Ultimate Success Rate Research Articles

A predictive score for early in-patient tuberculosis mortality: A case-control study

IntroductionIn-hospital mortality rates for tuberculosis (TB) patients are high within the first seven days of admission. This study sought to identify predictors of early inpatient mortality and assess the performance of a predictive score for early mortality in a Ugandan tertiary hospital. Materials and methodsA case-control study was conducted at Kiruddu National Referral Hospital in Kampala, Uganda. Cases included patients admitted with TB who died within seven days of admission, while controls survived beyond this period. Logistic regression was utilized to identify early mortality predictors. The performance of an adapted predictive score (PROS score) was evaluated, assigning scores based on the following criteria: Pulse rate >100 beats/min (1 point), Respiratory rate >20 breaths/min (2 points), Oxygen saturation <92 % (4 points), and Systolic blood pressure <90 mmHg (2 points). ResultsOf 602 hospitalized TB patients, 187 (31.0 %) died during admission. Among these, 78 (41.7 %) died within seven days. Wasting (adjusted odds ratio [aOR] = 5.76, 95 % confidence interval [CI] 2.12–15.63, p = 0.001) and respiratory rate >20 breaths/min (aOR = 2.89, 95 % CI 1.19–7.00, p = 0.019) predicted early mortality. PROS score of ≥1 demonstrated a sensitivity of 87.8 % and negative predictive value of 90.0 %. The ultimate TB treatment success rate of all hospitalized patients (n = 599) was 47.4 % with 275 (45.9 %) dying during TB treatment. ConclusionEarly and long term mortality rates among hospitalized TB patients are high. Wasting and tachypnea predict early inpatient mortality. The PROS score could be useful in ruling out low-risk patients in low-resource settings.

Enhancing self-learning skills and quality through formative actions and feedback within chemistry classes in the laboratory – A useful model

In here a novel method is described to improve student success rates in a first-year basic chemistry theoretical/practical hybrid course (n = 31 students) by implementing simple ways of formative assessment. This to reduce student dropout rates following the philosophy of encouraging students’ self-control. Essential is to train first-year bachelor students in their self-learning skills and to enhance their evaluative judgment. As a result, students are able to provide better quality of the assessment products at the end of the course. In practice the course is redesigned and intervention tools are integrated at multiple levels throughout the course. The lecturers’ role was adapted to a coaching role, thereby introducing low-effort personalized micro-interventions to meet the personalized needs of students. To clarify these learning needs for students, awareness of the quality desired for the final assessment products is important. Awareness was improved by providing examples of varying quality and introducing multiple peer- and self-assessment moments during the course. The final evaluation of the course examination products showed that the quality of the laboratory notebook was substantially higher after following this approach. Additionally students learned other important skills such as self-learning skills, collaborating in practical work and giving and receiving feedback. Unexpectedly, the high perceived lecturers’ workload decreased. The work presented here provides a novel approach in the form of a model and a practical blueprint with tools for a practical chemistry course design which develops students’ self-learning skills thereby substantially improving student success rates. In our example course, the ultimate student success rate increased form 83 % to 95 % after using this novel approach.

The role of venture capital and governments in clean energy: Lessons from the first cleantech bubble

After a boom and bust cycle in the early 2010s, venture capital (VC) investments have, once again, been flowing towards some green businesses since 2015. In this paper, we use Crunchbase data on 150,000 US startups active between 2000 and 2021 to better understand why VC investments have been relatively unsuccessful when funding new clean energy technologies. Both lackluster demand and a lower potential for outsized returns make clean energy firms less attractive to VC than startups in ICT or biotech. However, we find no clear evidence that financial constraints such as high-capital intensity or long development timeframe are behind the lack of success of VC in clean energy. In addition, our results show that while public sector investments might help attract VC investment, the ultimate success rate of firms receiving public funding remains small. Thus, stimulating demand will have a greater impact on clean energy innovation than investing in startups with a low likelihood of success. Only with demand-side policies in place should governments try to plug funding gaps by targeting clean energy startups with low potential for outsized returns, as they could continue to struggle attracting private capital.

Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Repair of Post-partum Rectovaginal Fistulas-A Single-Center Experience.

