrenal venous sampling (AVS). However, the subtype diagnosis by AVS is not necessarily consistent with the subtype diagnosis by CT. Patients with PA who show bilateral lesions (normal-appearing adrenals or bilateral adrenal nodules) on CT but unilateral disease on AVS are often found. The aim of this study was to evaluate whether patients with PA subtype discordance between CT and AVS obtain benefits from unilateral adrenalectomy. We retrospectively analyzed 362 consecutive patients with PA who underwent both CT and adrenocorticotropic hormone-unstimulated AVS at Kanazawa University Hospital. Surgical outcomes for unilateral PA were evaluated according to the criteria of the Primary Aldosteronism Surgical Outcome study. In our study, the success rate of AVS in patients with bilateral lesions on CT was 89% (191/214). Furthermore, the discordance rate between CT and AVS in patients with bilateral lesions on CT was 39% (74/191). After surgery, patients with bilateral lesions on CT but unilateral disease on AVS (n = 17) had a lower complete biochemical success rate than those with unilateral lesions on CT and ipsilateral disease on AVS (n = 30) (41% vs. 80%, p = 0.01), but clinical and biochemical benefits (the complete and partial success combined) were not significantly different between them (76% vs. 93% (p = 0.11) and 70% vs. 90% (p = 0.10), respectively). In conclusion, patients with bilateral lesions on CT but unilateral disease on AVS benefited from surgery, and AVS should be performed for patients who pursue surgical management when the CT findings suggest bilateral lesions.

Gaps in the College Application Gauntlet

A large literature in higher education research has focused on disparities in rates of successful completion of the various steps along the path that leads to college enrollment (e.g. completing a college preparatory curriculum, taking the SAT or ACT, applying to a college) as an important source of inequitable college attainment between groups of students. In this study, we extend this prior work by explicitly examining race- and income-based gaps in these steps to college enrollment. Drawing on national- and state-representative samples from the High School Longitudinal Study of 2009, we use the V-statistic to calculate race- and income-based gaps in the completion of these steps. We have three main findings. First, we demonstrate that gaps calculated using the V-statistic method differ from gaps calculated using more traditional approaches leading to a new understanding of the size of these gaps. Second, among the steps we analyze, it appears that gaps in academic qualifications are large and similar in size to gaps in college application, admission, and enrollment. Finally, through regression analysis, we show that gaps in academic qualifications and gaps in taking a college entrance exam are the strongest predictors of gaps in the selectivity of eventual enrollment. Policymakers and practitioners interested in closing college enrollment gaps ought to identify interventions that specifically aim to address gaps identified by our analysis early in the postsecondary pathway.

Preliminary efficacy of penetrating canaloplasty in primary angle-closure glaucoma

Objective: To evaluate the preliminary efficacy and safety of penetrating canaloplasty for treating primary angle-closure glaucoma (PACG). Methods: It is a prospective interventional case series study. Twenty-two patients (24 eyes) with PACG were treated with penetrating canaloplasty (video attached) at the Eye Hospital of Wenzhou Medical University from June 2015 to August 2018. This modified canaloplasty was performed by making a window at the corneal-scleral bed. Aqueous was redirected to the opening of Schlemm's canal after the canaloplasty with intension sutures. Postoperative follow-up was made at 1 day, 7 days, 1 month, 3 months, and 6 months. Surgical success was defined as intraocular pressure (IOP) ≤ 21 mmHg (1 mmHg=0.133 kPa) with glaucoma medication (quantified success) and without any glaucoma medication (complete success). Main outcome measures included IOP, number of medication, surgical success rate, complications, and filtering bleb status. One-way repeated measure ANOVA and rank sum test were used in statistical analysis. Results: Due to the failure of circumferential catheterization of the canal, 4 eyes converted to trabeculectomy. A total of 19 PACG patients (20 eyes) achieved the successful 360-degree catheterization of the canal, including 11 males and 8 females. The mean age was (54±7) years old (range: 41-65 years old), and the mean angle-closure range was (326.3±46.6) degrees. The mean preoperative IOP was (38.0±11.9) mmHg with the median medication number of 3 (range: 2-5). The mean postoperative IOP was (14.5±11.1), (16.1±6.0), (17.7±5.5), (15.7±5.0), and (15.4±3.7) mmHg at 1 day, 7 days, 1 month, 3 months, and 6 months, respectively. There was significant difference in IOP between postoperative and preoperative (all P<0.01). The median medication number (range) was 0 (0-3), 0 (0-2), 0(0-3), 0(0-2), and 0 (0-2) at the 5 time points, respectively. There was significant difference in medication number between postoperative and preoperative (all P<0.01). The quantified success rate was 95%(19/20), and the complete success rate was 90%(18/20) at 6 months. Postoperative complications were observed in 7 eyes (35%) of 20 PACG eyes, including 3 eyes (15%) with hyphema, 2 eyes (10%) with shallow anterior chamber, 1 eye (5%) with Descemet membrane detachment, and 1 eye (5%) with filtration obstruction at the trabeculum ostium. According to the results of slit lamp and ultrasound biomicroscopy examinations, 70% of the eyes (14/20) had no filtering bleb. Eight eyes (40%) with IOP spike were observed. Conclusion: Preliminary study shows penetrating canaloplasty is safe and effective in the treatment of PACG, but needs a longer follow-up. (Chin J Ophthalmol, 2019, 55: 448-453).

