Outcomes Of Placement Research Articles

Efficacy of urodynamic studies in predicting long-term outcomes of the transobturator tape: do they augment clinical assessment?

IntroductionSome controversy exists regarding necessity for urodynamic evaluation prior to surgical management of stress urinary incontinence (SUI). We aimed to interrogate the role of pre and post-operative urodynamic studies versus clinical assessment in predicting long-term patient reported outcomes of transobturator tape (TOT) placement.Material and methodsA 100 patient cohort of women post TOT insertion for stress/mixed urinary incontinence 2005–2010, under a single surgeon, was identified. Results of pre and post-operative clinical assessment and urodynamic studies were retrospectively evaluated. Long-term patient reported outcome measures (PROMs) were assessed using the International Consultation on Incontinence Questionnaire (ICIQ) Short Form, Patient Global Impression of Severity (PGI-S) and Patient Global Impression of Improvement (PGI-I) questionnaires. The role of urodynamic studies in predicting postoperative voiding dysfunction, and long-term procedure outcomes was analysed. Statistical correlations were performed using SPSS.ResultsQuestionnaire response rate was 76/100 (76%) at mean follow-up 9.4 years (7.25–12.75). Mean ICIQ score was 6.32 (1–20). No significant correlations between preoperative pDet QMax and postoperative uroflow/duration of intermittent self catheterisation (ISC), or between preoperative leak-point pressures and outcome were observed. Postoperative urodynamic tests did not reliably predict long-term success in SUI cure. Preoperative clinical urgency was a more reliable predictor of long-term clinical urgency than urodynamic detrusor overactivity. Whilst patients with mixed urinary incontinence at long-term follow-up tended to have the highest (worst) overall ICIQ-SF and ICIQ quality of life score, no studied variables on preoperative CMG were significantly correlated with long-term PROMs.ConclusionsWhilst urodynamic studies provide important baseline bladder function data, prior to mid-urethral sling placement, this study finds no specific value of either pre or postoperative urodynamics in predicting long-term patient reported outcomes of transobturator tape placement.

Midterm Single-Center Results of Endovascular Aneurysm Repair With Additional EndoAnchors

Purpose: To review midterm clinical outcomes of EndoAnchor placement during or after endovascular aneurysm repair (EVAR) or chimney EVAR (ch-EVAR). Materials and Methods: A retrospective analysis was conducted of 51 consecutive patients [median age 75 years; 38 men] who underwent EVAR/ch-EVAR with EndoAnchor placement between June 2010 and December 2016 to prevent seal failures (31, 61%) or to treat type Ia endoleak and/or migration (20, 39%). Median aortic neck diameter was 27.7 mm and median neck length was 9.0 mm. Thirty-three (65%) had a conical neck; 48 (94%) had at least 1 hostile neck characteristic. Thirty-two (63%) patients had severe comorbidities (ASA score ⩾III). Eight patients had a single ch-EVAR procedure. Baseline patient characteristics, anatomic variables, procedure details, early and late complications, reinterventions, and aneurysm-related and all-cause mortality rates were recorded. Follow-up imaging was performed with computed tomography angiography (CTA) or duplex ultrasonography. Results: Median procedure time was 100 minutes; a median of 6 EndoAnchors were implanted. There were 10 (10%) residual type Ia endoleaks at the end of the procedure; 9 had resolved by the first postoperative CTA. One residual and 2 new type Ia endoleaks were identified at the first postoperative imaging. Median follow-up for the entire cohort was 24.0 months, during which 3 new type Ia endoleaks were identified. Five of the 6 type Ia endoleaks were treated, 1 resolved spontaneously. There was 1 endograft limb occlusion without clinical consequences, 1 chimney graft occlusion without possibilities for a reintervention, 1 rupture after type IV endoleak (a Nellix device was successfully deployed within the main device), and 1 complete graft explantation for infection. There was no new-onset hemodialysis. Kaplan-Meier estimates of freedom from type Ia endoleak, proximal neck–related reinterventions, and aneurysm-related mortality at 2 years were 87.3%, 92.2%, and 94.0%, respectively. Conclusion: EndoAnchors are helpful in the endovascular treatment of unfavorable proximal aortic necks, with fair midterm results.

