Failure Of Procedure Research Articles

Current Literature Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review

Category: Ankle; Other Introduction/Purpose: Treatment for lateral ankle instability (LAI) varies drastically from conservative to operative management depending on the individual's injury, symptoms, and lifestyle. Typically, surgical treatment is recommended when conservative treatments fail for LAI. The importance of determining the most effective treatment is necessary due to LAI costing $2 billion annually within the health care system [1]. Furthermore, residual physical disability following failed treatment for LAI occurs in up to 70% of patients [2]. Unfortunately, despite exceedingly high incidences and economic impact, a standard definition of failure for the surgical treatment of LAI alludes clinicians and researchers. Therefore, the purpose of this project is to identify LAI treatment 'failure' definitions that are currently in the literature and work towards standardization of the definition. Methods: A systematic search of Medline, SportDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for lateral ankle instability and included information about surgical failures. Studies with level of evidence I to IV were included for this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinion were excluded. These studies were then reviewed for definitions of failure of any surgical procedure used to correct lateral ankle instability. Results: Of the 1,200 studies, 3.5% (42/1,200) studies published between 1984 and 2020 met inclusion criteria and were analyzed. After reviewing the data, numerous definitions were found in the literature for LAI surgical failure. The most common was 'recurrent instability' (40%, 17/42) followed by 're-rupture' (24%, 10/42). For the original operation, the Modified Brostrom Gould technique was used most frequently (40%, 17/42) in cases treated operatively. The failure rate of this procedure ranged from 1.1% to 45.2% depending on the definition of 'failure.' Conclusion: There were multiple definitions of failure for surgical treatment of lateral ankle instability and is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from a standardization of ankle instability treatment 'failure' definition. This definition should incorporate multiple facets, including history, physical examination findings, outcome scores, imaging, and surgical findings for an inclusive understanding of failure.

Patient Reported Outcomes Following Hindfoot Fusion Utilizing the Triple Arthrodesis Procedure

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Fusions are used as a salvage procedure to improve stability and return patient to regular functions of daily activities. Triple Arthrodesis is a fusion of three joints, talonavicular, subtalar, calcaneocuboid. There is limited literature on the patient-reported long-term outcomes for this procedure. The aim of this study is to quantify the patient-reported outcomes for the Triple Arthrodesis procedure. Methods: A retrospective analysis was conducted for patients that underwent Triple Arthrodesis at our facility from 2014-2021. Using the electronic medical record (EMR), basic patient demographics, time since surgery, presence of osteoarthritis or rheumatoid arthritis, development of infection, nonunion, hardware failure, and history of previous foot and ankle procedures were all noted. Additionally, we recorded the hardware used during the operation and whether concomitant procedures were performed during the time of surgery. To evaluate outcomes, we used the Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores. Results: A total of 132 patients were included in this study with 50 participants completing the PROMIS and FFI surveys. The average time point at which the outcomes were collected was 5.50 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function was 38.35, pain interference was 61.52, and depression was 49.82 for this population. The mean FFI scores were 58.56 for pain, 60.06 for disability, 48.06 for activity limitation. There was a significant decrease in postoperative pain scores when compared to preoperative pain of 5.4 to 2.55 (p=0.023). Four patients experienced wound infection, four patients experienced nonunion, six patients required revisional surgery, and three patients experienced hardware failure. Conclusion: Preliminary results Triple Arthrodesis may be beneficial in decreasing pain and lead variable long-term patient satisfaction. We plan to include further statistical analysis comparing the various types of fixation techniques used and the resultant PROMIS and FFI scores. Additionally, we are currently continuing patient calls to collect more completed PROMIS and FFI reports.

Reoperation after failure of Nuss procedure on severe Wenlin chest

Wenlin chest is a rare complex deformity. It may be misdiagnosed as pectus carinatum or pectus excavatum due to the presence of both protrusion and depression. In the early years, it was just regarded as a kind of pectus carinatum. Considering the operation of this deformity was Ravich procedure, which was also normally used for pectus carinatum, the diagnosis did not affect the treatment. However, once misdiagnosed as pectus excavatum and treated with Nuss procedure, it would be difficult to obtain good results. We met a 22-year-old female Wenlin chest patient recently. She was misdiagnosed as pectus excavatum and underwent Nuss procedure in local hospital 3 years before. Because of no effect, the patient had to come to our hospital for another operation. We performed Wenlin procedure and Wang procedure for her and achieved satisfactory results.

