Treatment Process Of Patients Research Articles

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data.

Background:The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered.Purpose:To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI.Study Design:A consensus statement of the Chinese Society of Sports Medicine.Methods:A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized.Results:A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded.Conclusion:This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.

Classification of MR Brain tumors with Deep Plain and Residual Feed forward CNNs through Transfer learning

Medical imaging plays an important role in the diagnosis of some critical diseases and further treatment process of patients. Brain is a central and most complex structure in the human body that works with billions of cells, which controls all other organ functioning. Brain tumours observed as uncontrolled abnormal cell growth in brain tissues. Classification of such cells in a early stage will increase the survival rate of the patient. Machine learning algorithms have contributed much in automation of such tasks. Further improvement in prediction rate is possible through deep learning models. In this paper presents experiments by deep transfer learning models on publicly available dataset for Brain tumour classification. Pre-trained plain and residual feed forward models such as Alexnet, VGG19, ResNet50, ResNet101 and GoogleNet are used for the purpose of feature extraction, Fully connected layers and softmax layer for classification is used commonly. The evaluation metrics Accuracy, Sensitivity, Specificity and F1-Score were computed.

Wann und wie berücksichtigen Intensivpflegende Schmerz im Behandlungsprozess von Patientinnen und Patienten auf der Intensivstation? - Eine qualitative Studie.

Guided by the question "When and how do intensive care nurses consider pain in the treatment process of patients with impaired consciousness and cognition?", we wanted to explore their patterns of thought and decision-making in the context of pain management. As part of a Mixed Methods research program on pain assessment in nonverbal intensive care patients we performed a secondary analysis of data from the qualitative substudy using qualitative content analysis according to Mayring. Pain plays an important but subordinate role in the treatment process. After vital functions have been initially stabilized, intensive care nurses assess patients' consciousness and cognition in order to receive further information directly from them. Intensive care nurses differentiate between pain, anxiety, stress and discomfort. Their decisions are based on experience and intuition. Education promotes intensive care nurses' knowledge and awareness in pain management. Observational pain assessment instruments provide valid information. They support an analytical approach and thus the development of competence in clinical reasoning and decision-making.

Effectiveness of Cardiometabolic Therapy in the Treatment of Acute Coronary Syndrome without ST-segment Elevation in Perimenopausal Women

Acute forms of coronary heart disease (CHD) are one of the most pressing problems in the structure of morbidity and mortality, especially among perimenopausal women. Of particular interest are approaches to the medical correction of acute myocardial ischemia that occurs on the background of non-obstructive lesions or intact coronary arteries. The objective: to study the effectiveness of a fixed combination of meldonium with γ-butyrobetaine (γ-BB) as part of the optimal pharmacotherapy of GKSbelST. Materials and methods. 81 women with percutaneous and postmenopausal GKSbelST at the age of 39–69 years (mean age – 50.26 ± 1.24 years) were examined. Patients were evaluated major circadian blood pressure monitoring parameters (MMAD) was determined levels of female sex hormones (estradiol, follicle-stimulating hormone (FSH) and luteinizing hormone (LH)), circulating endothelial dysfunction markers (endothelial NO-synthase (eNOS), endothelin-1 (ET-1)), indicators of systemic inflammation (PSA) and POL (malonic dialdehyde (MDA), ceruloplasmin (CP)), the main indicators of lipid, carbohydrate and purine metabolism at the beginning of the study on the first day of hospitalization and after 2 weeks hospital treatment. Patients were divided into two groups. The 1-st group (n = 29) included women (average age – 51.26 ± 1.82 years), to whom a fixed combination of γ-BB dihydrate (60 mg) and meldonium dihydrate (180 mg) was added to the standard OMT (Kapikor, “Olainfarm”, Latvia) 2 capsules 2 times a day; in the 2nd group (n = 52) – women with GKSbelST women (average age – 49.64 ± 1.12 years), who received only the standard OMT complex. Results. On the first day of hospitalization of patients with GKSbelST, there was a decrease in eNOS and an increase in ET-1, MDA, CB, and SRP compared to practically healthy individuals, with ABPM, an increase in BP variability (VAD), an increase in BP (HV AD), time index (YV ) at night and insufficient nightly decrease in blood pressure. Compared with women of the 2 nd group, two-week treatment of patients of the 1st group significantly accelerates the restoration of endothelial function. The content of eNOS increased in the 1st group by 22.13% (from 191.76 ± 7.67 to 234.82 ± 17.26 pg / ml; p 0.05), levels of E T-1 decreased (by 23.45% in the 1st group (from 15 , 31 ± 0.60 to 11.71 ± 0.68 pg / ml; p 0.05). Conclusion. Adding to the GKSbelST treatment in women of a fixed combination of meldonium with γ-BB significantly speeds up the restoration of endothelial function and contributes to a decrease in peripheral resistance, balances vascular tone, stabilizes systemic and regional blood flow, which is manifested by the rapid positive dynamics of pressure loads, improved clinical course of NS and reduced hospitalization. Women who took the meldonium with γ-BB combination, in addition to the standard OMT, recorded significant positive changes in the content of female sex hormones in the blood, in particular estradiol (by 20.8%), which may be a consequence of the beneficial effect of meldonium with γ-BB on the microcirculation ovary.