The benefits of international volunteering in a low-resource setting: development of a core outcome set

BackgroundQualitative narrative analysis and case studies form the majority of the current peer-reviewed literature about the benefits of professional volunteering or international placements for healthcare professionals. These often describe generalised outcomes that are difficult to define or have multiple meanings (such as ‘communication skills’ or ‘leadership’) and are therefore difficult to measure. However, there is an interest from employers, professional groups and individual volunteers in generating metrics for monitoring personal and professional development of volunteers and comparing different volunteering experiences in terms of their impact on the volunteers. In this paper, we describe two studies in which we (a) consolidated qualitative research and individual accounts into a core outcome set and (b) tested the core outcome set in a large group of global health stakeholders.MethodWe conducted a systematic review and meta-synthesis of literature to extract outcomes of international placements and variables that may affect these outcomes. We presented these outcomes to 58 stakeholders in global health, employing a Delphi method to reach consensus about which were ‘core’ and which were likely to be developed through international volunteering.ResultsThe systematic review of 55 papers generated 133 unique outcomes and 34 potential variables. One hundred fifty-six statements were then presented to the Delphi stakeholders, of which they agreed 116 were core to a wide variety of healthcare professional practice and likely to be developed through international experiences. The core outcomes (COs) were both negative and positive and included skills, knowledge, attitudes and outcomes for healthcare organisations.ConclusionsWe summarised existing literature and stakeholder opinion into a core outcome set of 116 items that are core to healthcare professional practice and likely to be developed through international experiences. We identified, in the literature, a set of variables that could affect learning outcomes. The core outcome set will be used in a future study to develop a psychometric assessment tool.

Palliation of malignant gastroduodenal obstruction with self-expandable metal stent using side- and forward-viewing endoscope: Feasibility and outcome.

BackgroundThe endoscopic placement of a self‐expandable metal stent (SEMS), an alternative to surgical bypass for the palliation of malignant gastric outlet obstruction (GOO), is commonly performed using a forward‐viewing endoscope with a wide therapeutic channel; however, due to limited availability, most Indian centers use a side‐viewing duodenoscope. We studied the feasibility and outcome of SEMS placement using side‐ and forward‐viewing endoscopes.MethodData of patients undergoing SEMS placement using side‐ and forward‐viewing endoscopes with a therapeutic channel for the palliation of malignant GOO presenting during a 5‐year period were analyzed retrospectively. Follow‐up data were obtained from records and telephonic interviews, and technical and clinical success, complications, and survival were evaluated.ResultsOf 114 patients (age 56.5 ± 11.6 years, 59 [52%] female), 90 (79%) and 24 (21%) underwent SEMS placement using side‐ and forward‐viewing endoscopes, respectively. Technical (89, 98.9% vs. 24, 100%, P = ns) and clinical success (84, 93.3% vs. 23, 95.8%, P = ns) and complication rate (3, 3.3% vs. 0, P = ns) between side‐ and forward‐viewing endoscopes were comparable. However, SEMS could be placed in a shorter time using a forward‐ rather than side‐viewing endoscope (21 min [inter‐quartile range 19.5–35] vs. 34 min [25–45], P = < 0.001). SEMS could be deployed successfully with a forward‐viewing endoscope in two patients in whom an initial attempt using side‐viewing endoscope failed. Gastric outlet obstruction scoring system (GOOSS) improved following stent placement (median 0, range 0–2 vs. 2, 0–3, P = 0.0001). The survival of patients undergoing SEMS placement using side‐ and forward‐viewing endoscopes was comparable.ConclusionAlthough side‐ and forward‐viewing endoscopes are equally effective for antroduodenal SEMS placement, the procedure can be performed faster using the latter.

Superiority of Gastrojejunostomy Over Endoscopic Stenting for Palliation of Malignant Gastric Outlet Obstruction