Revision Surgery after Failed Index Synthetic Cartilage Implant Resurfacing for Hallux Rigidus: Single Surgeon Five-Year Experience

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a prevalent arthritic disease which causes pain and stiffness. While MTPJ arthrodesis is regarded as the gold standard treatment option for HR (Grade II and III), synthetic cartilage implant (SCI) resurfacing has gained popularity since it demonstrates similar biomechanical properties as native cartilage, eliminates pain, and preserves MTPJ motion. However, recent studies have reported variable failure rates on SCI treatment, with implant subsidence most commonly leading to a revision. The purpose of this study was to identify the SCI resurfacing failure rate by a single surgeon, while also comparing clinical outcomes of patients who underwent SCI replacement or MTPJ arthrodesis after failed index SCI resurfacing. Methods: Electronic health records were queried from 2016 to 2021 for patients who were experiencing symptomatic HR and were treated with SCI (Synthetic Cartilage Implant) by a single surgeon. Patient demographics, body mass index (BMI), medical comorbidities, American Society for Anesthesiologists (ASA) physical status, past surgical history and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, hallux valgus (HV) angles, and x- ray imaging were compared. Subgroup analysis was performed on patients who underwent revision with either a SCI replacement or MTPJ arthrodesis. SCI replacement included the use of bone graft and/or a custom 3D-printed baseplate to prevent implant subsidence. Descriptive and univariate statistics were used to analyze data. Results: A total of 219 SCI resurfacing procedures were performed by a single surgeon, including 23 revisions. When only analyzing index procedures, a revision rate of 8.2% was determined. The revision cohort (n=23) consisted of 19 females, and presented with a mean BMI of 29.5+-5 Kg/m2, mean age of 52.8+-11 years, and mean followup of 22.3 (range, 3-54) months. Patients underwent revision surgery at an average of 12.1+-12 (range, 1-50) months after index SCI resurfacing. Specifically, 12 procedures resulted in an SCI replacement, while 11 procedures resulted in arthrodesis. There was significantly lower postoperative pain VAS (P=0.04) and a significant improvement from preoperative to postoperative pain VAS for the arthrodesis cohort (P<0.001) (Table 1). Conclusion: Eight percent of index SCI resurfacing procedures performed by a single surgeon resulted in failure. When revising a failed index SCI resurfacing procedure, MTPJ arthrodesis was found to reduce pain more significantly compared to SCI replacement procedures. Future prospective studies should be performed to expand upon the limited clinical outcomes data comparing SCI revision procedures such as joint arthrodesis and SCI replacement.

Distal transradial access. Initial experience. Results

Introduction: Conventional access through the radial artery (cTRA) is a standard approach in coronary interventions. Unfortunately, it carries a risk of long-term complications such as radial artery occlusion (RAO) and local complications, usually hematomas. Aim: Sharing initial experience in the application of distal transradial access (dTRA) on 134 patients, from single operator in one center and its applicability on patients with STEMI. Number of procedures required to get experience with this access, assessed by the degree of reduction of failed procedures. Materials and methods: From 08.03.21 to 18.11.21, 134 patients with dTRA (110 successful, 24 unsuccessful) were included in the study. dTRA is comsidered to be an access to the anatomical snuffbox. Completion of the entire procedure, not just a successful puncture or insertion of an introducer, was considered the access successful. Results: It was found that the success of the method was 82% of the criteria preset. Among the successful procedures, 48% were interventions. Of these, 71% had ACS and 43.6% had STEMI. The access was used on 3 patients who had CTO. Two patients underwent rotablation using a 7 in 6 Fr introduser. On 98% of the patients a 6 Fr introducer was used. Right dTRA was used on 93% of patients. From the 134 procedures performed, it was found that 92% of failures were up to the 80th procedures. After the 80’th procedures the frequency of failures decreased significantly. Complications ‒ 3 small hematomas and 2 numbness in the thumb, which did not require additional interventions. Conclusion: The procedure with dTRA was successfully completed by high percentage of patients, including the high-risk patients with ACS and STEMI. After the 80th dTRA procedure was reached level of skills with a low frequency of failed procedures. This suggests that dTRA can be an alternative to standard radial access to prevent radial artery occlusion, which has been confirmed by previous studies, better patient comfort, and lower risk of complications. The results were achieved without the need of reduction of the introducer’s diameter or use of special devices for hemostasis.