Do Canadian Radiation Oncologists Consider Geriatric Assessment in the Decision-Making Process for Treatment of Patients 80 years and Older with Non-Metastatic Prostate Cancer? - National Survey.

Clinical judgement may not be sufficient to detect relevant problems in older cancer patients. We investigated what Geriatric Assessment tools (GA) are used by Canadian radiation oncologists (CROs) to treat non-metastatic prostate cancer patients aged 80 years and older. A 27-item cross-sectional survey was developed with input from a multidisciplinary team and distributed electronically to Genitourinary (GU) CROs via LimeSurvey. Survey contents included: demographics, treatment choice based on components of GA, and how GA tools are used in clinic. Descriptive statistics were used to analyze multiple-choice data, with Open-ended question being coded and analyzed for emerging themes. 154 GU CRO's were contacted, 44 responded (29%). Active surveillance was the choice of therapy in older low risk prostate cancer patients regardless of factors used in a GA assessment (97%). Results in intermediate and high-risk older prostate cancer patients were more heterogenous. Functional status and comorbidities were the most important factor in the decision-making-process (94%, 91%). Sixty-six percent of CROs did not use any GA tools; yet 77% felt comfortable to very comfortable treating older patients. Eighty-eight percent felt there were some to very few guidelines in helping them to treat older patients. Barriers to using GA included lack of knowledge, time, support, and resources. GAs are not commonly utilized by CROs. Majority of CROs felt comfortable treating older patients with prostate cancer, regardless of guidelines/evidence in this population. This may have negative implications on patient care. CROs are however open to referring patients for a formal GA.

Carotid Endarterectomy and Carotid Artery Stenting in a Predominantly Symptomatic Real-World Patient Population

Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are well-established treatments that have been shown to decrease stroke recurrence in patients with underlying carotid artery disease. We assessed clinical outcome, safety, and restenosis rates for patients who underwent standardized CEA or CAS at our tertiary care center using patient selection criteria based on available scientific evidence. Retrospective chart review of patients who underwent CEA or CAS between 2009 and2016. In total, 314 cases (204 with CEA and 110 with CAS) were analyzed. Patients were predominantly white (84.4%), men (61.1%) with hypertension (86.9%) and hyperlipidemia (81.8%). Most patients (84.5%) had symptomatic carotid disease. No significant differences were observed in median postoperative National Institutes of Health Stroke Scale and modified Rankin scale (mRS) scores based on pretreatment symptomatic status or treatment modality (CEA vs. CAS). Most patients (85.9%) had favorable outcomes (mRS score 0-2) at a median follow-up of 11.7 months (interquartile range, 1.8-28.8). The perioperative complication rate was low (3.2%), and permanent neurologic deficit was seen in only 3 patients (1%). Restenosis was found in 7.3%, without significant difference between CEA and CAS at last follow-up. Restenosis was asymptomatic in most patients. Our findings in a real-world predominantly symptomatic cohort demonstrate that favorable patient outcomes and low restenosis and complication rates can be achieved with both CEA and CAS by the utilization of a consistent institutional patient selection and treatment process.