Rectovaginal fistulas (RVFs) account for approximately 40% of anorectal complications from obstetrical trauma. Treatment can be challenging requiring multiple surgical repairs. Interposition of healthy transposed tissue (lotus or Martius flap or gracilis muscle) has been used for recurrent RVF. We aimed to review our experience with gracilis muscle interposition (GMI) for post-partum RVF. A retrospective analysis of patients who underwent GMI for post-partum RVF from February 1995 to December 2019 was undertaken. Patient demographics, number of prior treatments, comorbidities, tobacco use, postoperative complications, additional procedures, and outcome were assessed. Success was defined as absence of leakage from the repair site after stoma reversal. Six of 119 patients who underwent GMI did so for recurrent post-partum RVF. Median age was 34.2 (28-48) years. All patients had at least 1 previously failed procedure [median: 3 (1-7)] including endorectal advancement flap, fistulotomy, vaginoplasty, mesh interposition, and sphincteroplasty. All patients underwent fecal diversion prior to or at initial procedure. Success was achieved in 4/6 (66.7%) patients; 2 underwent further procedures (1 fistulotomy and 1 rectal flap advancement) for a final 100% success rate as all ileostomies were reversed. Morbidity was reported in 3 (50%) patients, including wound dehiscence, delayed rectoperineal fistula, and granuloma formation in one each, all managed without surgery. There was no morbidity related to stoma closure. Gracilis muscle interposition is a valuable tool for recurrent post-partum RVF. Our ultimate success rate in this very small series was 100% with a relatively low morbidity rate.

The incidence of awake tracheal intubation in anesthetic practice is decreasing: a historical cohort study of the years 2014-2020 at a single tertiary care institution.

PurposeAwake tracheal intubation (ATI) is recommended in airway management guidelines when significant difficulty is predicted with airway management. Use of the technique may be declining, which may have implications for patient safety or for skills acquisition and maintenance. This historical cohort database study sought to determine if the use of ATI was decreasing in our adult tertiary care center.MethodsWith institutional research ethics board approval, we queried our anesthesia information management system for cases with ATI descriptors for each year from 2014 to 2020. Records of the retrieved cases were independently reviewed by all three authors to verify they met inclusion criteria for the ATI cohort prior to analysis for the primary outcome. Secondary outcome measures included airway device and route used for ATI, first attempt and ultimate success rates, and reported adverse issues recorded in cases of failed ATI or those requiring more than one attempt.ResultsA total of 692 cases of ATI were identified between 2014 and 2020. There was a statistically significant decrease in yearly ATIs over the seven-year study period (Chi square goodness of fit, P < 0.001), with ATI use decreasing by about 50%. First attempt success was significantly greater with use of flexible bronchoscopy vs video laryngoscopy to facilitate ATI (84% vs 60%; P < 0.001), while there was no difference in first attempt success with the oral vs nasal route (82% vs 82%; P = 1.0).ConclusionIn this single-center historical cohort study, the use of ATI decreased significantly from 2014 to 2020. Whether this decrease will result in morbidity or mortality related to airway management is currently unclear. Regardless, it has implications for training opportunities and maintenance of competence in performing the procedure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-022-02344-8.

Ligation of Intersphincteric Fistula Tract (LIFT) with or Without Injection of Bone Marrow Mononuclear Cells in the Treatment of Trans-sphincteric Anal Fistula: a Randomized Controlled Trial

BackgroundLigation of intersphincteric fistula tract (LIFT) is a sphincter-saving procedure used for treatment of complex anal fistula. The current study aimed to assess the outcome of local injection of bone marrow mononuclear cells (BM-MNCs) in conjunction with LIFT as compared to LIFT alone in regards to healing rate, time to healing, and ultimate success rate. MethodsThis was a prospective randomized trial on patients with trans-sphincteric anal fistula. Patients were randomly allocated to one of two equal groups: LIFT and LIFT with BM-MNC injection. The main outcome measures were healing at 10 weeks of follow-up, recurrence after healing, and complications. ResultsSeventy patients (48 male and 22 female) of a mean age of 37.9±10.4 years were included. The mean time to complete healing after LIFT + BM-MNCs was significantly shorter than after LIFT alone (20.5±5.2 vs 28.04±5.8 days; P < 0.0001). The ultimate success rates of both groups were similar (LIFT = 60% vs LIFT with BM-MNCs = 68.6%, P = 0.62). There was no significant difference in the mean operation time or complication rate between the two groups. Secondary extension and previous anal surgery were significant independent predictors of failure of healing. ConclusionLIFT combined with BM-MNC injection was associated with a shorter time to complete healing than LIFT alone. However, BM-MNC injection did not have a significant impact on the overall healing and ultimate success rate.