What is the impact of intravitreal injection of conbercept on neovascular glaucoma patients: a prospective, interventional case series study

BackgroundThe aim of the present study was to evaluate the efficacy and safety of intravitreal conbercept combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma (NVG).MethodsFifty patients (54 eyes) with NVG were included in this prospective study. Fifty-two eyes initially underwent intravitreal conbercept (0.5 mg/0.05 ml) treatment followed by trabeculectomy and panretinal photocoagulation. Preoperative and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucoma medications, and surgical complications were recorded. The levels of VEGF-A, TGF-β1 and PLGF in aqueous humour samples collected during surgery were measured by enzyme-linked immunosorbent assay (ELISA). Light microscopy and transmission electron microscopy were used to observe the surgically excised trabecular tissue; enucleation was performed in 2 eyes, and light microscopy was used as the histopathological control.ResultsThe follow-up period after trabeculectomy was 1 year. Of the 52 eyes, 39 completed 1 year of follow-up, and 13 were lost to follow-up. Recurrence of iris neovascularization was observed in 5 eyes, 9 had hyphema, 16 had filter-bled scarring, and no eye had complications attributable to the drug. The mean IOP was reduced from 48.1 ± 14.2 to 23.2 ± 8.7 mmHg, and the mean number of antiglaucoma medications used decreased from 3.0 (3.0, 4.0) to 1.0 (0.0, 1.0) after 1 year (both P < 0.05). The complete success rate was 76.9, 76.9, 71.0, 51.6, and 32.3% at 1 week, 1 month, 3 months, 6 months and 12 months, respectively, when the cut-off IOP was 18 mmHg. After patients underwent intravitreal injection, the concentrations of VEGF-A and TGF-β1 in the aqueous humour in NVG patients decreased from 168.8 ± 13.4 and 159.6 ± 15.4 pg/ml to 160.2 ± 7.6 and 151.9 ± 2.3 pg/ml, respectively (both P < 0.05). Light microscopy revealed neovascularization regression in the iris in specimens treated with intravitreal conbercept. Electron microscopy revealed trabecular endothelial cell degeneration in the conbercept-treated specimens.ConclusionsOur initial findings suggest that intravitreal conbercept is an effective treatment for managing NVG that has fewer short-term postoperative complications.Trial registrationCurrent Controlled Trials ChiCTR1800019918, 8 December 2018, retrospectively registered.

Gender Differences and Similarities in Accelerated Nursing Education Programs: Evidence of Success From the New Careers in Nursing Program.

The aim of the study was to examine the profile of male students in accelerated nursing education programs (ANEPs) focusing on key demographic, educational, and outcome variables and compare male and female students on these variables. Though ANEPs have proliferated over the last two decades, there has been little study of students enrolled in these programs and, consequently, the role ANEPs could play in enhancing nursing workforce diversity. This study is a secondary analysis of data collected from 3,502 students who participated in the Robert Wood Johnson Foundation New Careers in Nursing Program from 2008 to 2016. ANEP completion and NCLEX-RN success rates were strong overall. Male and female ANEP students differed on several dimensions often associated with academic success, differences that have relevance for purposes of teaching, research, and program planning. ANEPs could be an effective mechanism for increasing the gender, racial, and ethnic diversity of the nursing workforce.