Gastric outlet obstruction (GOO) in patients with malignancies causes nausea, vomiting, abdominal pain, malnutrition, and dehydration. Endoscopic placement of self-expandable metallic stent (SEMS) and gastrojejunostomy are the 2 main palliative options. We aimed to compare the outcomes of endoscopic SEMS placement with gastrojejunostomy in a propensity score matched study and identified factors associated with clinical success. We performed a retrospective analysis of patients with malignant GOO who underwent endoscopic SEMS placement (n= 183) or gastrojejunostomy (n= 127) from 2011 through 2017 at a tertiary academic medical center. Clinical success was defined as successful resumption of oral intake and relief of obstructive symptoms after either procedure. A propensity score matched analysis was conducted to compare clinical success rate, luminal patency duration, survival length, and adverse outcomes. We performed multivariable analyses to identify factors associated with clinical success. Proportions of patients with clinical success did not differ significantly between the SMES group (79.4%) and the gastrojejunostomy group (80.1%) (P= .83). The mean patency duration and survival lengths were significantly longer in the gastrojejunostomy group (169.2 and 193.4 days respectively), compared to the endoscopic stenting group (96.5 and 119.9 days respectively). Poor performance status, presence of ascites and low albumin were independent risk factors for failure of enteral stenting and gastrojejunostomy. In a retrospective analysis of patients with GOO, due to cancer, who underwent endoscopic SEMS placement or gastrojejunostomy, we found gastrojejunostomy to provide significant increases in patency duration and survival time. Gastrojejunostomy should therefore be considered the primary treatment option for patients with good performance status and reasonable survival expectancy. Nutritional status, the absence of ascites, and pre-procedure performance status are associated with clinical success.

Do contradictions in TQIP measures affect perceptions of quality. An analysis of TQIP definitions on quality outcomes for placement of ICP monitoring at a single level one trauma center

BackgroundTQIP quality measures as currently defined on occasion provide discordant conclusions. A recent TQIP report of an urban level one-trauma center suggested a low employment of ICP monitoring while also demonstrating aggressive implementation of ICP monitoring (ave. within 90 min of arrival). This apparent contradiction leads to the question; Does TQIP define correctly the patient cohort who would most benefit from ICP monitoring? MethodsA retrospective IRB approved review of all patients reported to TQIP with severe TBI was performed at an ACS verified level one trauma center. All patients admitted to the TS during the TQIP study period were reviewed. Demographic data as well as AIS, ISS, GCS, injury type and outcomes were reviewed. Data were reported as aggregate. ResultsTrauma registry review determined 108 patients met the TQIP definition for severe TBI. Analysis of these patients revealed only 58%(63) met clinical criteria for severe TBI. In this group 45.4%(49) suffered non-survivable TBI. ICP monitoring was not initiated in this subgroup of patients. 42%(45) of the patients were determined to have mild to moderate TBI. In this cohort the initial GCS reported in the trauma registry overestimated the severity of the TBI in 19.4%(21) of the patients. ICP monitoring was initiated 29%(30) patients. The analysis would indicate 13%(14) would have benefited from ICP monitoring indicating an 15%(16) over utilization. The majority of these patients sustained meaningful neurologic recovery indicating a better-defined criterion may be necessary to determine when ICP monitoring is a quality indicator. ConclusionThis study indicates the current TQIP definition used to justify ICP monitoring appears to overestimate the number of patients who would benefit from ICP monitoring. The corrected quality analysis indicates an overutilization rather than an underutilization of ICP monitoring. Further study of the effect of definitions on quality measures should be considered.

Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement.

Image-guided percutaneous cholecystostomy may be performed by a transhepatic or transperitoneal approach. We compared the short- and long-term outcomes of percutaneous cholecystostomy related to route of catheter placement. A retrospective observational study of image-guided percutaneous cholecystostomy was performed from 2004 to 2016. A search of the hospital's radiology information service was performed using the keywords "percutaneous cholecystostomy," "gallbladder drain," and "cholecystostomy tube" and the relevant Current Procedural Terminology codes. All search results were reviewed to identify the cohort of 373 patients who underwent initial percutaneous cholecystostomy catheter placement. Imaging was reviewed to determine the method and route of percutaneous cholecystostomy and complications. A chart review was performed to determine clinical outcomes. Differences were examined using a generalized linear model assuming a binary distribution and logit function. Percutaneous cholecystostomy catheter placement was performed using ultrasound guidance alone in 229 patients, ultrasound access with fluoroscopic guidance in 129 patients, CT guidance in 14 patients, and fluoroscopic guidance in one patient. The trocar technique was used for 183 patients, and the Seldinger technique was used for 190 patients. Two hundred eighteen percutaneous cholecystostomy catheters were placed via the transhepatic route, and 153 were placed via the transperitoneal route. The most common catheter sizes used were 8.5 French (n = 234) and 10 French (n = 124). No significant differences were observed between transperitoneal and transhepatic placement with regard to the frequency of pain, clogging, skin infection, bleeding, biloma, cholangitis, leakage, abscess, unplanned catheter removal, or need for replacement (p > 0.05). No evidence of a difference in outcomes was observed for transhepatic cholecystostomy tube placement over transperitoneal placement. The route that appears safer and less technically challenging should therefore be chosen.

