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Blood Pressure Dec 2023Interventional approaches to treat hypertension are an emerging option that may be suitable for patients whose BP control cannot be achieved with lifestyle and/or... (Review)
Review
Interventional approaches to treat hypertension are an emerging option that may be suitable for patients whose BP control cannot be achieved with lifestyle and/or pharmacotherapy and possibly for those who do not wish to take drug therapy. Interventional strategies include renal denervation with radiofrequency, ultrasound and alcohol-mediated platforms as well as baroreflex activation therapy and cardiac neuromodulation therapy. Presently renal denervation is the most advanced of the therapeutic options and is currently being commercialised in the EU. It is apparent that RDN is effective in both unmedicated patients and patients with more severe hypertension including those with resistant hypertension. However, at present there is no evidence for the use of RDN in patients with secondary forms of hypertension and thus evaluation to rule these out is necessary before proceeding with a procedure. Furthermore, there are numerous pitfalls in the diagnosis and management of secondary hypertension which need to be taken into consideration. Finally, prior to performing an intervention it is appropriate to document presence/absence of hypertension-mediated organ damage.
Topics: Humans; Patient Selection; Hypertension; Kidney; Baroreflex; Diuretics
PubMed: 37665430
DOI: 10.1080/08037051.2023.2248276 -
Acta Chirurgica Belgica Dec 2022The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like...
BACKGROUND
The surgical removal of tonsils has been performed from as long as three thousand years ago, as mentioned in Hindu literature. The role medieval physicians like Albucasis played in the history of tonsillectomy is very important. This article aims to show the contributions Albucasis made to this procedure.
METHODS
The present library-documentary research relied on the third chapter of the book , Albucasis' surgical text, as the main information source.
RESULTS
Albucasis discussed the conditions necessary for tonsillectomy, he introduced three surgical tools for this operation, and he also described the surgical method. Albucasis succeeded in inventing and discovering new tools and methods for tonsillectomy.
CONCLUSION
The comparison of the tonsil surgery introduced by Albucasis and those of earlier and later surgeons reveals Albucasis' superiority in both operation performance and equipment used. Some of his methods are comparable with approaches to operations used in the 20th century.
Topics: Humans; Tonsillectomy; Surgeons; Books; Research Design
PubMed: 36000511
DOI: 10.1080/00015458.2022.2117458 -
Methods in Molecular Biology (Clifton,... 2023Despite nonanimal methods (NAMs) are more and more exploited and new NAMs are developed and validated, animal models are still used in cancer research. Animals are used...
Despite nonanimal methods (NAMs) are more and more exploited and new NAMs are developed and validated, animal models are still used in cancer research. Animals are used at multiple levels, from understanding molecular traits and pathways, to mimicking clinical aspects of tumor progression, to drug testing. In vivo approaches are not trivial and involve cross-disciplinary knowledge: animal biology and physiology, genetics, pathology, and animal welfare.The aim of this chapter is not to list and address all animal models used in cancer research. Instead, the authors would like to guide experimenters in the strategies to adopt in both planning and performing in vivo experimental procedures, including the choice of cancer animal models.
Topics: Animals; Disease Models, Animal; Animal Welfare; Research Design; Neoplasms
PubMed: 37202613
DOI: 10.1007/978-1-0716-3056-3_4 -
Journal of Hospital Medicine Apr 2021As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by... (Review)
Review
BACKGROUND
As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience.
METHODS
We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures.
RESULTS
Our synthesis of the literature characterizes contributors to hospitalists' procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists.
CONCLUSION
We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.
Topics: Credentialing; Hospital Medicine; Hospitalists; Hospitalization; Humans; Referral and Consultation
PubMed: 33734979
DOI: 10.12788/jhm.3590 -
Pediatric Surgery International Apr 2023Ladd's Procedure has been the surgical intervention of choice in the management of congenital intestinal malrotation for the past century. Historically, the procedure... (Review)
Review
BACKGROUND
Ladd's Procedure has been the surgical intervention of choice in the management of congenital intestinal malrotation for the past century. Historically, the procedure included performing an appendectomy to prevent future misdiagnosis of appendicitis, since the location of the appendix will be shifted to the left side of the abdomen. This study consists of two parts. A review of the available literature on appendectomy as part of Ladd's procedure and then a survey sent to pediatric surgeons about their approach (to remove the appendix or not) while performing a Ladd's procedure and the clinical reasoning behind their approach.
METHODS
The study consists of 2 parts: (1) a systematic review was performed to extract articles that fulfill the inclusion criteria; (2) a short online survey was designed and sent by email to 168 pediatric surgeons. The questions in the survey were centered on whether a surgeon performs an appendectomy as part of the Ladd's procedure or not, as well as their reasoning behind either choice.
RESULTS
The literature search yielded five articles, the data from the available literature are inconsistent with performing appendectomy as part of Ladd's procedure. The challenge of leaving the appendix in place has been briefly described with minimal to no focus on the clinical reasoning. The survey demonstrated that 102 responses were received (60% response rate). Ninety pediatric surgeons stated performing an appendectomy as part of the procedure (88%). Only 12% of pediatric surgeons are not performing appendectomy during Ladd's procedure.