Ologen implant versus mitomycin-C for trabeculectomy: A meta-analysis.

Aim:To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant.Methods:Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications.Results:A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was −3.69 (95% CI: −6.70 to −0.68) at 1 month, −2.69 (−5.17 to −0.21) at 3 months, −3.67 (−6.09 to −1.25)at 6 months, −3.24 (−6.08 to −0.41) at 12 months, 1.24 (−9.43 to 11.90) at 24 months, and 1.10 (−10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10–0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01).Conclusion:Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.

Stop hedging your bets: reasons for non-adherence to a tri-modality regimen in the treatment of esophageal cancer in a multidisciplinary setting.

In locally-advanced esophageal cancer (LAEC), providers' concerns regarding eventual surgical candidacy can persuade physicians to defer to definitive doses of 50 Gy or higher preoperatively. We report the successful completion rate of tri-modality therapy (TMT) (documented at the outset) and reasons for TMT non-adherence at a large multi-disciplinary esophageal program. LAEC patients diagnosed 2007-2016 from a prospective institutional database were subdivided into CRT/S+ [completed chemoradiation (CRT) and surgery] and CRT/S- (CRT and no subsequent surgery) groups. Chart review provided surgery non-adherence reasons. A total of 283 patients met planned TMT criteria: 164 (58.0%) patients received 50 or 50.4 Gy CRT, 27 patients (9.5%) received greater than 50.4 Gy, and 92 patients received less than 50 Gy (32.5%, only 8 patients received CRT to 41.4 Gy); 221 (78.1%) completed surgery (CRT/S+), while 62 (21.9%) failed to advance to surgery (CRT/S-): 25 of 62 CRT/S- patients (40.3%) evidenced metastatic progression before surgery, 4 (6.5%) were deemed unresectable intraoperatively, 4 (6.5%) expired prior to planned surgery (3 from unknown causes, 1 suicide), 8 (12.9%) experienced significant CRT-related medical decompensation and were withdrawn from surgical consideration, 16 (25.8%) voluntarily declined surgery post-CRT (largely due to long-term quality of life concerns), and 5 (8.1%) failed to advance for unknown reasons. Four of the 16 patients who voluntarily declined surgery after CRT received less than 50 Gy. The 22.2% of CRT/S+ patients achieved pathologic complete response (21.6% for adenocarcinoma and 29.0% for squamous cell carcinoma). Our institution's 78% surgery completion rate among TMT-indicated patients highlights the benefits of upfront multidisciplinary care. Metastatic disease development most commonly truncated TMT with a low rate failing due to medical decompensation. Given the number of patients who voluntarily declined surgery following CRT, TMT counseling and involvement of a patient advocate are paramount prior to treatment planning.

Transvenous extraction of very old (over 20-year-old) pacemaker leads using mechanical systems: Effectiveness and safety.

To analyze and compare the effectiveness and safety of transvenous lead extraction (TLE) with mechanical systems of pacing leads older than 20 years (group A) versus younger leads (group B). We performed TLE of 591 pacing leads in 377 patients. Fifty (8.5%) leads in 43 (11.4%) patients were implanted for equal to or more than 20 years. The mean dwell time of all extracted leads was 8.9 years (range, 0.1-36.0). Infection related to cardiovascular implantable electronic device was an indication for TLE in 18.3% of patients. Complete lead removal and complete procedural success rates were similar between both groups (94.7% in group A vs 97.1% in group B, P=0.445, and 90.7% in group A vs 95.8% in group B, P=0.329, respectively). Incomplete lead removal in group A was observed only in leads older than 20 years. Removal of leads in group A was associated with significantly longer fluoroscopy time compared with group B (4.6vs 1.9minutes, P<0.001). We did not find a significant difference in major and minor complication rates between groups (2.3% in group A vs 0.9% in group B and 2.3% in group A vs 2.2% in group B, P=0.687, respectively). There were no deaths associated with the TLE procedure within 30 days after the procedure in either group. This study shows that TLE of leads older than 20 years conducted at an experienced center seems to be comparably safe and effective as extraction of younger leads but requires longer fluoroscopy time.