Anatomical variants of upper arm veins on preoperative mapping venography for hemodialysis access in Korean adults.

The number of elderly patients requiring hemodialysis has increased, along with the need for multiple vascular access placements. Thus, the frequency of access creation using the upper arm veins, including transposed basilic arteriovenous fistula, has also increased. The purpose of this study was to identify the prevalence of anatomical variations in the upper arm veins on preoperative mapping venography and to investigate the implications of such variants on access creation. A total of 494 venograms were performed on 251 patients for primary access creation from June 2014 to June 2017 in this single-center, retrospective study. The venograms were classified into eight subtypes, based on the anatomical relationship between the basilic and brachial veins. The presence of bifid cephalic arches and brachial-basilic ladders was also examined. The presence of bifid cephalic arches and brachial-basilic ladders was identified in 8.7% and 14.0% of cases, respectively. Paired brachial veins joined separately with the basilic vein in 67.4% of venograms, whereas these veins merged into a common brachial vein before connecting to the basilic vein in 13.1% of cases. A single brachial vein was present in 19.3% of cases. 15.7% of cases were considered unsuitable for basilic vein transposition due to the early confluence of the brachial-basilic vein, posing a risk of obliterating the deep venous drainage if transposed. There are significant anatomical variations of upper arm veins, and the recognition of certain variants can affect surgical planning and outcomes of access placement. It is important to identify anatomical variants of the upper arm veins during preoperative vein mapping.

Ureteral stents for malignant extrinsic ureteral obstruction: outcomes and factors predicting stent failure.

This study investigated the clinical outcomes of stent placement for malignant extrinsic ureteral obstruction (MUO) and predictive factors for stent failure. We retrospectively analyzed clinical data for 91 patients with radiologically significant hydronephrosis due to MUO who underwent successful stent placement. In total, 132 ureters were stented for the decompression. Factors related to stent failure were analyzed with a Cox proportional hazards model. Stent failure occurred in 25 ureters in 20 patients. The median interval to failure was 63 days. The multivariate analysis showed that the significant predictors of stent failure were bladder invasion and severe hydronephrosis before the stent insertion. The patients were divided into three groups based on these two factors: low-risk (neither factor; 85 patients), intermediate-risk (one factor; 37), and high-risk (both factors; 10). The median stent failure-free survival rate at 3 months was 94.8% in the low-risk, 71.8% in the intermediate-risk and 55.6% in the high-risk group, respectively. Of the ureters with stent failure, there was successful re-replacement of internal stents in 3 low-risk, 6 intermediate-risk and no high-risk ureters. Replacement by nephrostomy was done in 2 low-risk, 5 intermediate-risk and 7 high-risk ureters. The patients considered at low-risk could be managed without stent failure by internal stenting. However, the patients at high-risk may require the consideration of nephrostomy or other alternatives as the initial treatment. Our stratification model may allow better risk stratification for patients with regard to ureteral stenting, helping to identify patients for whom ureteral stenting is indicated.

Exploring the outcomes of standards-based concurrent enrollment and Advanced Placement in Arkansas

Accelerated programs (concurrent enrollment and Advanced Placement) are expanding across the US, yet there is little evidence on the relationships between participation in different accelerated programs, standards-based concurrent enrollment programs (e.g., accredited programs), and educational outcomes. This study used data from a cohort of Arkansas high school graduates and school-level fixed effects to assess how different accelerated programs predict students’ likelihood of enrolling in and being retained in an Arkansas college. We found that participation in concurrent enrollment and Advanced Placement predicts college access and college retention. However, we found no differences in college access and retention based on whether students participated in a NACEP-accredited concurrent enrollment program or not. The results suggest the need to expand access to both concurrent enrollment and Advanced Placement and the need for more research on standards-based concurrent enrollment programs such as those that are NACEP-accredited.

Technical and Clinical Outcomes of Colonic Stent Placement in Patients With Proximal Malignant Large Bowel Obstruction

Technical and Clinical Outcomes of Colonic Stent Placement in Patients With Proximal Malignant Large Bowel Obstruction

Impact of simulation-based learning on immediate outcomes of temporary haemodialysis catheter placements by nephrology fellows.