Causes of and factors that exacerbate faecal incontinence in older people.

Faecal incontinence (FI) can be defined as a decline in bowel function that results in the involuntary loss of solid or liquid faeces (Menees et al, 2018). It is a common and distressing symptom that occurs at any age. There are numerous reasons why a person might lose control of their bowel function; the causes are multifactorial and often complex. It is important to recognise that while many of the causes of incontinence are not within the scope of the community nurse to change, many of the exacerbating factors are modifiable. This article highlights the importance of identifying FI and describes some of the structural and functional causes of this condition. Specific management will not be covered in this article as this was covered in an earlier issue in the series (Kelly, 2019). While it should not be considered an expected outcome of advanced age, FI is more prevalent in older people. Statistics vary according to the definition of FI and research methodology used for analysis. A recent systematic review (Sharma et al, 2016) revealed that the prevalence estimates of FI among older people varied between 1.4 and 19.5%. However, one study found that up to 55% older people experience FI as compared with 18% people in the general population (Alavi et al, 2015). The higher estimate seems plausible, as FI is under-reported due to people being reticent to disclose this problem to a healthcare professional (NICE, 2007). Additionally, GPs' knowledge and awareness of the treatment and referral process for patients with FI is sometimes limited (Thekkinkattil et al, 2008). Community nurses are ideally placed to recognise and support older people who have FI, either through referral or specific advice in relation to symptom control.

HUBUNGAN KARAKTERISTIK PASIEN HUMAN IMMUNODEFICIANCY VIRUS (HIV) DENGAN PENGAMBILAN KEPUTUSAN PENGOBATAN DI PUSKESMAS DUPAK

Dupak primary health care is one of health care which have complete HIV and Acquired Immuno Deficiency Syndrom (AIDS) prevention program. The number of HIV-AIDS sufferers increasing every year, but the number of new HIV positive cases taking Anti Retroviral Virus(ARV) treatment at Dupak primary health care are low. The purpose of this research was analyzed the HIV treatment decision making process of patients at Dupak primary health care. The method in this research was descriptive quantitive research through questionnaires. Variables of this study are individual characteristics include age, level of education, knowledges, status of severity with decision making process of treatment. The results of this study indicate that most respondents (50%) have a high knowledge of HIV treatment. Decision-making process of HIV positive patient treatment have 2 stages that most respondents didn’t do. There are stage of the information search (75%) and stage of alternative evaluation (56.25%). The conclusion of this research are most respondents didn’t do information searching and alternative evaluation in decision making process at Dupak primary health care. According suggested from this study are to improve HIV related socialization programs through promotional activities and discussions related to HIV treatment services to improve knowledge and activeness of seeking information through print and electronic media.

The retention of physicians to primary health care in Brazil: motivation and limitations from a qualitative perspective

BackgroundThis study analyzed the reasons why physicians migrated from the Program to Value Primary Healthcare Professionals (PROVAB) to the Mais Médicos (More doctors) Program in 2015, opting to become physicians of the Primary Health Care.MethodsThe focal group techniques were used consisting of six doctors that made the option to remain in the PHC, being the results analyzed through content monitoring as well as the respective categories, which were identified as theme analysis.ResultsIt was evidenced that the physician’s retention on primary care has a strong relationship with the acquisition of knowledge that is consistent with the context and the health needs of the population. Thus, appropriate competencies for the management of the different biopsychosocial characteristics of the territories, in consonance with abilities that use the communication centered on the patient as well as on the interdisciplinarity, producing health projects that include the uniqueness of the people, essential factor for the daily confrontation of the work of these physicians, strengthened by the training component of the program. Personal factors related to the empathetic profile with this level of care and the possibility of continuous improvement, besides the factors related to the adequate infrastructure and organizational climate with guaranteed salary in keeping with the complexity of Primary Care, positively influenced the permanence of these professionals and were drivers of changes in healthcare and management in the health units they were related to. The bond created with the team and patients was a great satisfaction factor for the professional, being identified by them as a possibility to make a difference in the treatment process of patients, strengthening the promotion of a healthier life through health education.ConclusionsPROVAB had an unparalleled contribution to the qualification of care in Primary Health Care, contributing to the birth of a new logic of medical training in Brazil. Its effective cooperation with the consolidation of the Mais Médicos Program, still in progress, is a great movement of resistance to the disarticulation and deconstruction of Unified Health System (SUS) which is in charge of public health in Brazil.

