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Scientific Reports Mar 2020In young children with small angle exotropia, making decisions for the individual patient whether to perform surgery or not, and choosing the optimal time for surgical... (Comparative Study)
Comparative Study
In young children with small angle exotropia, making decisions for the individual patient whether to perform surgery or not, and choosing the optimal time for surgical intervention are quite difficult. We aimed to compare the long-term outcomes of small angle intermittent exotropia of 20 prism diopters (PD) or less after observation versus strabismus surgery. A retrospective study was performed on 164 patients aged 3 to 13 who underwent surgical intervention or observation with or without conservative management for intermittent exotropia of 14 to 20 PD. The minimum follow-up period was 2 years. The average follow-up period was 3.9 ± 2.2 years in the observation group and 4.5 ± 2.3 years in the surgery group. At the final examination, the mean angle of deviation at distance was 11.1 ± 8.9 PD in the observation group and 9.0 ± 7.5 PD in the surgery group, which was not significantly different (P = 0.121). Changes in sensory outcome and fusional control were not significantly different between both groups (P = 0.748 and P = 0.968). Subgroup analysis including patients with poor fusional control also showed similar results. By multivariate analysis, the type of surgery, unilateral recess-resect procedure, was the only predictive factor of good motor outcome in the surgery group. In conclusion, long-term surgical outcomes in small angle exotropia did not appear to be more satisfying than observation in terms of motor and sensory outcomes.
Topics: Adolescent; Child; Child, Preschool; Clinical Decision-Making; Conservative Treatment; Exotropia; Female; Humans; Male; Multivariate Analysis; Ophthalmologic Surgical Procedures; Retrospective Studies; Visual Acuity; Watchful Waiting
PubMed: 32170126
DOI: 10.1038/s41598-020-61568-0 -
British Journal of Haematology Oct 2013
Topics: Adolescent; Biopsy; Humans; Lymphoma, Follicular; Magnetic Resonance Imaging; Male; Neoplasm Staging; Positron-Emission Tomography; Watchful Waiting
PubMed: 23927399
DOI: 10.1111/bjh.12493 -
Journal de Gynecologie, Obstetrique Et... Dec 2011To determine when surveillance should be started in prolonged pregnancy and what would be the more appropriate frequency for it. (Review)
Review
OBJECTIVE
To determine when surveillance should be started in prolonged pregnancy and what would be the more appropriate frequency for it.
STUDY DESIGN
Systematic searches of Medline and the Cochrane Library were performed.
RESULTS
Fetal mortality diminishes from 37 weeks of gestation to a nadir of one death for 1000 births at 40(+0) weeks. It increases thereafter up to three deaths for 1000 births at 43(+0) weeks. Perinatal mortality rates show same pattern and is estimated to be of two and four to six deaths for 1000 births at 41(+0) and 43(+0) weeks, respectively. However, current available data does not allow for the determination of a gestational age cut-off associated with major increase of perinatal mortality and on which surveillance of prolonged pregnancy should be genuinely started. French epidemiological data from 2003 indicate that although 52.5% of pregnant women have reached 40(+0) weeks only 20,7% and 1% have reaches 41(+0) and 42(+0) weeks, respectively. Intrauterine fetal growth associated with prolonged pregnancy increases perinatal mortality. In most randomized trials having compared labour induction with expectant management, fetal surveillance was started at 41(+0) weeks.
CONCLUSION
Due to the increased risk of perinatal mortality, it seems appropriate that fetal surveillance is started at 41(+0) weeks (expert opinion). This implies a rational organization of care to support surveillance of 20% of pregnant women. The frequency of this monitoring consisting of at least twice-weekly cadiotocography and ultrasound estimation of amniotic fluid (expert opinion).
Topics: Female; Fetal Monitoring; Gestational Age; Humans; Incidence; Labor, Induced; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Time Factors; Watchful Waiting
PubMed: 22056185
DOI: 10.1016/j.jgyn.2011.09.015 -
Journal de Gynecologie, Obstetrique Et... Dec 2011More and more perimenopausal and menopausal women seek an alternative to hysterectomy because they desire future pregnancy or wish to retain their uteri even if they... (Review)
Review
More and more perimenopausal and menopausal women seek an alternative to hysterectomy because they desire future pregnancy or wish to retain their uteri even if they have completed childbearing. Myomectomy may be an option. We can't know the evolution of leiomyomas. Hysteroscopic myomectomy is the treatment of submucous fibromas. Recurrence and subsequent surgery occurs in 16 to 21 % of cases. Intramural and subserousal myomas can be treated by myomectomy. Myomectomy should be performed laparoscopically because of shorter hospital stay, faster recovery and reduced postoperative pain. Second surgery is needed in 4-16 % of patients. If hysterectomy is performed, it should be by vaginal or laparoscopic route. There is no difference in perioperative morbidity between hysterectomy and myomectomy. Intra- and postoperative complications are similar between myomectomy and hysterectomy. Hysterectomy may be prefered if there is risk factor of malignancy or if the fibroma is discovered or has a rapid growth after menopause.