Frailty and benign prostatic hyperplasia: The thrilling underlying impact.

World population is aging. The number of individuals aged over 65 are expected to be 71 million only in the US. 43% of this population will be men. Benign prostatic hyperplasia (BPH), defined as the benign neoplasm of the prostate gland affects 8% of men by their forties, but 90% of men over 90 years old. Lower urinary tract symptoms (LUTS) can be caused by an enlarged prostate, and it seems to be associated more with older and frailer individuals. The purpose of this study is to review the potential interplay between frailty syndrome and benign prostatic hyperplasia. A thorough MEDLINE/PubMed non-systematic literature review was conducted from 1990 to March of 2022. The terms used for the search were "frailty and benign prostatic hyperplasia" and "low muscle mass and benign prostatic hyperplasia". It seems that, frailty poses a negative impact on the prognosis of patients with BPH, as it is associated with increased incidence of LUTS. In addition, frailty seems to be a strong predictor concerning surgical procedure failure and mortality following invasive procedures for BPH. Prostatic stent placement on the other hand appears to be the ideal solution for frail patients. BPH has a strong association with frailty and increasing age.

Is a Polarized Party System a Too Extreme Party System? Understanding Perceptions of Party Extremity in the United States

The Democratic and Republican parties have polarized since the 1960s. Does the American public believe that the parties have grown “too extreme?” I leverage data from 18 national surveys to explain perceptions of party extremity as well as text-analysis of open-ended survey responses from an additional national survey to examine what the public associates with the concept of extremity. Three key results emerged. First, a growing proportion of Americans believe that both parties are too extreme, but this belief remains in the decided minority. Second, ideology and partisanship interact to shape beliefs about extremity. Moderates are more likely to believe that both parties are too extreme, but this is conditional on the presence of partisan motivations to say that only one party is too extreme. Finally, the public has a multifaceted conceptualization of extremity that is frequently tied to perceived procedural failures with only the highly knowledgeable reliably connecting perceived extremity to programmatic considerations. These results suggest that elite partisans have little reason to moderate their views given that most Americans do not perceive them to be too extreme, partisan considerations gain them ideological leeway, and many fail to connect extremity with the parties’ ideological reputations.

Radiographic assessment of root canal morphology of mandibular central incisors using new classification system: A cross-sectional study.

Lack of basic knowledge about the external and internal anatomies of the root canal system and common variations in teeth may lead to various procedural errors or treatment failure. In this study, the root canal configurations of mandibular incisors and the symmetry of the contralateral incisors of Saudi Arabian subpopulations were analyzed and determined using cone beam computed tomography (CBCT). A retrospective evaluation of 700 patients was conducted, and 1260 fully developed permanent mandibular central incisors were assessed. The number of root canals was determined, and the internal root canal anatomies were categorized based on Ahmed et al.’s criteria. The CBCT images were independently evaluated by 2 trained dentists and an endodontist. The data were assessed using the chi-square and one-way analysis of variance tests. All the mandibular central incisors included in the study were single-rooted. According to Ahmed et al’s classification system, the most common classification (82.6%) was 1ManA1 (Vertucci type I), followed by 1ManA1-2-1 (Vertucci type III; 13%). Second canals were more frequently recorded in the male participants than in the female participants. The root canal configuration between contralateral incisors was largely symmetrical. Most of the mandibular incisors in the examined Saudi Arabian population had a single canal. Nevertheless, a substantial number of patients had a complex root morphology. Hence, CBCT can be utilized as a potential supplementary tool during root canal treatment.