Traditional apprenticeship model (AM) of teaching in invasive procedures such as temporary haemodialysis catheter (THDC) insertion can result in propagation of errors and complications. Simulation-based learning (SBL) offers standardization of skills and allows trainees to repeatedly practice invasive procedures prior to performing them on actual patient. Retrospective cohort study of first-, second- and third-year Nephrology Fellows from a tertiary teaching hospital from September 2008 to September 2015. The intervention group (n = 9) received simulation training in ultrasound-guided THDC placement. The historical control group (n = 12) received training through traditional AM. The primary and secondary outcomes were the immediate complications and success rates of THDC insertion. A total of 2481 THDCs were placed in 1787 patients. Success rate of internal jugular THDC placement for AM vs. SBL Fellow was 99.8% versus 100% (P = 0.90), while the success rate for femoral THDC placement was 99.6% versus 99.2% (P = 0.53). SBL Fellows reported fewer overall peri-procedure complications (8.3% vs. 11.2%, P = 0.02) and mechanical complications (1% vs. 2.4%, P = 0.02) compared to AM Fellows. The rate of reported technical difficulty was similar (7.5% vs. 9.2%, P = 0.17). After adjusting for side and site of THDC placement, body mass index and laboratory indices, THDC inserted by AM Fellows were independently associated with increased overall peri-procedure complications (OR = 1.396, 95% CI: 1.052-1.854, P = 0.02) and mechanical complications (OR = 2.481, 95% CI: 1.178-4.810, P = 0.02). Simulation-based learning was associated with lower procedure related complications and should be an integral component in the teaching of procedural skills in Nephrology.

The association between disciplinary alternative school placement and youth outcomes: A meta-analytic assessment

ABSTRACTThe purpose of this study is to conduct a meta-analytic assessment of the effects of disciplinary alternative program (DAP) placement on student outcomes, including disciplinary sanctions, academic performance, and truancy. A total of 14 eligible studies were identified in peer-reviewed and grey literature, producing a total of 62 effect sizes. Five subgroup analyses were conducted. Results of the meta-analysis found an overall nonsignificant effect of DAP placement on student outcomes and subgroup analyses revealed differences in the effects of DAP placement by measurement time point and outcome type. Results of this study indicate DAP placement does not significantly improve student outcomes. This study emphasizes the need for rigorous methodological research examining the effect of DAP placement on adolescent delinquency.

Neglected children with severe obesity have a right to health: Is foster home an alternative?-A qualitative study.

To explore key person's perspectives of foster home placement or notification of risk of harm to Social Services of children with severe obesity. This case study research was performed in the southwest of Sweden and based on interviews with nine informants: a foster home youth, two foster parents, a social worker, two hospital social workers, a pediatric physician, a pediatric nurse, and a psychologist. Content analysis was used for narrative evaluations, within- and cross case analyses and displays. Positive health outcomes of the foster home placement were described as a healthy and normalized weight status, a physically and socially active life, and an optimistic outlook on the future. The foster parents made no major changes in their family routines, but applied an authoritative parenting style regarding limit setting about sweets and food portions and supporting physical activity. The professionals described children with severe obesity as having suffered parental as well as societal neglect. Their biological parents lacked the ability to undertake necessary lifestyle changes. Neglected investigations into learning disabilities and neuropsychiatric disorders were seen in the school and healthcare sector, and better collaboration with the Social Services after a report of harm might be a potential for future improvements. Rival discourses were underlying the (in) decision regarding foster home placement. A child's right to health was a strong discourse for acting when a child was at risk for harm, but parental rights are strong when relocation to a foster home is judged to be necessary.

Transcutaneous Osseointegrated Implants for Pediatric Patients With Aural Atresia