Topics: Disease Progression; Female; Fertility; Gynecologic Surgical Procedures; Humans; Leiomyoma; Perimenopause; Postmenopause; Postoperative Complications; Pregnancy; Uterine Neoplasms; Watchful Waiting
PubMed: 22056189
DOI: 10.1016/j.jgyn.2011.09.024 -
Obstetrics and Gynecology Feb 2021To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management.
METHODS
We conducted a secondary analysis of a multicenter randomized trial of elective induction of labor at 39 weeks of gestation compared with expectant management in low-risk nulliparous patients. Participants with nonanomalous neonates, who were randomized to and underwent expectant management and attained 39 0/7 weeks of gestation, were included. Delivery gestation was categorized by completed week: 39 0/7-39 6/7 (39 weeks), 40 0/7-40 6/7 (40 weeks), and 41 0/7-42 2/7 (41-42 weeks) (none delivered after 42 2/7). The coprimary outcomes were cesarean delivery and a perinatal composite (death, respiratory support, 5-minute Apgar score 3 or less, hypoxic ischemic encephalopathy, seizure, sepsis, meconium aspiration syndrome, birth trauma, intracranial or subgaleal hemorrhage, or hypotension requiring vasopressor support). Other outcomes included a maternal composite (blood transfusion, surgical intervention for postpartum hemorrhage, or intensive care unit admission), hypertensive disorders of pregnancy, peripartum infection, and neonatal intermediate or intensive care unit admission. For multivariable analysis, P<.0125 was considered to indicate statistical significance for the coprimary outcomes.
RESULTS
Of 2,502 participants who underwent expectant management, 964 (38.5%) delivered at 39 weeks of gestation, 1,111 (44.4%) at 40 weeks, and 427 (17.1%) at 41-42 weeks. The prevalence of medically indicated delivery was 37.9% overall and increased from 23.8% at 39 weeks of gestation to 80.3% at 41-42 weeks. The frequency of cesarean delivery (17.3%, 22.0%, 37.5%; P<.001) and the perinatal composite (5.1%, 5.9%, 8.2%; P=.03) increased with 39, 40, and 41-42 weeks of gestation, respectively, and hypertensive disorders of pregnancy decreased (16.4%, 12.1%, 10.8%, P=.001). The adjusted relative risk, 95% CI (39 weeks as referent) was significant for cesarean delivery at 41-42 weeks of gestation (1.93, 1.61-2.32) and for hypertensive disorders of pregnancy at 40 weeks (0.71, 0.58-0.88) and 41-42 weeks (0.61, 0.45-0.82). None of the other outcomes were significant.
CONCLUSION
In expectantly managed low-risk nulliparous participants, the frequency of medically indicated induction of labor, and the risks of cesarean delivery but not the perinatal composite outcome, increased significantly from 39 to 42 weeks of gestation.
Topics: Cesarean Section; Female; Humans; Labor, Induced; Parity; Pregnancy; Watchful Waiting
PubMed: 33416294
DOI: 10.1097/AOG.0000000000004230 -
Journal of Vascular Surgery Apr 2016
Topics: Aneurysm; Aneurysm, Ruptured; Arteries; Digestive System; Female; Humans; Male; Vascular Surgical Procedures; Watchful Waiting
PubMed: 26792543
DOI: 10.1016/j.jvs.2015.10.069 -
The Journal of Urology Apr 2022The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease...
PURPOSE
The underlying premise of prostate cancer active surveillance (AS) is that cancers likely to metastasize will be recognized and eliminated before cancer-related disease can ensue. Our study was designed to determine the prostate cancer upgrading rate when biopsy guided by magnetic resonance imaging (MRGBx) is used before entry and during AS.
MATERIALS AND METHODS
The cohort included 519 men with low- or intermediate-risk prostate cancer who enrolled in prospective studies (NCT00949819 and NCT00102544) between February 2008 and February 2020. Subjects were preliminarily diagnosed with Gleason Grade Group (GG) 1 cancer; AS began when subsequent MRGBx confirmed GG1 or GG2. Participants underwent confirmatory MRGBx (targeted and systematic) followed by surveillance MRGBx approximately every 12 to 24 months. The primary outcome was tumor upgrading to ≥GG3.
RESULTS
Upgrading to ≥GG3 was found in 92 men after a median followup of 4.8 years (IQR 3.1-6.5) after confirmatory MRGBx. Upgrade-free probability after 5 years was 0.85 (95% CI 0.81-0.88). Cancer detected in a magnetic resonance imaging lesion at confirmatory MRGBx increased risk of subsequent upgrading during AS (HR 2.8; 95% CI 1.3-6.0), as did presence of GG2 (HR 2.9; 95% CI 1.1-8.2) In men who upgraded ≥GG3 during AS, upgrading was detected by targeted cores only in 27%, systematic cores only in 25% and both in 47%. In 63 men undergoing prostatectomy, upgrading from MRGBx was found in only 5 (8%).