Characteristics of the Rights of Medical Practitioners in Treatment Process of Minor Patients

Nowadays the rights of medical practitioners are not so widely developed as the rights of minor patients. Protection of the rights of medical practitioners is directly subject to implementation of the rights of minor patients. Interaction or legal cooperation of medical practitioners and minor patients has been studied rather little from the scientific perspective. Despite several aspects – introduction of new Internet era in relations of doctors and patients, establishment of judicial practice in the sphere of protection of the rights of patients, the institute of the protection of the rights of medical practitioners in Latvia has not been sufficiently developed yet. Main conditions of interaction of medical practitioners and minor patients are defined both in the Medical Treatment Law and the Law on the Rights of Patients. However, the main feature of these relations is that within such framework, medical practitioners mostly have prohibitions and restrictions, whereas minor patients mostly have their rights stipulated. The aim of the article is to define the characteristics of the rights of medical practitioners in treatment process of minor patients. Descriptive, analytical, systematic and grammatical methods were used in compiling of the article. Mūsdienās ārstniecības personu tiesības nav tik plaši attīstītas kā pacientu tiesības. Īpašs jautājums ir par ārstniecības personu un nepilngadīgo pacientu tiesiskajām attiecībām. Praksē eksistē virkne jautājumu, kas liecina par attiecīgā rakstura problemātiku. Piemēram, aktuāls ir jautājums par ārstniecības personu tiesību raksturojumu gadījumos, kad jāveic nepilngadīgā pacienta vakcinācija. Saskaņā ar Pacientu tiesību likuma 13. panta pirmo daļu, veicot vakcinācijas, lēmumu par vakcinācijas veikšanu vai neveikšanu nepilngadīgam (līdz 14 gadu vecumam) pacientam pieņem šā bērna vecāki. Līdz ar to ārstniecības personu tiesībām ir sekundāra loma attiecībā pret bērna vecāku tiesībām. Taču jāatzīmē – ja bērns pats pēc 14 gadu vecuma atsakās no vakcinācijas, bet ārsts uzskata, ka vakcinācija konkrētajā gadījumā ir pacienta interesēs, tad ārstniecības personai ir tiesības vērsties ar iesniegumu bāriņtiesā. Taču minētais ārstniecības personu tiesību realizācijas mehānisms nav efektīvs no praktiskā viedokļa, jo, iesaistoties papildu institūcijai, pastāv vairāki šķēršļi ātra lēmuma pieņemšanai. Ārstniecības personu tiesības tiek ierobežotas arī jautājumā par pilnvarojuma nepieciešamību. Arī jautājums par ārstniecību gadījumā, ja nepilngadīgu pacientu uz izmeklējumu atved persona, kurai nav sakārtota pilnvarojuma dokumentācija, ir neskaidrs un komplicēts no ārstniecības personu tiesību viedokļa. Piemēram, Pacientu tiesību likumā ārstniecības personām noteikts pienākums sniegt ārstniecības pakalpojumus nepilngadīgām personām, ja tam savu piekrišanu devis likumiskais pārstāvis. Saskaņā ar Civillikuma 177. un 223. pantu bērna likumīgie pārstāvji ir vecāki. Tomēr praksē ir situācijas, kad bērnu uz izmeklējumu atved trešā persona. Tādējādi ārstniecības persona ir lēmuma izvēles priekšā – sniegt vai nesniegt ārstniecības pakalpojumu bērnam, kurš ir ieradies uz izmeklējumu ar personu, kurai nav sniegts pilnvarojums. Šajā gadījumā būtu vērtējami ne tikai riski, kas saistīti ar pakalpojuma nesniegšanu, bet arī ar nepilngadīgo pacientu tiesībām uz veselību. Ārstniecības personu tiesību aizsardzība tiešā veidā ir atkarīga no nepilngadīgo pacientu tiesību attīstības un šo tiesību īstenošanas. Ārstniecības personu un nepilngadīgo pacientu mijiedarbība vai tiesiskā sadarbība no zinātniskā viedokļa ir pētīta diezgan maz. Neskatoties uz vairākiem aspektiem – interneta laikmeta iespēju ieviešanas ārstniecības personu un pacientu attiecībās, jaunas tiesu prakses pacientu tiesību aizsardzības jomā utt., ārstniecības personu tiesību aizsardzība Latvijā joprojām nav pietiekami attīstīta. Galvenie ārstniecības personu un nepilngadīgo pacientu mijiedarbības nosacījumi ir definēti gan Ārstniecības likumā, gan Pacientu likumā, gan citos tiesību aktos. Tomēr ārstniecības personu un nepilngadīgo pacientu tiesiskās attiecības raksturo galvenokārt ārstniecības personu tiesību ierobežojošs faktors attiecībā pret nepilngadīgo pacientu un viņu likumisko pārstāvju tiesībām. Tas rada problēmas savstarpējo attiecību pilnveidošanā. Neskatoties uz ārstniecības personu tiesībām izvēlēties vienu vai otru ārstēšanas metodi, medikamentus utt., tomēr gala lēmumu par nepilngadīgā pacienta ārstniecību lielākoties pieņem vecāki.