Does Mammotome biopsy affect surgery option and margin status of breast conserving surgery in breast cancer?

The Mammotome, an image-guided, usually ultrasound-guided vacuum-assisted breast biopsy (US-VABB) system, has been widely used in the early diagnosis of breast disease and the complete excision of benign lesions. However, in some malignant lesions underestimated by U.S., whether Mammotome biopsy would affect the surgery option, especially the margin status in breast-conserving surgery (BCS), has never been studied. Between 2015 and 2019, 198 patients with 200 lesions who have been diagnosed with breast cancer by Mammotome elsewhere received surgery by pathological confirmation in our center. The clinicopathological characteristics, surgery options, therapies, and the details of the specimen, such as margin status of BCS, tumor residual after VABB, and hematoma were reviewed. Among 200 lesions, 90% were evaluated below US-BIRADS 4b before Mammotome biopsy and 94.5% with a tumor size ≤3 cm. 131 patients received mastectomy (66.2%) and 67 received BCS (33.8%). Hematoma and tumor residual were observed in 37.5% and 71.5% of all lesions, respectively. There is a higher incidence of hematoma in the mastectomy group than in the BCS group (44.4% vs. 23.9%, P=0.005). In BCS group, the positive margin was found in 7 patients at first examination including four focals with re-excision, two extensive with mastectomy and one focal but refusing further surgery. The ultimate success rate of BCS was 95.5%. Margin positivity correlated with tumor residual (P=0.044) but not with hematoma. Mammotome biopsy might lead to hematoma and tumor residual; however, it is not the determinant factor for a surgery option, and BCS is feasible through a complete excision of tumor residual to acquire negative margin.

Single center experience of pediatric percutaneous balloon pericardiotomy.

Percutaneous balloon pericardiotomy is a percutaneous procedure that creates a window in the parietal pericardium by balloon dilation. The use of percutaneous balloon pericardiotomy has not been reported well in children. The objective of this study was to describe the single centre experience of percutaneous balloon pericardiotomy in children. This was a retrospective study to describe all the children aged <20 years undergoing percutaneous balloon pericardiotomy during an 18-year period (2001-2019). Patient characteristics, technical and ultimate procedural success, and repeat interventions were collected. A total of 13 percutaneous balloon pericardiotomy's were performed in 11 children at the median age of 12 years (range 1.8-19). The etiologies of pericardial effusion were post-pericardiotomy syndrome (n = 4), restrictive cardiomyopathy (n = 1), autoimmune diseases (n = 3), malignancy (n = 2), and idiopathic (n = 1). Two patients received two percutaneous balloon pericardiotomy. The technical success of percutaneous balloon pericardiotomy was 100% with no acute adverse events (balloon rupture or local bleeding). Five (45%) required re-intervention and ultimately three required a surgical pericardial window 6 to 35 days after the percutaneous balloon pericardiotomy. As a result, ultimate procedural success rate was 73% (8/11). Percutaneous balloon pericardiotomy was performed safely with high technical success in children. Percutaneous balloon pericardiotomy may be considered for recurrent and persistent pericardial effusion, before considering a surgical pericardial window.

Feasibility of the ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in very small weight infants: A case series.

The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in infants weighing less than 1500g. The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using an in-plane approach the brachiocephalic vein was cannulated by using a 24-gauge intravenous cannula under real-time ultrasound guidance into the vein followed by the insertion of a 2-French single lumen catheter using the Seldinger technique. Forty-six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5kg (Median: 1.2; 95%-CI: 0.9-1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts. The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) over the time course of this series. Median catheter dwell time was 15days (95%-CI: 9-20) with one catheter being removed prematurely after 8days due to obstruction. Supracalvicular in-plane real-time ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large-bore central venous access for very small and sick babies.

Interventional radiology in the management of renal vascular injury: A prospective study.

