Examine Success Rates Research Articles

Airway management education: simulation based training versus non-simulation based training-A systematic review and meta-analyses

BackgroundSimulation-based training (SBT) has become a standard for medical education. However, the efficacy of simulation based training in airway management education remains unclear.MethodsThe aim of this study was to evaluate all published evidence comparing the effectiveness of SBT for airway management versus non-simulation based training (NSBT) on learner and patient outcomes.Systematic review with meta-analyses were used. Data were derived from PubMed, EMBASE, CINAHL, Scopus, the Cochrane Controlled Trials Register and Cochrane Database of Systematic Reviews from inception to May 2016. Published comparative trials that evaluated the effect of SBT on airway management training in compared with NSBT were considered. The effect sizes with 95% confidence intervals (CI) were calculated for outcomes measures.ResultsSeventeen eligible studies were included. SBT was associated with improved behavior performance [standardized mean difference (SMD):0.30, 95% CI: 0.06 to 0.54] in comparison with NSBT. However, the benefits of SBT were not seen in time-skill (SMD:-0.13, 95% CI: −0.82 to 0.52), written examination score (SMD: 0.39, 95% CI: −0.09 to 0.86) and success rate of procedure completion on patients [relative risk (RR): 1.26, 95% CI: 0.96 to 1.66].ConclusionSBT may be not superior to NSBT on airway management training.

Diagnostic Performance of MR Elastography and Vibration-controlled Transient Elastography in the Detection of Hepatic Fibrosis in Patients with Severe to Morbid Obesity.

Purpose To evaluate the diagnostic performance and examination success rate of magnetic resonance (MR) elastography and vibration-controlled transient elastography (VCTE) in the detection of hepatic fibrosis in patients with severe to morbid obesity. Materials and Methods This prospective and HIPAA-compliant study was approved by the institutional review board. A total of 111 patients (71 women, 40 men) participated. Written informed consent was obtained from all patients. Patients underwent MR elastography with two readers and VCTE with three observers to acquire liver stiffness measurements for liver fibrosis assessment. The results were compared with those from liver biopsy. Each pathology specimen was evaluated by two hepatopathologists according to the METAVIR scoring system or Brunt classification when appropriate. All imaging observers were blinded to the biopsy results, and all hepatopathologists were blinded to the imaging results. Examination success rate, interobserver agreement, and diagnostic accuracy for fibrosis detection were assessed. Results In this obese patient population (mean body mass index = 40.3 kg/m2; 95% confidence interval [CI]: 38.7 kg/m2, 41.8 kg/m2]), the examination success rate was 95.8% (92 of 96 patients) for MR elastography and 81.3% (78 of 96 patients) or 88.5% (85 of 96 patients) for VCTE. Interobserver agreement was higher with MR elastography than with biopsy (intraclass correlation coefficient, 0.95 vs 0.89). In patients with successful MR elastography and VCTE examinations (excluding unreliable VCTE examinations), both MR elastography and VCTE had excellent diagnostic accuracy in the detection of clinically significant hepatic fibrosis (stage F2-F4) (mean area under the curve: 0.93 [95% CI: 0.85, 0.97] vs 0.91 [95% CI: 0.83, 0.96]; P = .551). Conclusion In this obese patient population, both MR elastography and VCTE had excellent diagnostic performance for assessing hepatic fibrosis; MR elastography was more technically reliable than VCTE and had a higher interobserver agreement than liver biopsy. © RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on January 25, 2017.

A comparative study of injecting air or carbon dioxide in patients undergoing routine painless colonoscopy after gynecological surgery