The effect of trabeculectomy combined with prophylactic sclerotomy as a treatment of late stage juvenile open angle glaucoma and primary congenital glaucoma patients: a primary observational study

Objective: To evaluate the outcomes of trabeculectomy combined with a new prophylactic sclerotomy in late stage juvenile open angle glaucoma (JOAG) and primary congenital glaucoma (PCG) patients at high risks of intraoperative and postoperative suprachoroidal hemorrhage (SCH). Method: A retrospective case series study. Thirty-three eyes of 28 JOAG patients and 15 eyes of 12 PCG patients with high risk factors for severe choroidal effusion or SCH were enrolled from November 2006 to April 2012 at Eye and ENT Hospital of Fudan University. The standard trabeculectomy accompanied by prophylactic sclerotomy was performed (video attached). Ophthalmic examinations were performed before and after the surgery. Surgical outcome was assessed in terms of intraocular pressure (IOP), best-corrected visual acuity, optic nerve head cup disc ratio, visual field, and complications. All patients were followed up for at least 1 year. Complete success was defined as an IOP ≥6 mmHg (1 mmHg=0.133 kPa) but ≤18 mmHg without medication. Qualified success was defined as an IOP ≥6 mmHg but ≤18 mmHg with local application of medications. Kaplan-Meier survival curves were drawn for the success rate calculation. Results: The mean age of all 40 patients was (13.2±9.4) years old. And among them, 22 patients were male and 18 patients were female. The mean follow-up time was (31.8±15.9) months. At the postoperative 3(rd) year, the complete success rate was 75.8%, and the qualified success rate was 90.0%. In our case series, one eye had expulsive SCH intraoperatively and two eyes had delayed SCH postoperatively. All of them were successfully saved without further surgery and with no significant damage to visual function. Conclusion: Trabeculectomy combined with prophylactic sclerotomy is a promising technique developed to control IOP in late stage JOAG and PCG patients, which provides a potential intervention to reduce severe consequences of massive choroidal effusion or SCH. (Chin J Ophthalmol, 2019, 55: 347-354).

Multicenter experience with the Evolution RL mechanical sheath for lead extraction using a stepwise approach: Safety, effectiveness, and outcome.

In addition to the Evolution RL sheath, tools by Cook Medical (Bloomington, IN, USA), supporting lead extraction (LE), are available. Data on their use are not reported in detail in previous studies. Moreover, data regarding outcome are lacking. The aim was to evaluate the safety and effectiveness of the Evolution sheath (Evolution RL and Evolution Shortie, Cook Medical) by using a stepwise approach with the available extraction tools and the outcome. A total of 393 leads in 198 consecutive patients were removed with the Evolution RL sheath and ancillary tools using a stepwise approach. The main indication for LE was infection in 125 (63.1%) cases. The mean implant duration was 95.4 ± 59.7 months. According to our stepwise approach, the Evolution Shortie RL sheath was used in all cases and complete LE was achieved in 24 (12.2%) cases. The Evolution RL was used in 174 (87.8%) cases and the SteadySheath Evolution tissue stabilization sheath (Cook Medical) in 87 (44%) because of tenacious fibrosis anchored targeted leads. Compression coil (OneTie, Cook Medical) was used in 141 (71%) cases. Complete procedural success rate, clinical success rate, and lead removal with clinical success rate were 97%, 99%, and 99.5%, respectively. One major complication (0.5%) and 10 (5%) minor complications were encountered. During a mean time follow-up of 12 ± 9 months, 14 (7%) patients died. Predictors of mortality included impaired renal function (HR 5.7; 95% CI 1.9-17.6; P=0.002), extraction because of infection (hazard ratio [HR] 4.0; 95% confidence interval [CI] 1-18.1; P=0.045), and diabetes (HR 3.2; 95% CI 1.1-9.8; P=0.036). Lead extraction using the Evolution RL bidirectional rotational mechanical sheath and ancillary tools in a systematic stepwise approach was effective and safe.

Impact of anticoagulationtherapy on outcomes in patients with cardiac implantable resynchronization devices undergoing transvenous lead extraction: A substudy of the ESC-EHRA EORP ELECTRa (European Lead Extraction ConTRolled) Registry.