Simulation training streamlines the real-life performance in endovascular repair of ruptured abdominal aortic aneurysms

ObjectiveDifficulties in distributing endovascular experience among all operating room (OR) personnel prevented full-scale use of endovascular aneurysm repair (EVAR) in emergencies. To streamline the procedure of EVAR for ruptured aneurysm (rEVAR) and to provide this method even to unstable patients, we initiated regular simulation training sessions. MethodsThis is an observational study of 29 simulation sessions performed between January 2015 and December 2017. We analyzed the development of time from OR door to aortic balloon occlusion during simulations and OR door to needle times in real-life rEVARs as well as the outcome of the 185 ruptured abdominal aortic aneurysm (rAAA) patients who arrived at the university hospital between January 2013 and December 2017. A questionnaire was sent for simulation attendants before and after the simulation session. ResultsIn the first simulations, the door to occlusion time was 20 to 35 minutes. After adding a hemodynamic collapse to the simulation protocol, the time decreased to 10 to 13 minutes in the 10 recent simulations, including a 5-minute cardiopulmonary resuscitation (P = .01). The electronic questionnaire performed for attendees before and after the simulation session showed significant improvement in both confidence and knowledge of the OR staff regarding rEVAR procedure. In the real-life rEVARs, 75 of the 185 patients with rAAAs underwent EVAR. Among rEVAR patients, the median OR door to needle time was 65 minutes before and 16 minutes after the onset of simulations (P = .000). The overall 30-day mortality among all rAAA patients was 44.8% and 30.6% accordingly (P = .046). When patients who were turned down from the emergency surgery were excluded, the 30-day operative mortality was 39.2% and 25.1% during the periods, respectively (P = .051). The 30-day mortality was 16.2% after rEVAR and 40.6% after open surgery (P = .001). ConclusionsSimulation training for rEVAR significantly improves the treatment process in real-life patients and may enhance the outcome of rAAA patients.

Impact of attachment behavior on the treatment process of chronic pain patients.