Objective To investigate and compare the effects of injecting air or carbon dioxide(CO2) in patients undergoing routine colonoscopy after gynecological surgery. Methods Sixty-two patients undergoing painless colonoscopy after gynecological surgery were divided into CO2 group and air group by random number table method with 31 patients in each group, CO2 and air were injected to patients, respectively. The success rate of colonoscopy, procedure time, dose of propofol, recovery time and the degree of abdominal pain at different time after colonoscopy were recorded. The changes of HR, MAP, SpO2 and transcutaneous carbon dioxide partial pressure(PtcCO2) before and after the procedure were measured and compared at the same time point. Each patient rated, using VAS, the intensity of abdominal pain at 15 min, 1 h, 3 h, 6 h and 24 h after colonoscopy. Results There was no difference in the success rate of examination, procedure time, dose of propofol and recovery time between the two groups(P>0.05). Furthermore, there was no difference in HR, MAP, SpO2 and PtcCO2 between the two groups before, during and after the examination, respectively(P>0.05). However, at 15 min, 1 h, 3 h, 6 h, 24 h after examination, the VAS scores of patients in the CO2 group were significantly lower than that of the air group with the data of [(21.6±9.5) vs (46.7±14.1), (14.4±5.4) vs (32.6±9.6), (9.1±3.6) vs (22.9±8.4), (4.3±1.1) vs (9.7±3.5), (2.3±1.1) vs(4.1±1.9)](P<0.05), respectively. Conclusions CO2 is safe and effective in patients undergoing routine painless colonoscopy after gynecological surgery, moreover, it can reduce the degree of abdominal pain after the examination. Key words: Colonoscopy; Carbon dioxide; Gynecological surgery; Abdominal pain

Patients with high-risk differentiated thyroid cancer have a lower I-131 ablation success rate than low-risk ones in spite of a high ablation activity.

To examine success rates in strictly defined high-risk differentiated thyroid cancer (DTC) patients who received a high-activity (≥5550 MBq) adjuvant postoperative I-131 therapy and compare these to the rates found in highest risk and low-risk patients. Retrospective database study. We examined 377 patients with DTC who received I-131 ablation. Patients with distant metastases were classified as very high risk. Patients with primary tumours >4 cm, extensive extrathyroidal invasion (pT4a or pT4b in accordance with the 7th edition of the TNM system), and patients with ≥5 lymph node metastases or any lateral compartment lymph node metastases were considered high risk. All other patients were considered low risk. Ablation success rate at first TSH-stimulated follow-up. The ablation success rate was 72·6% in low-risk patients, 51·7% in high-risk patients and 13·8% in highest risk patients (all differences P < 0·001). In none of the groups, a significant difference in the initial I-131 activity was found between patients with successful and unsuccessful ablation (low risk: P = 0·16, high risk: P = 0·91 and highest risk: P = 0·48). Furthermore, there was no difference in ablation success between patients who received <5550 MBq and those who received ≥5550 Mbq (low risk: P = 0·31, high risk: P = 0·69 and highest risk: P = 0·22). Patients with high-risk DTC have a significantly reduced I-131 ablation success rate compared to low-risk ones in spite of high initial I-131 activities. As successful ablation is prognostically important, efforts should be made to improve outcome in these patients.

Cutaneous manifestations in patients on chronic hemodialysis in a developing country

Le but de cette étude était deconnaître les affections cutanées les plus fréquentes chez les patients hémodialysés chroniques du Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO) de Ouagadougou. L’étude, de type transversal descriptif, menée du 15 Septembre au 31 Décembre 2014, s'estdéroulée au CHU-YO. Elle concernait les patients qui avaient au moins trois mois d'ancienneté en hémodialyse chronique. La fréquence des séances d'hémodialyse était d'une tous les cinq jours. Le seuil de signification des tests statistiques était défini pour une probabilité p ≤ 0,05. Quatre-vingt-quinze patients (61,1% d'hommes et 38,9% de femmes), de moyenne d’âge 42,1 ans participaient à l’étude. La durée moyenne en hémodialyse était de 31,9 mois. Le taux de réalisation des analyses biologiques variait de 7,4 à 85,3%. Quatre-vingt patients (85,3%) avaient au moins une manifestation cutanée. La xérose cutanée (67,4%), le prurit (45,3%), et l'hyperpigmentation (23,2%) étaient les plus fréquentes des manifestations cutanées pouvant être spécifiques de l'hémodialyse. L'hypomélanose en gouttes (11,6%), le prurigo (11,6%) et la folliculite (8,4%) étaient les principales manifestations cutanées non spécifiques. L'atteinte cutanée était fréquente mais ne semblait pas liée à l'ancienneté en hémodialyse. Les mauvaises conditions d'hémodialyse et l'environnement sec et chaud à Ouagadougou, ont pu favoriser ces atteintes, en particulier la xérose et le prurit. Une meilleure subvention des soins de santé contribuerait à réduire la prévalence des maladies cutanées et à améliorer la qualité de vie de nos patients hémodialysés chroniques.