Patients with aural atresia typically have maximal conductive hearing loss, which can have negative academic and social consequences. Transcutaneous osseointegrated implants (TOIs) can potentially restore hearing on the affected side. To review the demographic, audiological, and surgical outcomes of TOI placement in pediatric patients with aural atresia and to describe a modification in incision technique in anticipation of later auricular reconstruction. This retrospective case series reviewed 41 cases of TOI placement in pediatric patients between January 1, 2014, and September 30, 2016, at Lurie Children's Microtia and Aural Atresia Clinic. Patients, all younger than 18 years and with atresia or microtia, received at least 6 months of follow-up and underwent testing before and after surgery. Patient age, indication for procedure, ear sidedness, case length, incision type, complications, and other postoperative events. Audiological outcomes before and after implantation were measured using pure-tone averages and the Hearing In Noise Test for Children, presented in variable signal to noise ratios. In total, 46 TOIs were performed in 38 pediatric patients, but only 41 implantations in 34 patients were included in this study. Of the 34 patients, 13 (38%) were males and 21 (62%) were females, with a mean age of 8.9 (range, 5-17) years at the time of TOI placement. Microtia on the implanted side was present in 39 cases (95%). A modified posterior-superior scalp incision technique was used in 30 (73%) of 41 ears, all in cases of microtia. One perioperative surgical complication occurred: a seroma requiring drainage. Two patients developed minor skin irritation and erythema at the magnet site related to the overnight use of the processor, which resolved when removed while sleeping. The mean (SD; range) score for the Speech In Noise test at 5 dB signal to noise ratio improved from 75.3% (14.4%; range, 50%-92%) correct in unaided/preoperative condition to 93.6% (6.95%; range, 80%-100%) correct in the aided/postoperative condition. The mean improvement in score was 18.3% (95% CI, 10.8%-25.9%), with an effect size of 1.62 (95% CI, 0.95-2.29). The mean pure-tone averages (SD; range) similarly improved from 63.7 (13.2; range, 25-11) dB to 9.6 (4.9; range, 5-15) dB. Transcutaneous osseointegrated implantation has a low complication rate among pediatric patients with atresia or microtia and can provide excellent audiological results. It should be included as a treatment option for this population of patients who meet audiological criteria.

Trends and Outcomes of Early Versus Late Percutaneous Endoscopic Gastrostomy Placement in Patients With Traumatic Brain Injury: Nationwide Population-based Study

Oral intake for traumatic brain injury (TBI) patients is often not an option because of facial trauma, swallowing dysfunctions, altered consciousness, etc. These patients often require percutaneous endoscopic gastrostomy (PEG) placement for nutrition support. To date, there is lack of studies examining the relationship between the timing of PEG placement and patient outcome in the TBI group. We conducted a population-based study in a retrospective cohort of TBI patients undergoing PEG, using the national inpatient sample for years 2011 to 2013. A total of 96,625 patients were identified for TBI and 3343 of those patients received PEG. TBI patients who undergo an early or late PEG placement had a higher rate of in-hospital mortality, when compared with patients with a standard timing of PEG placement. Late PEG was preferably placed in patients with higher Charlson index and trauma-related comorbidities, and these patients had a higher incidence of complications, that is, sepsis, urinary tract infection, acute respiratory distress syndrome/pneumonia, and deep vein thrombosis/pulmonary embolism. When stratified by mortality-risk groups, early PEG was associated with higher rates of in-hospital mortality while standard PEG was associated with best mortality outcomes in low-mortality-risk group and moderate-mortality-risk group. The results of this study suggest that if a PEG placement is indicated for a TBI patient, a standard (7 to 14 d) timing may be associated with better patient outcomes. However, secondary to limitations associated with the use of administrative databases, further prospective studies are needed to establish clear guidelines regarding the optimal timing of placing PEG in TBI patients.

Serious Illness and End-of-Life Quality for US Foster Children: A National Study.

Of the nearly 500 000 children in foster care, several hundred children die each year. Their quality of life at end of life is a matter of their foster care experience. The purpose of this study was to investigate whether serious illness was associated with foster care placement outcomes. US foster care data from 2005 to 2015 were used. Children who were younger than 18 years with residence in the United States were included. Serious illness (ie, physical health, mental/behavioral health, developmental disabilities) was measured via the foster care files. Two foster care placement outcomes were created (ie, type of placement, placement instability). Using multinomial and logistic regressions, the influence of serious illness on placement outcomes was evaluated while controlling for demographic, geographic, prior trauma, and foster care support characteristics. Fifty-seven percent of the children were placed with nonrelatives, 27% in group homes/institutions, and 17% with relatives. Twenty-eight percent experienced placement instability. Serious illness was significantly associated with nonrelative (relative risk ratio [RRR] = 1.97; 95% confidence interval [CI] = 1.58-2.45) and group home/institution placement (RRR = 2.67; 95% CI = 2.09-3.40). Serious illness was not significantly related to placement instability. Children with serious illness were no more likely than their peers to experience multiple foster care placements. Foster care youth at end of life were more likely to be placed with nonrelatives or in group homes/institutions. They also did not experience the disruption and stress of being moved to multiple foster homes while seriously ill.

Long-term Outcomes of One Stage Surgery Using Transanal Colorectal Tube for Acute Colorectal Obstruction of Stage II/III Distal Colon Cancer.