CONCLUSION
It is difficult to implement a modification in a successful procedure like Ladd's procedure. The majority of pediatric surgeons perform an appendectomy as part of its original description. This study has identified gaps in the literature pertaining to analyze the outcomes of performing Ladd's procedure without an appendectomy which should be explored in future research.
Topics: Child; Humans; Appendectomy; Laparoscopy; Intestinal Volvulus; Digestive System Surgical Procedures
PubMed: 37010655
DOI: 10.1007/s00383-023-05437-7 -
Statistics in Medicine Oct 2021Approaches and guidelines for performing subgroup analysis to assess heterogeneity of treatment effect in clinical trials have been the topic of numerous papers in the...
Approaches and guidelines for performing subgroup analysis to assess heterogeneity of treatment effect in clinical trials have been the topic of numerous papers in the statistical and clinical literature, but have been discussed predominantly in the context of conventional superiority trials. Concerns about treatment heterogeneity are the same if not greater in non-inferiority (NI) trials, especially since overall similarity between two treatment arms in a successful NI trial could be due to the existence of qualitative interactions that are more likely when comparing two active therapies. Even in unsuccessful NI trials, subgroup analyses can yield important insights about the potential reasons for failure to demonstrate non-inferiority of the experimental therapy. Recent NI trials have performed a priori subgroup analyses using standard statistical tests for interaction, but there is increasing interest in more flexible machine learning approaches for post-hoc subgroup discovery. The performance and practical application of such methods in NI trials have not been systematically explored, however. We considered the Virtual Twin method for the NI setting, an algorithm for subgroup identification that combines random forest with classification and regression trees, and conducted extensive simulation studies to examine its performance under different NI trial conditions and to devise decision rules for selecting the final subgroups. We illustrate the utility of the method with data from a NI trial that was conducted to compare two acupuncture treatments for chronic musculoskeletal pain.
Topics: Computer Simulation; Equivalence Trials as Topic; Humans; Research Design
PubMed: 34155676
DOI: 10.1002/sim.9118 -
Obesity Surgery Aug 2022One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by...
PURPOSE
One anastomosis/mini gastric bypass (OAGB/MGB) is up to date the third most performed obesity and metabolic procedure worldwide, which recently has been endorsed by ASMBS. The main criticisms are the risk of bile reflux, esophageal cancer, and malnutrition. Although IFSO has recognized this procedure, guidance is needed regarding selection criteria. To give clinicians a daily support in performing the right patient selection in OAGB/MGB, the aim of this paper is to generate clinical guidelines based on an expert modified Delphi consensus.
METHODS
A committee of 57 recognized bariatric surgeons from 24 countries created 69 statements. Modified Delphi consensus voting was performed in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was considered to indicate a consensus.
RESULTS
Consensus was achieved for 56 statements. Remarkably, ≥ 90.0% of the experts felt that OAGB/MGB is an acceptable and suitable option "in patients with Body mass index (BMI) > 70, BMI > 60, BMI > 50 kg/m as a one-stage procedure," "as the second stage of a two-stage bariatric surgery after Sleeve Gastrectomy for BMI > 50 kg/m (instead of BPD/DS)," and "in patients with weight regain after restrictive procedures. No consensus was reached on the statement that OAGB/MGB is a suitable option in case of resistant Helicobacter pylori. This is likely as there is a concern that this procedure is associated with reflux and its related long-term complications including risk of cancer in the esophagus or stomach. Also no consensus reached on OAGB/MGB as conversional surgery in patients with GERD after restrictive procedures. Consensus for disagreement was predominantly achieved "in case of intestinal metaplasia of the stomach" (74.55%), "in patients with severe Gastro Esophageal Reflux Disease (GERD)(C,D)" (75.44%), "in patients with Barrett's metaplasia" (89.29%), and "in documented insulinoma" (89.47%).
CONCLUSION
Patient selection in OAGB/MGB is still a point of discussion among experts. There was consensus that OAGB/MGB is a suitable option in elderly patients, patients with low BMI (30-35 kg/m) with associated metabolic problems, and patients with BMIs more than 50 kg/m as one-stage procedure. OAGB/MGB can also be a safe procedure in vegetarian and vegan patients. Although OAGB/MGB can be a suitable procedure in patients with large hiatal hernia with concurrent hiatal hernia, it should not be offered to patients with grade C or D esophagitis or Barrett's metaplasia.