Factors Associated with No or Insufficient Temporal Bone Window Using Transcranial Color-coded Sonography

PurposeTranscranial color-coded sonography (TCCS) noninvasively assesses physiologic and pathologic intracranial blood flow especially in non-Caucasians who have high prevalence of intracranial steno-occlusive arterial disease. However, a higher temporal bone window failure (WF) rate is found in non-Caucasians and thus limits the utilization of TCCS. This study was performed to explore the associated factors of temporal bone WF in Taiwanese patients. MethodsBetween January 2014 and June 2014, 355 consecutive patients who received TCCS examination during their hospitalization at neurological ward were enrolled in this study, including 218 men and 137 women. Patients were classified into two groups, one with no or insufficient temporal bone window and the other with good temporal bone window for identification of middle, anterior, and posterior cerebral arteries via transtemporal approach. Age, sex, and conventional vascular risk factors in each group were compared. ResultsIt was found that 28.8% of the patients had no or insufficient temporal bone window. Among them, 20.3% had complete bilateral temporal bone WF. For all factors studied, older age and female sex were significantly associated with no or insufficient temporal bone window. ConclusionThe failure rate of temporal bone window was considered high as compared to Western countries but, not surprisingly, age and sex remained the significant factors. Introducing echo contrast agents during the TCCS examination might help to increase the success rate of TCCS examination and provide useful information to clinicians.

Long-Term Outcomes and Prognostic Factors of Trabeculectomy following Intraocular Bevacizumab Injection for Neovascular Glaucoma.

PurposeTo evaluate long-term outcomes and identify prognostic factors of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma.MethodsSixty-one eyes of 54 patients with neovascular glaucoma treated by trabeculectomy following intraocular bevacizumab injection were consecutively enrolled. Surgical success criteria were sufficient intraocular pressure (IOP) reduction (IOP ≤21 mmHg, ≥20% IOP reduction, no additional medications or glaucoma surgeries) without devastating complications (loss of light perception, phthisis bulbi, and endophthalmitis) or significant hypotony (IOP ≤5 mmHg continued ≥6 months and until the last follow-up visit or hypotony requiring intervention). Kaplan-Meier survival curves and Cox regression analysis were used to examine success rates and risk factors for surgical outcomes.ResultsThe follow-up period after trabeculectomy was 45.0 ± 22.2 months (mean ± standard deviation). Surgical success rate was 86.9 ± 4.3% (± standard error), 74.0 ± 6.1%, and 51.3 ± 8.6% at 1, 3, and 5 years. Multivariate Cox regression analysis identified two risk factors; lower preoperative IOP (≤30 mmHg) for surgical failure and hypotony [hazard ratio (HR), 2.92, 6.64; 95% confidence interval (CI), 1.22 to 7.03, 1.47 to 30.0; P = 0.018, 0.014, respectively], and vitrectomy after trabeculectomy for surgical failure with or without hypotony criteria (HR, 2.32, 4.06; 95% CI, 1.02 to 5.28, 1.30 to 12.7; P = 0.045, 0.016, respectively).ConclusionsThe long-term outcomes of trabeculectomy following intraocular bevacizumab injection for neovascular glaucoma were favorable. Lower baseline IOP was associated with development of significant hypotony, while additional vitrectomy was related to insufficient IOP reduction.

The impact of a cadaver-based airway lab on critical care fellows' direct laryngoscopy skills.

This study sought to determine the impact of a cadaver-based airway lab on critical care medicine fellows' direct laryngoscopy skills and hypothesised that fellows can improve their self-reported percentage of glottic opening (POGO) scores in cadaver models to achieve POGO scores similar to that of expert faculty. Nineteen fellows attended an airway management skills laboratory utilising five modified cadavers. Initial fellow POGO (POGOi) visualised was recorded at the onset with direct laryngoscopy. Maximum fellow POGO score with optimised direct laryngoscopy was recorded after two additional hours of teaching and also during a testing phase several days later. Data was assessed for significant differences between trainee POGO scores at each time interval and between trainee POGO scores and expert scores. A departmental procedural database was utilised to examine success rates of intubation as a clinical correlation. Fellows' mean POGOi scores, averaged across all five specimens, were significantly lower than both their maximum POGO scores and their testing phase POGO scores. Mean POGOi scores for fellows, averaged over all five cadavers, were lower than the instructors' POGOi scores. There was no difference between fellows' and instructors' mean maximum POGO or mean testing phase POGO scores. Clinical success rates of intubation were over 98%. A short training session using modified cadavers can be utilised to teach new critical care medicine fellows additional techniques for airway management and assist them in obtaining higher POGO scores, similar to those of expert instructors. Success rates of clinical intubations were favourable in the wake of this training.