Introduction:Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the management of renal vascular injury.Materials and Methods:Our prospective study was performed over a period of 6 months. Twenty-five patients who presented with either persistent hematuria or hemodynamic instability after traumatic or iatrogenic renal injuries were selected. Angiographic embolization using varying combinations of coils, glue, and Gelfoam® was performed to address the vascular injuries, either directly in hemodynamically unstable patients or after preprocedural imaging in hemodynamically stable patients. Patients were then followed up till discharge from hospital 48 h later and at 2 weeks and 4 weeks postprocedure for any recurrence of hematuria or hemodynamic instability. Technical and clinical success rates were calculated using descriptive statistics.Results:Pseudoaneurysms were the most common form of arterial injury (22 cases), followed by arteriovenous fistula (8) and active extravasation (5). Segmental arteries are the most commonly involved (12 cases), followed by interlobar (9) and arcuate (3) arteries. Gelfoam® was used in five patients with active contrast extravasation and was 100% effective in arresting active bleeding. Coiling alone had a 79.16% technical success rate in management, while additional use of glue in four failed cases led to a 95.83% technical success rate in the first attempt. The ultimate technical and clinical success rate of interventional radiology in renal trauma management (after the second attempt in one failed case) was 100%.Conclusion:Endovascular management is an effective and safe alternative to surgical management of both iatrogenic and accidental renal vascular injuries.

42 Clinical Characteristics of Emergency Department Intubations in Patients With Angioedema: A Report from the National Emergency Airway Registry

Angioedema is common and life-threatening airway obstruction may occur. When intubation is required, it is often difficult to complete when swelling is extensive. First-attempt success is crucial since multiple intubation attempts are associated with increased peri-intubation complications. With more widespread availability of flexible and rigid video equipment, it is important to characterize current airway management practices, success rates and rescue techniques in these patients. We analyzed data from the National Emergency Airway Registry (NEAR), a multicenter prospective observational registry of 25 community and academic EDs. Patients with an intubation attempt for angioedema between January 1, 2016 and December 31, 2017 were included. We report univariate descriptive data as proportions with 95% confidence intervals (CIs). Of 12,044 discrete patient encounters, 71 (0.6%) patients underwent an intubation attempt for angioedema. The median patient age was 59 years (IQR 42 to 64 years), and 17 (23.9%) were female. Emergency physicians were the primary operators during the first-attempt in 92% of cases. Flexible endoscopic devices were the most common initial device (51%) followed by the C-MAC video laryngoscope (21%) and Glidescope video laryngoscope (13%). A direct laryngoscope was used in only 6 cases (8%). Oral and nasal intubation routes were used in 56% and 44%, respectively. A sedative agent was used during first intubation attempt in 82% of encounters and a paralytic was used in 61% of patients. Etomidate and succinylcholine were the most common sedative and paralytic agents administered, respectively. The first-attempt success rate among all angioedema patients was 82% (95% CI [71% to 90%]). Ultimate success was 99%. Nasal routes had a higher first-attempt success rate compared to oral routes (97%, 95% CI [83.3-99.2] vs. 69%, 95% CI [52.4-83.0], respectively). Flexible endoscopes were successful on first-attempt in 33/36 (92%, 95% CI [78%-98%]) patients. Rigid video laryngoscopes and direct laryngoscopes were successful in 24/29 (83%, 95% CI [64%-94%]) and 2/6 (33%, 95% CI [4%-78%]), respectively. The first-attempt success rate among patients in whom a sedative agent was used was 79% (95% CI, [67%-89%]) vs 92% (95% CI, [64%-99%]) among patients in whom no sedative agent was administered. First-attempt success rates were similar between paralyzed and non-paralyzed patients (81% vs. 82%, respectively). No patients underwent a primary cricothyrotomy on first attempt; one patient required a rescue surgical airway. Intubation for angioedema in this multicenter ED cohort was rare. In the hands of emergency physicians, first-attempt success rate was 82% with an ultimate success rate of 99%. The highest first attempt success was observed in patients undergoing nasal flexible endoscopic intubations. Rescue cricothyrotomy was performed once. Further study is needed to determine optimal emergent airway management in this population of patients.

Results of the York Mason Procedure with and without Concomitant Graciloplasty to Treat Iatrogenic Rectourethral Fistulas