BackgroundInsecure attachment patterns are related to the onset and development of chronic pain. However, it is less documented on how short- and long-term effects of pain therapy might differ with the attachment style in interaction with specific pain conditions. We therefore examined how two different groups of chronic pain patients differ in their treatment trajectories and in regard to attachment.MethodN=85/76/67 (T1/T2/T3) patients with medically unexplained musculoskeletal pain (UMP group) were compared to n=89/76/56 patients with joint pain from osteoarthritis (OA group), using multilevel modeling. UMP patients received a multimodal pain program, and OA patients received surgery. Pain intensity before (T1) and after (T2) treatment and at a 6 months follow-up (T3) was assessed by using a visual analog scale of pain.ResultsPain patients report a significant reduction in pain intensity upon the completion of the treatment compared to T1. Over the next 6 months, the pain intensity has further declined for patients with low attachment anxiety. In contrast, patients with highly anxious attachment report an increase in pain intensity. This main effect of anxious attachment on pain is significant when predicting changes both in acute treatment and during follow-up while controlling for group effect. In addition, there is also an interactive effect of group by avoidant attachment. In the UMP group, high scores in avoidant attachment were associated with the lower reduction in pain severity, while in the OA group, high scores in attachment avoidance were associated with a steeper reduction in pain severity.ConclusionThe results indicate that insecurely attached patients with pain symptoms only benefit from a multimodal pain therapy in limited ways in regard to posttreatment trajectories. Maintaining positive results over a period of 6 months is a challenge, compared with securely attached patients.SignificanceThe results of this study suggest the importance of direct and indirect mechanisms of attachment and its relevance for the management of pain experiences. Therefore, to include the individual attachment patterns in the treatment may be a promising way to enhance the treatment prospects.

Nutrition of Patients with Jaw Fracture and After Orthognatik Surgery, Review of the Literature

Nutritional deficiencies occurring during treatment process in patients with jaw fractures will have a negative impact as: reducing of immune indicators in the body, weakening of protective reactions, tendency to complications, and traumatic effects. This article summarizes the content of scientific studies related to the nutritional status or nutrition of patients with fractures. Methods: Was conducted a systematic review of randomized controlled trials evaluating the nutritional status of patients with jaw fractures and post-orthodontic surgery during immobilization. Results: Were identified twenty-seven studies. It is established that during the immobilization period the patient has changes of the trophic status, nutritional insufficiency (malnutrition), explained by weight loss and changes in anthropometric parameters, blood changes (hypoalbuminemia, decrease of hemoglobin of blood). Oral nutritional supplements or alternative feeding methods improve nutritional status, as many studies have observed (weight and other anthropometric parameters, normalization of biochemical blood parameters,). In addition, according to some authors, decreased the number of complications and reduced the duration of hospitalization and expenditure. It is recommended that nutritional supplements be offered to malnourished patients during this period. Keywords: Maxillofacial trauma; Mandibular fracture; Jaw fracture; Nutrition; Feeding; Diet; Nutritional assessment; Nutritional status; Intermaxillar fixation; Orthognatik surgery;

GW29-e1124 Optimization of Emergency Treatment Process for Patients with STEMI and Assessment of Effects in Chest Pain Center

To discuss the impact of optimizing the emergency treatment process leaded by nurses on reducing the time delayed in treating patients with ST-Segment Elevated Myocardial Infarction(STEMI) in hospital. Chest Pain Center was set up in the ED, and the emergency treatment process for patients with

Automatic segmentation of abnormal capillary nonperfusion regions in optical coherence tomography angiography images using marker-controlled watershed algorithm.

Diabetic retinopathy (DR) is one of the most complications of diabetes. It is a progressive disease leading to significant vision loss in the patients. Abnormal capillary nonperfusion (CNP) regions are one of the important characteristics of DR increasing with its progression. Therefore, automatic segmentation and quantification of abnormal CNP regions can be helpful to monitor the patient's treatment process. We propose an automatic method for segmentation of abnormal CNP regions on the superficial and deep capillary plexuses of optical coherence tomography angiography (OCTA) images using the marker-controlled watershed algorithm. The proposed method has three main steps. In the first step, original images are enhanced using the vesselness filter and then foreground and background marker images are computed. In the second step, abnormal CNP region candidates are segmented using the marker-controlled watershed algorithm, and in the third step, the candidates are modeled using an undirected weighted graph and finally, by applying merging and removing procedures correct abnormal CNP regions are identified. The proposed method was evaluated on a dataset with 36 normal and diabetic subjects using the ground truth obtained by two observers. The results show the proposed method outperformed some of the state-of-the-art methods on the superficial and deep capillary plexuses according to the most important metrics.