자기공명검사에서 통증제어가 불가능한 급성 요통 환자의 옆으로 누운 자세에 대한 영상평가

본 연구에서는 통증제어가 거의 불가능한 급성요통 환자를 대상으로 바로 누운 자세를 할 수 없는 환자에게 불가피하게 자기공명검사를 받아야할 환자를 위해 기존촬영방법인 정상 체위 바로 누운 자세 대신 변형된 옆으로 누운 자세를 취하게 하여 기존 척추 전용 코일과 복부 전용 코일을 이용하여 요통을 경감시키고 불안정한 자세 보정과 움직임에 의한 인공물을 줄여 장시간 검사를 받는 환자에게 피로감을 감소시켜 자기공명검사의 성공률을 높이고자 한다. 평가방법으로는 영상의 질을 정성적 평가로 하였으며 결과로는 정상인 연구대상자 기존촬영방법인 바로 누운 자세의 평균 점수는 4.64점, 정상인 연구대상자 옆으로 누운 자세(A군)는 3.44점, 극심한 요통을 호소하는 비정상인 연구대상자 옆으로 누운 자세(B군)는 3.40점으로 나타났다. 결론적으로 정상인 연구대상자의 기존촬영방법인 바로 누운 자세에서 검사한 정성적인 평가는 예상대로 높게 나타났으나 정상인 연구대상자 옆으로 누운 자세와 극심한 요통을 호소하는 비정상인 연구대상자 옆으로 누운 자세로 검사한 영상의 정성적 평가는 거의 비슷하게 나타났다. 또한 극심한 요통을 호소하는 비정상인 연구대상자 옆으로 누운 자세(B군)의 영상평가에서 영상의학과 전문의의 영상판독에도 문제가 없는 것으로 나타났다. 이에 바로 누운 자세에서 검사를 진행함에 불편을 겪는 환자에게 이러한 기법이 보편화 된다면 임상에서 많이 활용될 것으로 사료된다. The acute lumbar pain patients who were unavoidable to take MRI examination were made to take altered lateral recumbent position. they were also not able to control their painfulness and to be in supine position. In this study, it is supposed to increase success rate of the MRI examination through taking the altered lateral recumbent position in using spine and body matrix coil. This altered position made relaxing lumber pain and fatigue for the patients who suffered from sever lumber pain. In these reasons, it decreases the motion artifacts through correcting uncomfortable posture. As a result, qualitative analysis for the image quality was estimated to have average points of supine position A group(lateral recumbent position) of normal candidates and B group(lateral recumbent position) of the abnormal candidates who have sever pain at 4.64, 3.44, and 3.40, respectively. In conclusion, while qualitative analysis in the examination with supine position of the normal patients had significantly high points, the qualitative analysis in the examination with lateral recumbent position of the normal patients and abnormal patients who had sever lumbar pain was almost same. In addition, it was judged that radiologists' imagery interpretation had no other problems in the image evaluation of B group who had acute lumbar pain of abnormal patients. Hereupon, if this technique becomes generalized for the patients who suffer from supine position in the examination, it is supposed to be useful in medical field.

Success rates for functional MR imaging in children.