BackgroundRectourethral fistulas (RUFs) are rare but devastating complications after surgery or radiation therapy to the urethra, prostate, or rectum. RUF repair is challenging, especially in irradiated patients. ObjectiveTo evaluate the efficacy of the York Mason (YM) procedure with or without concomitant gracilis muscle interposition (graciloplasty) for RUF repair. Design, setting, and participantsRecords of patients with an iatrogenic RUF who underwent the YM procedure between 2008 and 2018 in two university hospitals were reviewed. Data on etiology, diagnostic and operative procedures, urinary and fecal diversion, and postoperative follow-up were collected. InterventionTwenty-eight patients underwent 33 YM procedures. Concomitant graciloplasty was performed in four (14%) primary repairs and two (7%) repairs for recurrent RUFs. Outcome measurements and statistical analysisThe primary endpoint was successful RUF repair, defined as absence of symptoms and no leakage on control urethrocystography. The secondary endpoint was colostomy reversal rate. Results and limitationsMedian follow-up was 24 mo. Ten patients (36%) were irradiated previously. The ultimate success rate was 75% after a maximum of three YM procedures. Success rates were 89% and 50% in patients with nonirradiated and irradiated fistulas, respectively. In irradiated patients, the success rates of the first YM procedure with and without graciloplasty were 100% and 29%, respectively. In recurrent cases, concomitant graciloplasty did not result in better outcomes. Colostomy reversal was possible in 15 patients after successful repair. In all patients, fecal continence was intact and no anal stenosis was reported. Limitations of the study include small sample size and the retrospective design. ConclusionsCombination of the YM procedure with graciloplasty resulted in higher success rates of RUF repair in patients with irradiated fistulas. Fecal continence was preserved, and colostomy reversal is feasible. Patient summaryWe analyzed the outcomes, complications, and colostomy reversal rate of the York Mason procedure for the repair of rectourethral fistulas (RUFs). We found that concomitant graciloplasty increases success rates in case of prior radiation therapy. Colostomy reversal is feasible after RUF repair.

A Retrospective Analysis of the Clinical Effectiveness of Supraclavicular, Ultrasound-guided Brachiocephalic Vein Cannulations in Preterm Infants.

The aim of this retrospective analysis was to evaluate the clinical effectiveness of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in preterm infants. The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using a strict in-plane approach the brachiocephalic vein was cannulated by advancing a 22- or 24-gauge iv cannula from lateral to medial under the long axis of the ultrasound probe under real-time ultrasound guidance into the vein. One hundred and forty-two cannulations in infants weighing between 0.59 and 2.5 kg (median: 2.1; CI: 2.0 to 2.2) were included. Ultimate success rate was 94% (134 of 142). One cannulation attempt was required in 100 (70%) patients, two attempts in 21 (15%), and three attempts in 13 (9%). The smaller the weight of the infant the more attempts were needed. More attempts also were needed for the right brachiocephalic vein, which was primarily targeted in 75 (53%) neonates. One (1%) inadvertent arterial puncture was noted. This supraclavicular, in-plane, real-time, ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and effective method to insert central venous catheters in preterm infants.

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

ObjectiveTo report the surgical details and results of our technique of buccal mucosal graft (BMG) urethroplasty for panurethral stricture, as many studies have reported repair of panurethral stricture by single-stage BMG urethroplasty by placing buccal mucosa ventrally, dorsally or dorsolaterally. Patients and methodsThis was an observational analysis of 38 patients with panurethral stricture treated by placing two BMGs, one as a ventral onlay in the proximal bulbar urethra and the other as a dorsal onlay in the distal bulbar and penile urethra. Success was defined as asymptomatic state with or without need for a postoperative single intervention such as dilatation or internal urethrotomy. ResultsThe 38 patients had a mean age of 44 years, with lichen sclerosus as the predominant cause of stricture. The ultimate success rate was 84.2% at the end of 3 months and 89.5% at the end of 1 year. Recurrent strictures appeared only in the failed cases during the follow-up period of 11 months. None of the patients needed redo urethroplasty during the follow-up period. ConclusionsA proximal ventral and distal dorsal onlay technique of BMG urethroplasty is an available alternative for repairing panurethral stricture. The technique described is simple and easily reproducible with encouraging results compared to other similar techniques.

Endoscopic Treatment of Vesicoureteral Reflux

Optimal management of primary vesicoureteral reflux (VUR) remains a source of debate, and options include observation with or without continuous antibiotic prophylaxis and surgical repair via endoscopic, open, or laparoscopic/robotic approaches. Surgical intervention may be necessary in children with persistent reflux, renal scarring, or recurrent febrile urinary tract infections when other options fail. Need for surgical correction is dictated predominantly by a given child’s clinical course including risk for recurrent infections and potential for renal scarring. While recent studies suggest that endoscopic injection is effective for the treatment of most VUR, the importance of material injected, technique utilized, reflux grade, and structural/functional bladder anomalies on ultimate success rates must be emphasized. Long-term clinical success following endoscopic correction of primary VUR is high, and the majority of children avoid additional or more invasive surgical procedures. Efficacy rates are known to vary widely between surgeons, techniques, and implant materials.

Mining the Genome for Therapeutic Targets.