Relationship of Average Outcomes Scores and Change in Status Requires Further Interpretation Between 1 and 2 Years Following Hip Arthroscopy

Background: Previous studies have demonstrated a clinically impactful change in patients between 1 and 2 years after hip arthroscopy. Assessment of differences in patient-specific factors between patients who remain the same and those who change (ie, either improve or decline) could provide valuable outcome information for orthopaedic surgeons treating those patients. Purpose: To identify patients who experienced change in functional status between 1 and 2 years after hip arthroscopy for femoroacetabular impingement syndrome and assess differences in patient-specific factors between those who improved, remained the same, or declined in functional status. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data for patients who underwent hip arthroscopy at 1 of 7 centers were analyzed retrospectively at 1 year and 2 years postoperatively. Patients were categorized as “improved,”“remained the same,” or “declined” between 1- and 2-year follow-up based on the 12-item International Hip Outcome Tool (iHOT-12) minimal clinically important difference (MCID) value. A 1-way analysis of variance was used to assess differences in iHOT-12 scores, age, body mass index (BMI), alpha angle, and center-edge angle (CEA) between groups. Chi-square analyses were used to assess differences in the proportions of male and female patients in the outcome groups. Results: The study included 753 patients (515 women and 238 men), whose mean ± SD age was 34.7 ± 12 years. Average 1-year (±1 month) and 2-year (±2 months) iHOT-12 scores for all patients were 73.7 and 74.9, respectively. Based on the calculated MCID of ±11.5 points, 162 (21.5%) patients improved, 451 (59.9%) remained the same, and 140 (18.6%) declined in status between 1- and 2-year follow-up. Those who improved between 1 and 2 years had lower 1-year iHOT-12 scores (P < .0005). We found no difference in age, BMI, alpha angle, CEA, or sex between groups (P > .05). Conclusion: Between 1- and 2-year follow-up assessments, 21.5% of patients improved and 18.6% declined in self-reported functional status. Those with iHOT-12 scores indicating abnormal function at 1 year improved beyond the MCID at 2 years follow-up. Thus, any decisions about the failure or success of arthroscopic hip procedures should not be made until at least the 2-year follow-up. Failing to thrive at 1-year follow-up may not accurately predict outcomes at year 2 or beyond. This could potentially decrease the perceived need for revision surgery in patients who do not thrive before 2-year follow-up.

Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake

IntroductionAnterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. Material and methodThis article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. ResultsThe SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. ConclusionSFA DataLake strikes a balance between “indispensable” and “original” items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. Level of evidenceIV.

Clinical Outcomes in Patients With Dilated Cardiomyopathy and Ventricular Tachycardia

BackgroundRecurrent ventricular tachycardia (VT) due to dilated cardiomyopathy (DCM) is difficult to treat, and long-term outcome data are limited. ObjectivesThe aim of this study was to identify predictors of mortality or heart transplantation (HTx) and VT recurrence. MethodsConsecutive patients with DCM accepted for radiofrequency catheter ablation (RFCA) of VT at 9 centers were prospectively enrolled and followed. ResultsOf 281 consecutive patients (mean age 60 ± 13 years, 85% men, mean left ventricular ejection fraction [LVEF] 36% ± 12%), 35% had VT storm, 20% had incessant VT, and amiodarone was unsuccessful in 68%. During follow-up of 21 months (IQR: 6-30 months), 67 patients (24%) died or underwent HTx, and 138 (49%) had VT recurrence (45 within 30 days, defined as early); the 4-year rate of VT recurrence or mortality or HTx was 70%. Independent predictors of mortality or HTx were early VT recurrence (HR: 2.92; 95% CI: 1.37-6.21; P < 0.01), amiodarone at discharge (HR: 3.23; 95% CI: 1.43-7.33; P < 0.01), renal dysfunction (HR: 1.92; 95% CI: 1.01-3.64; P = 0.046), and LVEF (HR: 1.36; 95% CI: 1.0-1.84; P = 0.052). LVEF ≤32% identified patients at risk for mortality or HTx (area under the curve: 0.75). Mortality or HTx per 100 person-years was 40.4 events after early, compared with 14.2 events after later VT recurrence and 8.5 events with no VT recurrence after RFCA (P < 0.01 for both). Patients with early recurrence and LVEFs ≤32% had a 1-year rate of mortality or HTx of 55%. VT recurrence was predicted by prior implantable cardioverter-defibrillator shocks, basal anteroseptal VT origin, and procedural failure but not LVEF. ConclusionsPatients with DCM needing RFCA for VT are a high-risk group. Following RFCA, approximately one-half remain free of VT recurrence. Early VT recurrence with LVEF ≤32% identifies those at very high risk for mortality or HTx, and screening for mechanical support or HTx should be considered. Late VT recurrence after RFCA does not predict worse outcome.

Drivers of African Filovirus (Ebola and Marburg) Outbreaks.