Functional MR imaging is widely used for research in functional brain development in healthy children. However, obtaining high-quality brain imaging data from pediatric research participants requires cooperation that is challenging for young children. In this study, we examined success rates for fMRI in typically developing children in both longitudinal and cross-sectional research study designs to inform the recruitment needs of future pediatric brain imaging studies. In the cross-sectional study, 459 healthy children (5-18 years of age, 215 girls) were recruited. A subset of 30 healthy children 5-7 years of age from the cross-sectional cohort were selected and scanned for 10 consecutive years in the longitudinal arm of the study. Following anatomic scans, each participant attempted 4 functional MR imaging tasks. Success rate was defined as the proportion of fMRI tasks completed. Differences in success rates across sexes and in cross-sectional-versus-longitudinal cohorts were evaluated by using the Fischer exact test. In the cross-sectional study, 74% of the children completed all tasks. Success rates for individual tasks ranged from 34% to 67% for children 5-7 years of age and 76%-100% for those 8-18 years of age. In the longitudinal study, 89% of children completed all tasks in all 10 years. We established significance (P < .0001) between the cross-sectional and longitudinal cohorts for both 0% and 100% task completion rates. There was no significance between sexes. When designing pediatric fMRI studies in children, the sample sizes indicated by power analysis should be scaled up according to age (ie, 33% for ages 8-18 years, 50% for ages 5-7 years).

Fresh transfer outcome predicts the success of a subsequent frozen transfer utilizing blastocysts of the same cohort

The objective of this retrospective analysis was to assess whether the outcomes of fresh blastocyst transfer cycles are predictive of the chances for pregnancy and live birth in subsequent frozen blastocyst transfer cycles using sibling embryos from the same retrieval. Clinical pregnancy rate (CPR) and live birth rate (LBR) per fresh and frozen blastocyst transfer were assessed. All subgroups had similar patient and cycle characteristics. Overall, CPR and LBR in fresh cycles were 44% and 29%, and in frozen were 34% and 30%, respectively. However, the CPR and LBR in frozen cycles were significantly higher in patients who were not pregnant with their fresh cycles (CPR 43% versus 22%, P=0.01; and LBR 36% versus 17%, P=0.03, respectively). When fresh cycles are unsuccessful, the remaining frozen blastocysts of the same cohort have the same chance of success in producing a clinical pregnancy as the fresh cycle (43% versus 44%). Frozen cycles following successful fresh cycles have significantly lower CPR and LBR. These data reinforce the concept that only a few embryos per cohort are competent for a live birth.During IVF cycles, many patients are fortunate enough to have excess high-quality embryos remaining after their embryo transfer. These embryos can be frozen, or cryopreserved, for later transfer. The transfer of cryopreserved embryos increases the cumulative success rates after a single IVF stimulation. Many studies have examined success rates such as clinical pregnancy rate and live birth rate in frozen embryo transfer cycles. While these frozen embryo transfer cycles have excellent success rates, they are significantly lower than success rates in cycles where a “fresh”, non-frozen, embryo is transferred. Few studies have carefully examined the impact of the result of the fresh embryo transfer (whether the patient became pregnant or not) on subsequent frozen embryo transfer success. Here we show that women who are not pregnant after a fresh embryo transfer have higher success rates in subsequent frozen embryo transfer cycles that use frozen embryos generated during a single IVF cycle. In these women (not pregnant after a fresh embryo transfer), frozen embryo transfer pregnancy rates are the same as rates using fresh embryos.

Neuraxial Blockade for External Cephalic Version

Abstract Background The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. Methods A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases. Results Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15–1.32). Conclusions Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.

Neuraxial blockade for external cephalic version: a systematic review

Background The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. Methods A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases. Results Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15–1.32). Conclusions Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version.

Wide, Short Bore Magnetic Resonance at 1.5 T

Claustrophobic reactions in patients undergoing magnetic resonance imaging (MRI) have a significant impact on the workflow, patient acceptance and ultimately the costs involved in obtaining a diagnostic scan. The purpose of this study was to determine if the use of a wide, short bore MRI scanner could reduce the need for general anesthesia assistance in these cases. Between September 2006 and March 2008, all patients for whom MRI examinations of the head and/or spine were canceled or prematurely terminated due to claustrophobia on a standard 60cm bore, 1.5T scanner were scheduled to be re-scanned on a 70cm wide bore, 1.25m long 1.5T scanner. This re-scanning attempt was made 2 or more days prior to a scheduled anesthesia-assisted MRI appointment. If the patient successfully completed the wide bore MRI examination then the anesthesia-assisted MRI appointment was canceled. A total of 56 patients were included in this study. The examinations included individual body regions as well as combination examinations (head and cervical spine, entire spine etc.). A total of 72 body regions were examined in 56 patients. Of these regions, 65 (90%) were completed successfully, 50 patients (89%) successfully completed a diagnostic examination on the 70cm scanner and 6 patients (11%), all of whom were scheduled for examinations which included the head, were unable to complete the examination on the wide bore scanner. A 1.5T wide short bore scanner increases the examination success rate in patients with claustrophobia and substantially reduces the need for anesthesia-assisted MRI examinations even when claustrophobia is severe.