CONCLUSIONS
When AS begins and follows with MRGBx (targeted and systematic), upgrading rate (≥GG3) is greater when tumor is initially present within a magnetic resonance imaging lesion or when pathology is GG2 than when these features are absent.
Topics: Aged; Follow-Up Studies; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Risk Factors; Watchful Waiting
PubMed: 34854746
DOI: 10.1097/JU.0000000000002343 -
Health Expectations : An International... Oct 2019Men diagnosed with low-risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making...
OBJECTIVES
Men diagnosed with low-risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active intervention. Our study examined how risk for prostate cancer is perceived and experienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care.
METHOD
Participants were nine patients and three clinicians from a university hospital urology clinic. A staged, qualitative, multi-method data collection approach was undertaken, comprising: observations of consultations; patient and clinician interviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views.
RESULTS
Thirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of "Making sense of risk", "Talking about risk" and "Responding to risk".
CONCLUSION
Effective risk communication needs to be finely tuned and timed to individual patient's priorities and information requirements. A structured information exchange process that identifies patients' priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient-centric risk assessment procedures and service delivery models in prostate cancer care more broadly.
Topics: Aged; Humans; Interviews as Topic; Male; Middle Aged; Prostatic Neoplasms; Qualitative Research; Risk Assessment; Surveys and Questionnaires; Watchful Waiting
PubMed: 31095822
DOI: 10.1111/hex.12912 -
BioMed Research International 2016Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies,... (Review)
Review
Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies, clinicians tend to miss the diagnoses of AF and especially paroxysmal AF due mainly to its asymptomatic presentation and the rather limited duration dedicated for monitoring for AF after a stroke, which is 24 hours as per the current recommended guidelines. Hence, determining the optimal duration of monitoring for paroxysmal atrial fibrillation after acute ischemic stroke remains a matter of debate. Multiple trials were published in regard to this matter using both invasive and noninvasive monitoring strategies for different monitoring periods. The data provided by these trials showcase strong evidence suggesting a longer monitoring strategy beyond 24 hours is associated with higher detection rates of AF, with the higher percentage of patients detected consequently receiving proper secondary stroke prevention with anticoagulation and thus justifying the cost-effectiveness of such measures. Overall, we thus conclude that increasing the monitoring duration for AF after a cryptogenic stroke to at least 72 hours will indeed enhance the detection rates, but the cost-effectiveness of this monitoring strategy compared to longer monitoring durations is yet to be established.
Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Critical Care; Diagnosis, Differential; Electrocardiography, Ambulatory; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Stroke; Watchful Waiting
PubMed: 27314027
DOI: 10.1155/2016/5704963 -
Journal of Physiotherapy Jun 2014In people with neck pain, does Mechanical Diagnosis and Therapy (MDT) reduce pain and disability more than 'wait and see'? Does MDT reduce pain and disability more than... (Comparative Study)
Comparative Study Meta-Analysis Review
QUESTIONS
In people with neck pain, does Mechanical Diagnosis and Therapy (MDT) reduce pain and disability more than 'wait and see'? Does MDT reduce pain and disability more than other interventions? Are any differences in effect clinically important?
DESIGN
Systematic review of randomised trials with meta-analysis.
PARTICIPANTS
People with neck pain.
INTERVENTION
MDT.
OUTCOME MEASURES
Pain intensity and disability due to neck pain in the short (< 3 months), intermediate (< 1 year) and long term (≥ 1 year).
RESULTS
Five trials were included. Most comparisons demonstrated mean differences in effect that favoured MDT over wait-and-see controls or other interventions, although most were statistically non-significant. For pain, all comparisons had a 95% confidence interval (CI) with lower limits that were less than 20 on a scale of 0 to 100, which suggests that the difference may not be clinically important. For disability, even the upper limits of the 95% CI were below this threshold, confirming that the differences are not clinically important. In all of the trials, some or all of the treating therapists did not have the highest level of MDT training.
CONCLUSION
The additional benefit of MDT compared with the wait-and-see approach or other therapeutic approaches may not be clinically important in terms of pain intensity and is not clinically important in terms of disability. However, these estimates of the effect of MDT may reflect suboptimal training of the treating therapists. Further research could improve the precision of the estimates and assess whether the extent of training in MDT influences its effect.
Topics: Adult; Disability Evaluation; Exercise Therapy; Female; Humans; Male; Middle Aged; Neck Pain; Patient Education as Topic; Physical Therapists; Posture; Range of Motion, Articular; Severity of Illness Index; Treatment Outcome; Watchful Waiting
PubMed: 24952834
DOI: 10.1016/j.jphys.2014.05.006