PurposeSince oncological outcomes of transanal colorectal tube (TCT) placement, an endoscopic treatment for colorectal cancer (CRC) with acute colorectal obstruction (ACO), remain unknown, this study analyzed long-term outcomes of TCT placement for stage II/III CRC with ACO.Materials and MethodsData were retrospectively reviewed from consecutive patients with distal stage II/III CRC who underwent surgery between January 2007 and December 2011 at two Japanese hospitals. One hospital conducted emergency surgery and the other performed TCT placement as the standard treatment for all CRCs with ACO. Propensity score (PS) matching was used to adjust baseline characteristics between two groups.ResultsAmong 754 patients with distal stage II/III CRC, 680 did not have ACO (non-ACO group) and 74 had ACO (ACO group). The PS matching between both hospitals identified 234 pairs in the non-ACO group and 23 pairs in the ACO group. In the non-ACO group, the surgical quality was equivalent between the two institutions, with no significant differences in overall survival (OS) and disease-free survival (DFS). In the ACO group, the rate of primary resection/anastomosis was higher in the TCT group than in the surgery group (87.0% vs. 26.1%, p < 0.001). No significant differences were noted between the surgery and the TCT groups in OS (5-year OS, 61.9% vs. 51.5%; p=0.490) and DFS (5-year DFS, 45.9% vs. 38.3%; p=0.658).ConclusionTCT placement can achieve similar long-term outcomes to emergency surgery, with a high rate of primary resection/anastomosis for distal stage II/III colon cancer with ACO.

Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors

PurposeTo evaluate the safety and efficacy of endovascular management of pulmonary artery lesions caused by lung tumors. Materials and MethodsNineteen patients (15 men, 4 women; average age: 60.3 years, range, 51–86 years) treated for massive or recurrent hemoptysis with transarterial pulmonary artery embolization between 2010 and 2016 were included in this multicenter, retrospective study. Inclusion criteria were: patients with lung cancer and at least 1 episode of hemoptysis with a pulmonary artery lesion detected by computed tomography (CT) angiography or after failed bronchial artery embolization. No patient undergoing pulmonary embolization for a lung tumor was excluded. Technical success, clinical success, and complications were recorded. The survival curve was estimated using the Kaplan-Meier method ResultsMean follow-up was 188.1 days (range, 0–1440 days). Primary and assisted technical success rates were 73.7% (14/19) and 84.2% (16/19), respectively. Two patients died during the procedure due to massive hemoptysis and cardiac arrest, and 1 patient was treated with surgery. All patients with technical success achieved clinical success without further bleeding. No complications were noted, and no pulmonary infarction was detected on CT scan during follow-up. Survival rates after embolization at 1 and 3 months were 67% (95% confidence interval [CI]: 40%–90%) and 46% (95% CI: 23%–80%), respectively, with 36.8% (n = 7) of the patients still alive at the end of the study. ConclusionsEmbolization is an effective and safe treatment of lung tumors with pulmonary arterial bleeding.

Association Between Timing of Epidural Placement and Obstetric Outcome with Reference to the Start of Active Labor [26F

INTRODUCTION: Previous research suggests that there is no association between timing of epidural placement and mode of delivery. However, with active labor now defined as beginning at six centimeters cervical dilation, we explored if timing of epidural placement before active labor was associated with higher rates of Cesarean section. Secondary outcomes included rate of operative vaginal delivery and length of the second stage. METHODS: We conducted a retrospective chart review of patients who delivered at an urban, academic hospital between June 2015 and May 2016. Primiparous women delivering live-born, singleton, full-term infants were included. RESULTS: Of 433 women, 284 (66%) had epidurals placed prior to six centimeters cervical dilation, while the remaining 149 (34%) women had epidurals placed after six centimeters. There was no difference in the rate of Cesarean section between those who had epidurals placed prior to (15.8%, N=45) and after (13.4% N=20) six centimeters, as well as no difference in the rate of operative vaginal delivery (4.2% vs. 3.3%, respectively), [Χ2(2, N=433) = 0.701 P=0.704]. Finally, there was no difference in the mean length of the second stage of labor (mean of 88 minutes vs 80 minutes), [F(1, 356) = 0.929, P=0.336]. CONCLUSION: Placement of epidural prior to or after the onset of active labor did not differentiate mode of delivery or length of the second stage. With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary Cesarean section.