Outbreaks of African filoviruses often have high mortality, including more than 11,000 deaths among 28,562 cases during the West Africa Ebola outbreak of 2014-2016. Numerous studies have investigated the factors that contributed to individual filovirus outbreaks, but there has been little quantitative synthesis of this work. In addition, the ways in which the typical causes of filovirus outbreaks differ from other zoonoses remain poorly described. In this study, we quantify factors associated with 45 outbreaks of African filoviruses (ebolaviruses and Marburg virus) using a rubric of 48 candidate causal drivers. For filovirus outbreaks, we reviewed >700 peer-reviewed and gray literature sources and developed a list of the factors reported to contribute to each outbreak (i.e., a "driver profile" for each outbreak). We compare and contrast the profiles of filovirus outbreaks to 200 background outbreaks, randomly selected from a global database of 4463 outbreaks of bacterial and viral zoonotic diseases. We also test whether the quantitative patterns that we observed were robust to the influences of six covariates, country-level factors such as gross domestic product, population density, and latitude that have been shown to bias global outbreak data. We find that, regardless of whether covariates are included or excluded from models, the driver profile of filovirus outbreaks differs from that of background outbreaks. Socioeconomic factors such as trade and travel, wild game consumption, failures of medical procedures, and deficiencies in human health infrastructure were more frequently reported in filovirus outbreaks than in the comparison group. Based on our results, we also present a review of drivers reported in at least 10% of filovirus outbreaks, with examples of each provided.

Impact of operators' experience and patients' age on the success of nitrous oxide sedation for dental treatment in children.

To evaluate the success rates and potential influencing factors of nitrous oxide sedation for dental treatment in a specialised paediatric dental service. Medical records of all children treated under nitrous oxide sedation in a specialised pedodontics clinic between 2012 and 2017 were analysed retrospectively for parameters such as age of the patient, experience and change of operating dentists, treatment procedure and success or failure regarding the sedation and treatment. Given the high overall success rate of over 90%, nitrous oxide sedation can be a highly effective treatment option for performing dental treatment in pre-cooperative and/or anxious children and adolescents. With age of the children and experience of the dentist, success rates increased.

Percutaneous coronary intervention in calcified stenoses: a protocol for a systematic review with meta-analysis, trial sequential analysis and network meta-analysis

IntroductionSeverely calcified coronary stenoses are difficult to treat with percutaneous coronary interventions. The presence of severe calcifications complicates lesion preparation, advancement of stents and achievement of full stent expansion. Intervention...

Benefits of Meniscal Repair in Selected Patients Aged 60 Years and Older.

Background:Little is known about the benefits and outcomes of meniscal repair in patients older than 60 years.Purpose:To (1) report the clinical and radiographic outcomes of meniscal repair in patients aged ≥60 years and compare them with matched patients who underwent meniscectomy and (2) identify procedural failures.Study Design:Cohort study; Level of evidence, 2.Methods:We included 32 knees in 32 patients aged ≥60 years (20 female, 12 male; mean age, 64.5 ± 4.6 years) who underwent meniscal repair surgery at a single medical institution between 2010 and 2020. Patients were matched according to age, sex, body mass index, and meniscal tear type with a comparison cohort who underwent meniscectomy (n = 49 patients [49 knees]; 32 female, 17 male). For all patients, demographic information, clinical history, physical examination findings, treatment details, and radiographic images were reviewed and analyzed. At final follow-up (mean, 42.2 months; range, 13-128 months), patients completed the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Clinical failure was defined as revision surgery and/or progression to total knee arthroplasty (TKA). A matched-pairs t test was used to analyze differences between the 2 treatment groups, and Kaplan-Meier analysis was used to determine the rates of knee osteoarthritis and progression to TKA.Results:The majority of patients had a medial meniscal tear (72.8%), whereas the lateral meniscus was torn in 27.2% of cases. Most tears were located in the meniscal root (56.8%), followed by the posterior horn (34.6%) and midbody (8.6%). At final follow-up, all outcome scores were higher in the repair group compared with the meniscectomy group (IKDC, 78.9 ± 13.4 vs 56.0 ± 15.4; KOOS, 86.6 ± 11.9 vs 61.7 ± 16.2; Lysholm, 88.3 ± 13.3 vs 68.7 ± 15.2, respectively; P < .001 for all). Clinical failure was observed in 22% of patients in the repair group.Conclusion:All clinical outcome scores were higher in the meniscal repair group compared with the matched meniscectomy group at final follow-up. The clinical failure rate of the repair group was 22%. These findings support meniscal repair in selected patients aged ≥60 years.