Current pharmacological options for type 2 diabetes do not cure the disease. Despite the availability of multiple drug classes that modulate glycemia effectively and minimize long-term complications, these agents do not reverse pathogenesis, and in practice they are not selected to correct the molecular profile specific to the patient. Pharmaceutical companies find drug development programs increasingly costly and burdensome, and many promising compounds fail before launch to market. Human genetics can help advance the therapeutic enterprise. Genomic discovery that is agnostic to preexisting knowledge has uncovered dozens of loci that influence glycemic dysregulation. Physiological investigation has begun to define disease subtypes, clarifying heterogeneity and suggesting molecular pathways for intervention. Convincing genetic associations have paved the way for the identification of effector transcripts that underlie the phenotype, and genetic or experimental proof of gain or loss of function in select cases has clarified the direction of effect to guide therapeutic development. Genetic studies can also examine off-target effects and furnish causal inference. As this information is curated and made widely available to all stakeholders, it is hoped that it will enhance therapeutic development pipelines by accelerating efficiency, maximizing cost-effectiveness, and raising ultimate success rates.

Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery

OBJECTIVE:To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery.METHODS:A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed.RESULTS:There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (p<0.05).CONCLUSION:Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients.

Telemedicine-Assisted Intubation in Rural Emergency Departments: A National Emergency Airway Registry Study.

Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance. We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network. Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics. Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia. The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success. Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.

Rectourethral Fistulas Secondary to Prostate Cancer Treatment: Management and Outcomes from a Multi-Institutional Combined Experience

Rectourethral fistula is a known complication of prostate cancer treatment. Reports in the literature on rectourethral fistula repair technique and outcomes are limited to single institution series. We examined the variations in technique and outcomes of rectourethral fistula repair in a multi-institutional setting. We retrospectively identified patients who underwent rectourethral fistula repair after prostate cancer treatment at 1 of 4 large volume reconstructive urology centers, including University of California-San Francisco, University College London Hospitals, Lahey Clinic and Devine-Jordan Center for Reconstructive Surgery, in a 15-year period. We examined the types of prostate cancer treatment, technical aspects of rectourethral fistula repair and outcomes. After prostate cancer treatment 201 patients underwent rectourethral fistula repair. The fistula developed in 97 men (48.2%) after radical prostatectomy alone and in 104 (51.8%) who received a form of energy ablation. In the ablation group 84% of patients underwent bowel diversion before rectourethral fistula repair compared to 65% in the prostatectomy group. An interposition flap or graft was placed in 91% and 92% of the 2 groups, respectively. Concomitant bladder neck contracture or urethral stricture developed in 26% of patients in the ablation group and in 14% in the prostatectomy group. Postoperatively the rates of urinary incontinence and complications were higher in the energy ablation group at 35% and 25% vs 16% and 11%, respectively. The ultimate success rate of fistula repair in the energy ablation and radical prostatectomy groups was 87% and 99% with 92% overall success. Rectourethral fistulas due to prostate cancer therapy can be reconstructed successfully in a high percent of patients. This avoids permanent urinary diversion in these complex cases.

Techniques and Trends, Success Rates, and Adverse Events in Emergency Department Pediatric Intubations: A Report From the National Emergency Airway Registry

We describe emergency department (ED) intubation practices for children younger than 16 years through multicenter prospective surveillance. Academic and community EDs in the United States, Canada, and Australia recorded data electronically, from 2002 to 2012, with verified greater than or equal to 90% reporting. Ten of 18 participating centers provided qualifying data, reporting 1,053 encounters. Emergency physicians initiated 85% of intubations. Trainees initiated 83% (95% confidence interval [CI] 81% to 85%). Premedication became uncommon, reaching less than 30% by the last year. Etomidate was used in 78% of rapid sequence intubations. Rocuronium use increased during the period of study, whereas succinylcholine use declined. Video laryngoscopy increased, whereas direct laryngoscopy declined. The first attempt was successful in 83% of patients (95% CI 81% to 85%) overall. The risk of first-attempt failure was highest for infants (relative risk versus all others 2.3; 95% CI 1.8 to 3.0). Odds of first-attempt success for girls relative to boys were 0.57. The odds were 3.4 times greater for rapid sequence intubation than sedation without paralysis. The ultimate success rate was 99.5%. Because we sampled only 10 centers and most of the intubations were by trainees, our results may not be generalizable to the typical ED setting. We found that premedication is now uncommon, etomidate is the predominant induction agent, and rocuronium and video laryngoscopy are used increasingly. First-attempt failure is most common in infants.