Does compliance status predict clinical status in patients undergoing endoscopic management of vesico-ureteral reflux?

Objective Previous studies of endoscopic management of vesico-ureteral reflux (VUR) have had non-compliance rates around 50%. We examined success rates of patients non-compliant with a delayed follow up protocol after endoscopic injection for VUR. Materials and methods Patients undergoing Double HIT, dextranomer/hyaluronic acid copolymer endoscopic injection for VUR were enrolled in a 1-year, delayed voiding cysto-urethrogram (VCUG) study. All patients non-compliant with the VCUG were contacted and information on their clinical status was collected. Non-compliant patients were re-scheduled for a VCUG. Results 49/54 (91%) patients underwent endoscopic injection for VUR and completed the 6-week ultrasound. At 1-year 49% (24/49) were non-compliant with a VCUG; 75% (18/24) were contacted and provided clinical information. All but one patient agreed to the VCUG. Patients compliant with the 1-year VCUG showed 96% (24/25) clinical and 92% (23/25) radiologic success rates. Non-compliant patients had an 89% (16/18) clinical success rate; 5 (21%) non-compliant patients underwent VCUGs with a 100% success rate. Conclusions Long-term compliance remains an issue for patients treated endoscopically for VUR, but compliance does not predict clinical status as both groups have favorable clinical outcomes. The repeat VCUG is a barrier to long-term follow up as only 21% of patients underwent the study.

Retrospective Review of Predisposing Factors and Surgical Outcomes in Obstetric Fistula Patients at a Single Teaching Hospital in Western Kenya

ObjectiveWe examined success rates and complications of obstetric fistula (OF) surgical repairs in association with patient and fistula characteristics, including sociocultural and socioeconomic determinants of health. A better understanding of these associations will help guide surgical management and prevent predisposing factors. MethodsWe reviewed the medical records of 86 patients who underwent OF repair at Moi Teaching and Referral Hospital in Kenya between 1999 and 2007. ResultsWomen with OF presented for repair with a variety of concurrent conditions. Seventy-eight percent had laboured for at least 24 hours; 29% had undergone previous unsuccessful surgery. Of the women who presented at postoperative follow-up, 54% still complained of incontinence. Persistent incontinence was associated with larger, more complicated fistulas and having had previous failed attempts at surgical repair. ConclusionThe association of factors such as duration of labour with OF reflects the limited availability of obstetrical care in Western Kenya. There is a significant difference in postoperative success of fistula repair between women with large fistulas or those who had previous failed surgery and other patients. This reflects the importance of primary and secondary prevention.

Clinical application of prospective electrocardiogram-gated 320-detector computed tomography coronary angiography

to compare the success rate, radiation dose, image quality and diagnosis of prospective electrocardiogram(ECG)-gated 320-detector computed tomography coronary angiography (CTCA) versus retrospective ECG-gated CTCA. patients suspected coronary artery disease were divided into two groups which underwent 320-detector CTCA with prospective ECG-gated and retrospective ECG-gated scanning (n = 240 each, HR < 65 bpm). Curved-planar reconstruction (CPR), maximum intensity projection (MIP) and volume rendering (VR) were performed to demonstrate the coronary arteries. The image quality was defined as excellent, good and poor by motion and stair-step artifacts. Effective radiation exposure dose was estimated from the dose-length product. Effective radiation dose, image quality and diagnosis were evaluated. the success rate of examination was 100% in prospective ECG-gated group and retrospective ECG-gated group. The mean effective radiation dose of prospective ECG-gated CTCA [(3.3 ± 1.3) mSv] was significantly lower than that of retrospective ECG-gated CTCA [(13.0 ± 1.6) mSv, P < 0.01]. Segments of diagnostic image quality (95.42%, 3435/3600) and non-diagnostic coronary segments (4.58%, 165/3600) in prospective ECG-gated group were similar as those of retrospective ECG-gated group (95.81%, 3449/3600 and 4.19%, 151/3600, all P > 0.05). Compared with CAG, the sensitivity, specificity, false positive and false negative value in prospective ECG-gated group (93.22%, 99.21%, 91.64%, 99.05%) and retrospective ECG-gated group (94.55%, 98.80%, 95.86%, 98.54%) were not significantly different. though the effective radiation dose is significantly lower, the success rate, image quality and diagnosis of prospective ECG-gated 320-detector CTCA is comparable with that of retrospective ECG-gated 320-detector CTCA on patients with stable heart rates less than 65 bpm.