Little data are available on anticoagulation (AC) management in patients with cardiac resynchronization (CRT) devices who undergotransvenous lead extraction (TLE) procedure. We investigated the impact of AC on periprocedural complications in CRT patients undergoing TLE, enrolled in the ESC-EHRA European Lead Extraction ConTrolled (ELECTRa) registry. All CRT patients treated with TLE enrolled in the registry were considered. Perioperative AC management was left to the discretion of the Center. Major and minor intraprocedural and postprocedural complications were compared between patients without AC (Gp1) and patients with AC (Gp2). Regression analyses were performed to identify predictors of complications for Gp2. Out of 734 CRT pts, 328 (44.7%) were under AC (Gp2). Patients from Gp2 presented lower LVEF (Gp2 32.5 ± 10.9 vs Gp1 34.5 ± 11.9%; P = 0.03), more advanced heart failure disease (NYHA III/IV: Gp2 42.0 vs Gp1 31.5%; P = 0.02), and renal impairment (Gp2 39.0 vs Gp1 24.3%; P < 0.001). Perioperative regimens included AC interruption (Gp2A: n = 169, 51.5%), "bridging" (Gp2B: n = 135, 41.2%), or continued AC (Gp2C: n = 24, 7.3%). TLE complete success rates (98% in both groups) and major complication rates were comparable for both groups; minor bleeding events were more frequent in Gp2 (5.5%) compared to Gp1 (2.5%; P = 0.051). No independent predictors were identified for Gp2, but minor complications were associated with "bridging" approach (Gp2B: 16 events vs Gp2A/C: 9 events; P = 0.020). CRT patients treated with TLE under AC were more compromised but did not present more major complications compared to patients without AC. More minor complications were associated with "bridging" AC regimen.

A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma: The COMPARE Study

To compare the efficacy of different microinvasive glaucoma surgery (MIGS) devices for reducing intraocular pressure (IOP) and medications in open-angle glaucoma (OAG). Prospective, multicenter, randomized clinical trial. One hundred fifty-two eyes from 152 patients aged 45 to 84 years with OAG, Shaffer angle grade III-IV, best-corrected visual acuity (BCVA) 20/30 or better, and IOP 23 to 39 mmHg after washout of all hypotensive medications. Eyes with secondary glaucoma other than pseudoexfoliative or pigmentary glaucoma, angle closure, previous incisional glaucoma surgery, or any significant ocular pathology other than glaucoma were excluded. Study eyes were randomized 1:1 to standalone MIGS consisting of either 1 Hydrus Microstent (Ivantis, Inc, Irvine, CA) or 2 iStent Trabecular Micro Bypass devices (Glaukos Inc, San Clemente, CA). Follow-up was performed 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Within-group and between-group differences in IOP and medications at 12 months and complete surgical success defined as freedom from repeat glaucoma surgery, IOP 18 mmHg or less, and no glaucoma medications. Safety measures included the frequency of surgical complications, changes in visual acuity, slit-lamp findings, and adverse events. Study groups were well matched for baseline demographics, glaucoma status, medication use, and baseline IOP. Twelve-month follow-up was completed in 148 of 152 randomized subjects (97.3%). At 12 months, the Hydrus had a greater rate of complete surgical success (P < 0.001) and reduced medication use (difference= -0.6 medications, P= 0.004). More Hydrus subjects were medication free at 12 months (difference= 22.6% P= 0.0057). Secondary glaucoma surgery was performed in 2 eyes in the 2-iStent group (3.9%) and in none of the Hydrus eyes. Two eyes in the Hydrus group and 1 in the 2-iStent group had BCVA loss of ≥2 lines. Standalone MIGS in OAG with the Hydrus resulted in a higher surgical success rate andfewermedications compared with the 2-iStent procedure. The 2 MIGS devices have similar safety profiles.