Sonographic diameter of optic nerve sheath in differentiation of ischemic and hemorrhagic strokes; a diagnostic accuracy study

IntroductionDifferentiating between ischemic and hemorrhagic types is of special importance in the treatment process of patients with stroke. The present study was designed with the aim of evaluating the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) in differentiation of ischemic from hemorrhagic stroke. MethodsThe present research is a diagnostic accuracy study on patients with stroke presenting to emergency department during 1 year. Ultrasonographic diameter of optic nerve sheath of both eyes was measured for all the patients and its sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios in differentiating ischemic stroke from hemorrhagic type were calculated considering CT scan findings as the gold standard. Results80 patients with stroke (40 hemorrhagic and 40 ischemic) were studied. Mean age of the patients was 65.0 ± 13.1 years (57.5% male). Mean ONSD was 5.5 ± 0.4 mm in the ischemic group and 6.1 ± 0.7 mm in the hemorrhagic group (p < 0.0001). Area under the curve of ONSD in differentiation of hemorrhagic and ischemic stroke was 0.75 (95% CI: 0.64–0.86). In 5.5 mm cut-off point, sensitivity and specificity of ONSD in identifying the type of stroke were 75.0% (95% CI: 58.5–86.8) and 52.5% (95% CI: 36.3–68.2), respectively. These values were 57.5% (95% CI: 41.0–68.2) and 90.0% (95% CI: 75.4–96.7), respectively, in the 6 mm cut-off point. ConclusionFindings of the present study showed that ultrasonographic diameter of optic nerve sheath has moderate accuracy in differentiation of hemorrhagic and ischemic stroke.

Health State Utilities Associated with Attributes of Weekly Injection Devices and Subdermal Implant for Treatment of Type 2 Diabetes

Cost-utility analyses include health utilities to compare medical treatments. Health utilities, ranging from 0 to 1, represent the strength of a patient’s preference for a drug profile or health-related outcome. Recently glucagon-like peptide-1 (GLP-1) receptor agonists have been used for management of glycemic control in type 2 diabetes (T2DM). Many GLP-1 drugs have similar modes of administration. In contrast, ITCA 650 is an investigational product which is an implantable device that, following subdermal placement, provides continuous delivery of exenatide for 3 or 6 months. The study’s purpose was to estimate health utilities associated with treatment processes of GLP-1s for use in economic models. During a UK-based pilot study, 19 general population (general population) participants completed time trade-off (TTO) interviews to value health states (often called vignettes or scenarios) which were based on literature review, instructions for use, and clinician interviews. A follow-up pilot study was conducted in both general population and T2DM participants to value modified health states. Participants were recruited to ensure equal distribution across gender and education levels. A total of 20 general population and 18 T2DM patients completed face-to-face interviews (general population mean age= 50.7; T2DM mean age = 56.2). Mean utilities (SD) for ITCA-650 were 0.93 (0.06) for T2DM patients and 0.91 (0.11) for the general population. Mean utility scores for injection health states ranged from 0.83-0.92 for T2DM and 0.82-0.91 for general population. Results are higher than others found in the literature for diabetes treatment processes (range: 0.85 to 0.88). A main study with 200 participants will be conducted in early 2018. Results may be useful in cost-utility models comparing the value of treatment processes for patients with T2DM. Findings suggest the TTO method may be used to quantify preferences among different treatment processes. Disclosure A.M. Rentz: Other Relationship; Self; Intarcia Therapeutics, Inc., Servier. K. Cutts: None. K. Washington: None. M. Beillat: None. K. Yu-Isenberg: Employee; Self; Intarcia Therapeutics, Inc..