Topics: Aged; Delphi Technique; Gastric Bypass; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Metaplasia; Obesity, Morbid; Patient Selection; Retrospective Studies
PubMed: 35704259
DOI: 10.1007/s11695-022-06124-7 -
Minerva Cardiology and Angiology Dec 2021Percutaneous non-valvular structural interventions, encompassing patent foramen ovale, atrial or ventricular septal defect closure and left atrial appendage closure, are... (Review)
Review
Percutaneous non-valvular structural interventions, encompassing patent foramen ovale, atrial or ventricular septal defect closure and left atrial appendage closure, are usually performed in young and healthy patients and represent a valid alternative to pharmacological or surgical interventions. In order to minimize procedural and device related complications, a careful pre-procedural planning together with an accurate intra-procedural imaging are crucial to improve patient's outcome. In this article, we review currently available evidence on patient selection, procedural planning and interventional guidance helping physician to determine who will derive the most benefit from the procedure.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Foramen Ovale, Patent; Heart Septal Defects, Ventricular; Humans; Patient Selection
PubMed: 34870383
DOI: 10.23736/S2724-5683.21.05696-9 -
Statistics in Medicine Dec 2023In randomized trials, comparability of the treatment groups is ensured through allocation of treatments using a mechanism that involves some random element, thus...
In randomized trials, comparability of the treatment groups is ensured through allocation of treatments using a mechanism that involves some random element, thus controlling for confounding of the treatment effect. Completely random allocation ensures comparability between the treatment groups for all known and unknown prognostic factors. For a specific trial, however, imbalances in prognostic factors among the treatment groups may occur. Although accidental bias can be avoided in the presence of such imbalances by stratifying the analysis, most trialists, regulatory agencies, and other stakeholders prefer a balanced distribution of prognostic factors across the treatment groups. Some procedures attempt to achieve balance in baseline covariates, by stratifying the allocation for these covariates, or by dynamically adapting the allocation using covariate information during the trial (covariate-adaptive procedures). In this Tutorial, the performance of minimization, a popular covariate-adaptive procedure, is compared with two other commonly used procedures, completely random allocation and stratified blocked designs. Using individual patient data of 2 clinical trials (in advanced ovarian cancer and age-related macular degeneration), the procedures are compared in terms of operating characteristics (using asymptotic and randomization tests), predictability of treatment allocation, and achieved balance. Fifty actual trials of various sizes that applied minimization for treatment allocation are used to investigate the achieved balance. Implementation issues of minimization are described. Minimization procedures are useful in all trials but especially when (1) many major prognostic factors are known, (2) many centers of different sizes accrue patients, or (3) the trial sample size is moderate.
Topics: Humans; Bias; Randomized Controlled Trials as Topic; Research Design; Sample Size
PubMed: 37867447
DOI: 10.1002/sim.9916 -
International Journal of Surgery... Aug 2019To assess the efficacy and safety of double J (DJ) stented, external stented and stent-less procedures in pediatric pyeloplasty by adopting a network meta-analysis (NMA). (Comparative Study)
Comparative Study Review
OBJECTIVE
To assess the efficacy and safety of double J (DJ) stented, external stented and stent-less procedures in pediatric pyeloplasty by adopting a network meta-analysis (NMA).
MATERIAL AND METHODS
Electronic databases including PubMed, Cochrane Library, Web of science and Embase database were retrieved. The trials that compared double J (DJ) stented, external stented or stent-less procedures in pediatric pyeloplasty were identified. A network meta-analysis was conducted with the software of STATA 14.0. Probability-based ranking results were performed to identify the best treatment, and publication bias was analyzed by funnel plots.
RESULTS
15 studies with 1731 participants were enrolled in the analysis, including 4 randomized controlled trials (RCT) and 11 retrospective studies. The NMA results revealed that no significant differences were detected in the outcomes of operative time, operative success, hospital stay, improvement of renal functions, overall complications and redo pyeloplasty. DJ stented and external stented procedures were associated with more postoperative pain than that of stent-less procedures [DJ stented: OR = 4.47, 95%CI(1.05,19.08); external stented: OR = 5.83, 95%CI(0.09,1.43)]. DJ stented procedure had a lower rate of urine leakage than those of external stented procedure [OR = 0.18, 95%CI (0.04, 0.76)] and stent-less procedure [OR = 0.07, 95%CI=(0.01, 0.34)]. No significant difference was observed in other types of complications such as urinary tract infection (UTI), stent migration, recurrent ureteropelvic junction obstruction (UPJO) and fever. The probabilities of ranking results indicated that the DJ stented procedure was the best treatment in the outcomes of hospital stay, operative success, improvement of renal functions, and the complication of urine leakage. Stent-less procedure showed its advantages in the outcomes of operative time, flank pain and UTI. External stented procedure had the lowest rate of overall complications and redo pyeloplasty.
CONCLUSIONS
There were no obvious differences in operative time, operative success, hospital stay, improvement of renal functions, overall complications between external stented, DJ stented and stent-less procedures for pediatric pyeloplasty. When considering the ranking results, the DJ stented procedure seemed to be more beneficial for pediatric pyeloplasty than the other methods. However, with the limitation of our study, additional high-quality studies are needed for further evaluation.
Topics: Child; Humans; Kidney Pelvis; Length of Stay; Network Meta-Analysis; Plastic Surgery Procedures; Retrospective Studies; Stents; Ureteral Obstruction; Urologic Surgical Procedures
PubMed: 31279854
DOI: 10.1016/j.ijsu.2019.07.001