The Success Rate of Unsedated Colonoscopy Examination in Adult

Aim: . Aim of the study was to evaluate the feasibility of unsedated colonoscopy examination in the increasing trend of deep sedation colonoscopy examination in our countryMaterial & Methods: The endoscopy reporting system images of single-handed (one-man) method unsedated colonoscopy examinations were evaluated. Patients with history of colorectal surgery were excluded from the analysis.. We evaluated the success rate of caecal intubation by unsedated colonoscopy. Non parametric binomial test was applied for statistical analysis with p <0.05Results : There were 244 patients included in the study with 143 (82.66%) patients caecal intubated seccessfully(success group) and 30 (17.34%) patients failed to reach the caecum due to severe abdominal pain only(failure group) (p<0.0001). The lesions that obstructed the colonoscopy examination were 38 distal colon cancers, 9 proximal colon cancers, and 4 colon strictures. Eight patients with unfinished colonoscopy examination due to haemodynamic worsening, and 12 patients with unfinished colonoscopy examination due to bad bowel preparation (fecal obstruction). The success rate of endoscopic diagnosis confirmation was 86.61%(194) vs 13.39%(30) (p<0.0001). No complication or mortality was found in this study.Conclusion : the unsedated colonoscopy is still significantly feasible procedure for colon examination.

Nursing intervention in performing upper gastrointestinal longitudinal endoscopic ultrasonography

Objective To investigate the effects of systematically nursing intervention on performing upper gastrointestinal longitudinal endoscopic ultrasonography. Methods From July 2006 to August 2008, 80 patients with upper gastrointestinal disease were divided into the experimental group and the control group, with 40 patients in each group. The experimental group received mental nursing before endoscopy examination, to comfort and encourage them to eliminate the psychological tension, instructing patients to relax, turning off lights to reduce the horror resulted from seeing insertion of large visual endoscopic ultrasonography into their mouths. While the control group received standard care of gastrointestinal endoscopic examination. The horror, nausea, abrasion of laryngopharynx and repeated operation were compared in the two groups using x2 test. Results The incidence of abnormal conditions in the experimental group was lower than those of the control group. Conclusions Nursing intervention can elevate the success rate of exami-nation, reduce the suffering of patients and ensure the smooth conduct of examination. Key words: Upper gastrointestinal disease; Mental care; Longitudinal endoscopic ultrasanography

Ultrasound Contrast Agents in Ischemic Stroke

The general indication for the use of ultrasound contrast agents in neurosonologic applications is an insufficient signal-to-noise ratio when investigating the cerebral macro- and microcirculation. Clinical problems that are often encountered in native sonography are ‘no flow, slow flow and low flow’ phenomena. In these cases, ultrasound contrast agents are used to differentiate between vessel occlusion and insufficient insonation conditions, as well as for the detection of very slow blood flow velocities and low flow volumes. Echo-contrast agents significantly increase the success rate of transcranial color duplex examinations of patients with acute cerebrovascular disease. Ultrasound contrast imaging also allows assessment of the cerebral microcirculation. There are a number of techniques available for performing perfusion studies. These generally utilize high mechanical index imaging, since until recently lower acoustic outputs were unable to detect microbubbles in the brain. New-generation microbubbles in combination with very sensitive contrast-specific ultrasound techniques now enable real-time visualization of stroke. Moreover, destruction sequences with assessment of microbubble replenishment using real-time, low mechanical index imaging are now available. This article reviews of state-of-the-art contrast-specific imaging techniques for ultrasound evaluation of acute stroke patients.