A data-driven framework of typical treatment process extraction and evaluation

BackgroundA clinical pathway (CP) defines a standardized care process for a well-defined patient group that aims to improve patient outcomes and promote patient safety. However, the construction of a new pathway from scratch is a time-consuming task for medical staff because it involves many factors, including objects, multidisciplinary collaboration, sequential design, and outcome measurements. Recently, the rapid development of hospital information systems has allowed the storage of large volumes of electronic medical records (EMRs), and this information constitutes an abundant data resource for building CPs using data-mining methods. MethodsWe provide an automatic method for extracting typical treatment processes from EMRs that consists of four key steps. First, a novel similarity method is proposed to measure the similarity of two treatment records. Then, we perform an affinity propagation (AP) clustering algorithm to cluster doctor order set sequences (DOSSs). Next, a framework is proposed to extract a high-level description of each treatment cluster. Finally, we evaluate the extracted typical treatment processes by matching the treatment cluster with external information, such as the treatment efficacy, length of stay, and treatment cost. ResultsBy experiments on EMRs of 8287 cerebral infarction patients, it is concluded that our proposed method can effectively extract typical treatment processes from treatment records, and also has great potential to improve treatment outcome by personalizing the treatment process for patients with different conditions. ConclusionThe extracted typical treatment processes are intuitive and can provide managerial guidance for CP redesign and optimization. In addition, our work can assist clinicians in clearly understanding their routine treatment processes and recommend optimal treatment pathways for patients.

Nursing Management Method for Thrombolysis Time Window of Cerebral Ischemic Stroke

This paper aims to analyse the reasons for hospital-visit and in-hospital thrombolysis delays about the cerebral ischemic stroke patients, and then makes a related countermeasure study. In the study, at stage 1, the analysis was made for the reasons of stroke patients’ thrombolysis delay by tracking the treatment process of stroke patients, and making questionnaire survey to understand the patients’ cognition about cerebral stroke; at stage 2, based on reasons for thrombolysis delay, the countermeasures were studied, e.g. optimize the thrombolysis process on the basis of process management theory, formulate the illustrated health educational manual, and analyse the application effect of measures. Besides, the SPSS17.0 software was adopted to make statistical analysis. With the multi-level stroke management team (incl. nursery and administration etc.) established, the first-aid process can be optimized and the medical and nursing quality process control management system be improved. At last, considering the lack of related knowledge about cerebral stroke disease, the related health education should be enhanced, and the public awareness of hospital treatment in time should be improved, in order to reduce the patient’s clinic time and improve the thrombolytic ratio.

Experience in treatment of complex congenital intestinal atresia in children

To summarize experience in the treatment of complex congenital intestinal atresia in children, so as to investigate the key points and effect of the operation. Medical notes of 49 children with complex intestinal atresia treated between January 2012 and January 2018 were reviewed. The information of age, sex, age at operation, full-term or premature, birth weight, clinical manifestation, auxiliary examination, preliminary diagnosis, treatment process, discharge diagnosis, pathological results and prognosis of patients were analyzed. All patients underwent surgical treatment, including 42 cases with laparotomy (85.7%) and 7 with laparoscopic surgery (14.3%); 1 case undergoing laparoscopic surgery was converted to laparotomy due to meconium peritonitis. The mean operation time was (147±43) min (70-270 min); the mean fasting time after surgery was (8±3) d (4-16 d); the mean parenteral nutrition time was (12±6) d (3-30 d). Eleven cases were discharged against medical after operation and lost to follow-up. Among rest 38 children, 1 child (2.6%) received intestinal resection and ostomy five days after operation due to gastrointestinal perforation; 1 child (2.6%) received conservative treatment one month later due to adhered intestinal obstruction and left hospital with cure; 1 child (2.6%) received enterodialysis and ileostomy eight days after operation due to anastomotic leak, and received the operation for the closure of fistula after three months; 4 children had complications including fluid and electrolyte disorders, anemia, hypoproteinemia and so on, and recovered after conservative treatments. Postoperative follow-up showed that 1 child with duodenal atresia had lower body weight at 6 month after operation, but the body weight returned to normal when the child was one year old; 1 child with preterm labor of 32 weeks was treated with enteral nutrition, and gradually restored the normal diet after 6 months. Growth retardation was not observed in other children. With active treatment and reservation of normal bowel tube as much as possible during the operation, the prognosis of children with complex intestinal atresia is usually favorable.