Accuracy of a Novel Preoperative Failure Risk Model for Debridement Antibiotics and Implant Retention (DAIR) in Acute Prosthetic Joint Infection.

Given the variable success of the debridement, antibiotics and implant retention (DAIR) procedure in patients with acute prosthetic joint infection (PJI), an accurate selection of candidates is critical. In this study, we set about calculating the predictive value of a novel algorithm for predicting outcome following DAIR developed by Shohat et al. Sixty-four patients who underwent debridement for (early and late) acute PJI in a tertiary-level university hospital were selected, and the aforementioned algorithm was retrospectively applied. Patients with model scores of 40–50%, 50–60%, 60–70%, 70–80% and 80–90% displayed success rates of 33.34%, 41.18%, 57.9%, 78.27% and 100%, respectively. The receiver operating characteristic curve showed an area under the curve of 0.69. The calibration intercept value was 0, and the calibration slope value was 1. Failure rates were significantly higher for the following variables: revision surgery (p = 0.012) index surgery for reasons other than osteoarthritis (p = 0.01), and C-reactive protein level >30 mg/L (p = 0.042). This analysis demonstrated that the Shohat algorithm is associated with an optimal calibration value and a moderate predictive value for failure of a DAIR procedure in patients with acute PJI. Its validation is recommended before it can be routinely applied in daily practice.

MEDICATION ADMINISTRATION DISTRACTION OBSERVATION SHEET CHECKLIST: CULTURAL ADAPTATION AND VALIDATION INTO SPANISH

Introduction. Distractions are sensory inputs that exceed the individual's attention threshold, which is why they have been associated with procedural failures and clinical errors in care practice. Objective. To adapt and validate the “Observation Sheet for Distractions in the Administration of Medication” to the Colombian context. Materials and methods. The study followed a quantitative, cross-sectional, and methodological approach that included the cultural adaptation and validation of both the appearance and the content of an instrument measuring two attributes of the concept of distractions—namely, origin and frequency—with the input of five experts on the topic. Inter-observer reliability was determined through the kappa coefficient, and internal consistency with Cronbach's alpha coefficient in the statistical package SPSS v22. Results. Once adapted and validated to Colombian Spanish, the checklist kept all of the original items of the instrument, with a content validity ratio and index of 1, an inter-observer reliability between 0.82 and 1.00 (substantial agreement), and a Cronbach's alpha of 0.54 (acceptable). Conclusions. Few studies admit to using the instrument as the author proposes; some draw inspiration from it to create their own instruments, while others use it but do not report its validation. Only three studies, including this one, report psychometric analyses performed on the instrument with minor changes after its execution. The instrument can be applied to clinical nursing practice in Colombia; in the future, it is recommended to include new attributes of the concept.

CT guided injection of 99mTc-MAA for lung nodule localization prior to VATS

AimCT guided technetium99m-macroaggregated albumin (99mTc-MAA) injection for lung nodule localization prior to video-assisted thoracoscopic surgery (VATS) is employed at our institution for more than a decade. We retrospectively studied the success rate, factors that affect outcomes, and complications of this procedure. Materials and methods147 patients with 164 nodules underwent this procedure before VATS. Imaging and procedure characteristics, complications of the procedure, successful intra-operative localization and wedge resection, if there was conversion of primary VATS to open thoracotomy and if so the reason, and histopathological diagnosis for each nodule were reviewed by two radiologists in consensus. In case of unsuccessful wedge resection, reasons for failure were derived from electronic medical record. The impact of nodule and procedure characteristics on successful intra-operative localization was assessed. ResultsExcluding 9 nodules with unsuccessful localization due to non-procedure related reasons, the CT guided procedure was successful in 96.1% for intraoperative localization (149/155). Pleural leak of the radiotracer, split injection within the lobe, injection into a wrong nodule and gamma probe malfunction were primary reasons for failure. Nodule size, depth from pleura, and time between radiotracer injection and surgical incision did not impact success of the procedure. Among the 6 cases with procedure related failure, only 1 required conversion to open thoracotomy. ConclusionCT guided 99mTc-MAA injection for intra-operative lung nodule localization is a feasible procedure with a high success rate and low complication rate. Attention to technique can potentially avoid procedure failure.