Comparison of two methods for endoscopic full-thickness resection of gastrointestinal lesions using OTSC

Background and aims: The aim of this study was to compare and analyze the feasibility and safety of two methods of endoscopic full-thickness resection (EFTR) for the management of challenging epithelial and subepithelial neoplasms that are not amenable to resection techniques.Material and methods: This was a retrospective case series study of patients who underwent one of two methods of EFTR, resection using ESD knives and post-resection closure with OTSC (Group 1), or closure with OTSC and secondary EFTR with snare (Group 2).Results: Of 11 patients, six were in Group 1 and five in Group 2. The mean time of the EFTR procedure was 76.83 ± 34.97 min in Group 1 which is significantly longer than that of Group 2 (p = .0128). The mean time of OSTC closure and length of hospital stay of Group 1 were also longer compared to Group 2, but the difference was not significant. Complete resection (R0) and technical success rates of Group 1 and Group 2 were 83.3% and 100% (p = .338), respectively. VAS scores of Group 1 immediately after the operation and after 24 h are significantly higher than those of Group 2 (p = .047 and p = .009, respectively). In Group 1, one patient had delayed perforation which led to fever and pneumoperitoneum, and one patient developed abdominal pain. No complications associated with the endoscopic procedure were observed in Group 2.Conclusion: EFTR of pre-resection closure are potentially faster compared with the concept of applying closure after EFTR. Larger prospective controlled studies comparing these two techniques are warranted in the future.

Factors associated with successful completion of outpatient parenteral antibiotic therapy (OPAT): A 10-year review from a large West London service

Outpatient parenteral antibiotic therapy (OPAT) is an established antimicrobial delivery method in the UK. OPAT services differ nationwide, with a paucity of high-quality outcome data to enable benchmarking. A retrospective review of clinical outcomes and adverse events (AEs) of all patients treated during 2008-2017 was performed to identify factors associated with success and failure. Regression models were used to identify factors associated with OPAT success, and AEs were described for the study population using definitions recommended by BSAC. In the 10-year period, 2870 patient episodes resulted in 69 610 days of treatment, with a 91.7% rate of successful therapy completion and 92.0% of infections cured or improved. We encountered 196 AEs, including 1 case of Clostridium difficile-associated diarrhoea. AEs occurred in 10.9% of patient episodes. Adverse drug and line events occurred at a rate of 3.3 and 1.78 per 1000 treatment days, respectively. Rashes, blood dyscrasias and hepatitis were the most common drug AEs. The odds of OPAT success was greater for patients who spent more time (>14 days) on OPAT therapy (OR = 2.32; P < 0.01), utilised a peripheral line (OR = 1.83; P < 0.01), were treated in the clinic compared with self-administration (OR = 2.1; P < 0.02) and did not experience an AE (OR = 0.23; P < 0.01). In our setting, the odds of a successful OPAT episode were associated with longer treatment course, OPAT delivered via a peripheral line, administration in an OPAT clinic setting, and no adverse line or drug events.

Assessment of Call Voice Quality of GSM Network Operators in 5 Cities in Kwara State

This paper evaluates voice quality of four Global System for Mobile (GSM) Communication providers in five selected cities in Kwara State with thoughtfulness of network performance evaluation and the quality of service (QoS) improvement of GSM network system. Three assessment components/parameters which are network accessibility, service retainability and connection quality for evaluating QoS on the network were mainly adopted. The parameters were applied on four GSM networks in the studied areas using customers’ complaints method. Also, a standard method known as Perceptual Evaluation of Speech Quality (PESQ) — (International Telecommunication Union-Telecommunication Standardization Sector) ITU-T standard P.862, used for measuring call voice quality and Mean Opinion Score (MOS) is adopted. The two methods were therefore compared to assess call voice quality of the four GSM networks. The Key Performance Indicators (KPIs) on which the GSM networks were tested include call set-up success rates (CSSR), call drop rate (CDR), call completion success rates (CCSR), handover success rates (HSR) and traffic channel congestion rate (TCHR). The result of the study shows that the Quality of Service of GSM system in the selected cities is unreliable. The study also shows that the GSM network accessibility and retainability in the country are unsatisfactory. However, the call voice quality was observed to be on the peak in these cities across the four network providers. At the end of this manuscript, suggestions are given on how to advance both the Quality of Service and the positive impact of GSM network in the selected areas and the country as a whole.

Impact of early telephone contact on 3-month follow-up rates following residential drug and alcohol treatment: A randomized controlled trial

Background: Routine outcome monitoring (ROM) is an important component of service provision and qualitity assurance procedures. However, a major logistical and financial challenge for organizations is successfully following up participants once they have left residential alcohol and other drug treatment. The aim of the current study was to assess the impact and effectiveness of an “early” follow-up contact and brief interview on subsequent 3-month ROM follow-up success. Methods: Participants were 800 clients attending specialist residential alcohol and other drug treatment provided by The Salvation Army. As part of routine outcome assessment procedures, all people attending these programs are asked to complete a 3-month follow-up assessment. Participants were randomly allocated either to the early contact condition (i.e., “early” 2-week follow-up contact prior to the 3-month follow-up assessment) or to the control condition (i.e., no “early” 2-week follow-up prior to the 3-month follow-up assessment). The primary outcomes were the proportion of participants who were followed up and surveyed at 3 months. Results: There were significantly higher follow-up rates at 3 months post discharge for participants in the early contact group (55.6%) compared with the control condition (46.1%). Although there were higher rates of 3-month follow-up for participants in the early contact group, rates of successful survey completion were not significantly different between the 2 groups. Conclusions: Including an early 2-week telephone call prior to the 3-month assessment increased the number of participants we were able to follow up at 3 months post discharge but did not improve the rate of survey participation at 3 months. The additional costs associated with this activity and the modest increase in follow-up rates need to be considered prior to organizations investing in these follow-up enhancement activities.

Efficacy of Ologen matrix implant in Ahmed Glaucoma Valve Implantation

To determine the efficacy and safety of the Ologen collagen matrix adjunctive to Ahmed valve surgery. A randomized prospective multicentre clinical trial involving 58 patients that were followed for one year. Conventional surgery with Ahmed valve was performed in 31 eyes (Control group/CG) and in 27 Ologen (Ologen group/OG) was placed over the valve’s plate. Baseline data: age, corneal thickness, intraocular pressure(IOP) and antiglaucoma medications.Postoperative data (days 1, 7 and months 1, 3, 6 and 12): IOP, antiglaucoma medications, visual acuity and complications were recorded. Frequency of hypertensive phase, complete and qualified success and survival rate were studied. No differences were found between CG and OG in the baseline data. The only difference between groups was a significantly lower IOP at day 1. No other differences were found in the follow-up between groups. Hypertensive phase (56%CG and 55%OG, p = 0,947), complete success 28,6%CG and 30,4%OG (p = 0,88) and qualified success 96,4% and 95,9%(p = 0,794). Survival rates at 1 year were 76,7%(CG) and 69,2%(OG)(p = 0,531). 38,7% of patients in the CG suffered some complication during follow-up and 61,5% in OG(p = 0,086). Ologen does not increase safety or efficacy in Ahmed valve surgery at one-year follow-up. This is the first study that shows no benefit of Ologen adjunctive to this surgery.

Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors.

To evaluate the efficacy and safety of needle revision and examine factors predictive of failure. In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure. The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively. Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

Penetrating deep sclerectomy in primary open-angle and pseudoexfoliative glaucoma.

To evaluate the outcomes of a new antiglaucoma surgical method, a modification of the standard deep sclerectomy, the penetrating deep sclerectomy. Patients with medically uncontrolled primary open-angle glaucoma or pseudoexfoliative glaucoma were prospectively, in a consecutive way, enrolled in this study. The study was conducted in Glaucoma Unit, Department of Ophthalmology, University of Hospital of Alexandroupolis, Greece, in 29 eyes of 29 patients. In a fornix-based surgical procedure, all eyes underwent the proposed penetrating deep sclerectomy (deep sclerectomy plus trabeculectomy) with the use of mitomycin C applied intraoperatively (0.2 mg/mL for 2 min). The follow-up period was 3 years. Ocular examination was conducted before the operation and at 1, 3, 6, 12, 18, 24, and 36 months postoperatively. The average reduction in intraocular pressure at the end of follow-up was 11.24 (57.88%). The complete success rate (intraocular pressure ⩽21 mm Hg without medication) after 3 years was 58.6%. The qualified success rate (intraocular pressure ⩽21 mm Hg without or with medication) was 75.86%. Postoperatively, the mean number of medication dropped from 3.75 ± 0.89 to 0.89 ± 0.98. Low postoperative complications were recorded. During the 3-year follow-up period, penetrating deep sclerectomy presented very positive outcome. The addition of a controlled perforation of the trabeculo-Descemet's membrane in deep sclerectomy, playing the role of an early goniopuncture, seems to ensure a satisfactory outcome and is not associated with additional complications.