Percutaneous Closure of Mitral Paravalvular Leak: Long-Term Results in a Single-Center Experience.

Background: Paravalvular leak occurs in 5–17% of patients following surgical valve replacement, more often in mitral position. The prognosis without treatment is poor. Percutaneous device closure represents an alternative to repeat surgery. The objective of this work is to evaluate the medium and long-term results in the percutaneous closure of PVL in mitral prosthesis. Methods: This observational study is based on a retrospective registry including consecutive mitral PVL cases undergoing percutaneous closure at a single tertiary-care center from April 2010 to December 2020. The safety and efficacy results of the procedure, at 90 days and in the long term, were analyzed. Also, predictors of procedure failure and long-term events were identified. Results: A total of 128 consecutive mitral paravalvular leak closure procedures were included. Technical success was achieved in 115 (89.8%) procedures. The presence of multiple PVLs was the sole factor that independently predicted procedural failure. Median follow-up of our sample was 41.8 months (mean 47.7 ± 35.7 months). Underlying hemolytic anemia as the indication for PVL closure, a recent admission for decompensated HF, and lack of improvement in functional class emerged as consistent predictors of MACE and death during long-term follow-up, while lack of procedural success during the first PVL procedure and chronic kidney disease were also associated with MACE during follow-up. Conclusions: Percutaneous mitral PVL closure displayed high technical and procedural success rates, with an acceptable safety profile, in a high-risk population. Percutaneous mitral PVL closure achieved an improvement in short- and long-term functional class and a reduction of hemolysis in the vast majority of patients. In addition, long-term survival in our study was good, in particular for patients undergoing successful PVL closure procedures.

Ultrasonographic stabilization of hydronephrosis after pyeloplasty: Key determinant of postoperative follow-up?

Although more than 1500 pediatric pyeloplasties are performed in the United States per year, there is a lack of consensus on the adequate imaging modality and timing of follow-up after surgery. The aim of this study is to evaluate if ultrasonographic stabilization in the grade of hydronephrosis after pyeloplasty is an adequate parameter to define the optimal length of follow-up after surgery and to detect failed procedures. Secondarily, we want to analyze clinical variables that could impact ultrasonographic stabilization. This is a retrospective chart review of patients who underwent pyeloplasty between 2012 and 2020. Patients were included if they were ≤21 years-old at the time of surgery, had pre and postoperative renal-ultrasounds, had ≥3 months of postoperative follow-up, and had met the criteria for ultrasonographic stabilization after surgery. Ultrasonographic stabilization was defined as 2 consecutive ultrasounds after pyeloplasty, a minimum of 1-month apart, with the same degree of hydronephrosis according to the Society for Fetal Urology (SFU) grading system. Data concerning clinical, surgical, and postoperative variables were collected. A total of 143 pyeloplasties met the inclusion criteria. Median age at surgery was 10.5 months with a median post-operative follow-up time of 29 months. Ultrasonographic stabilization was achieved in a mean time of 14.5 months post-operatively. Compared to the preoperative US SFU grade, at ultrasonographic stabilization 127 (88.9%) patients had an improvement of ≥1 grades of hydronephrosis. There were 9 pyeloplasty failures that were diagnosed and surgically corrected in a median of 7.5 months after the initial surgery. No clinical or surgical variables were associated with time to achieve ultrasonographic stabilization. There is great variability in the length of follow-up after pyeloplasty, ranging from 3-months to 7-years. In our cohort, the bast majority of patients had achieved ultrasonographic stabilization and displayed improvement in their initial grade of hydronephrosis by 14.5 months after surgery. Timeframe in which surgical failures were diagnosed and corrected. There were not clinical or surgical variables associated to time to achieve stabilization. Similar results have been reported in the literature; however, most of them have evaluated as their main outcome resolution and not stabilization of hydronephrosis. Ultrasonographic stabilization is a suitable and non-invasive parameter for determining the length of follow-up after unilateral pyeloplasty, as it is an adequate timeframe for identifying failed pyeloplasties, observing improvement or stabilization of hydronephrosis, and performing any additional procedure required after the primary repair.