Add-on Plastic Tips for Cryogen Administration in Difficult-to-access Areas
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ABSTRACT:
SUBMITTER: Jayasree P
PROVIDER: S-EPMC9764957 | biostudies-literature | 2022 Jan
REPOSITORIES: biostudies-literature
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Project description:IntroductionPlastic surgery is an essential yet underdeveloped field in many African nations, especially in rural areas. The demand for plastic surgery is increasing, but differences in access to respective services between rural and urban domiciles remain ever existent, despite the exponentiation of trauma, burns, and congenital disorders. According to this review, urban areas have access to better facilities and specialized surgeons, while rural areas frequently lack infrastructure, educated healthcare personnel, and medical resources. This review compares the quality and accessibility of plastic surgery services in African rural and urban settings in order to determine the variables influencing said differences in access.MethodsThis literature review was performed using electronic search databases comprising PubMed/MEDLINE, Google Scholar, and Africa Journals online (AJOL). Regional medical journals were also reviewed using keywords and associated Boolean operators pertaining to "plastic surgery", "plastic surgery in rural" and plastic surgery in urban" by selecting studies based on their relevance and content quality. Studies focusing on plastic surgery in Africa were included. A total of 37 articles were analyzed to provide insights into the disparities between rural and urban access to plastic surgery services in Africa. Studies not focusing on plastic surgery were excluded.ResultsThe review highlighted significant disparities in access to plastic surgery services between Africa's rural and urban areas. Rural areas usually lack medical resources, specialized surgeons, infrastructure, while urban areas have access to better facilities and specialized surgeons. Urban regions not only hail more training opportunities for surgeons but also foster further specialized facilities, greater training options, access to modern surgical equipment, sterile facilities and advanced instruments, contributing to clinical and surgical excellence alongside patient satisfaction and outcomes. However, there is a scarcity of qualified plastic surgeons in rural regions, including antiquated technology and a dearth of resources and expertise. Besides, socioeconomic variables that hinder said indifference between rural and urban areas, such as poverty, education, money, and cultural attitudes, precipitated limited access to critical surgical intervention in rural populations.ConclusionFurther research should be done on how plastic surgery services differ in urban and rural areas. Availability of financial expertise and specialists who can provide specialized care in rural settings is recommended. To enhance patient outcomes, the implementation of technological innovation, improved healthcare infrastructure, and effective training initiatives should be implemented in rural Africa. Also, in the field of plastic surgery, emphasizing the use of telemedicine and mobile surgical units may aid universal healthcare for residents in rural domiciles. Significant progress towards ensuring equitable access to high-quality plastic surgery in rural Africa may be achieved through these initiatives.
| S-EPMC11670430 | biostudies-literature
Project description:Background and aimsBiliary cannulation, although critical to procedural success in ERCP, can be difficult and, if unsuccessful, can lead to longer hospital stays, repeat procedures, and increased costs. Expertise in adjunct techniques, including access fistulotomy, can increase success rates and potentially avoid these issues. The aim of this case series is to describe the technique of access fistulotomy and illustrate key points that are important for successful biliary access.MethodsThree cases are reviewed in which access fistulotomy was used to achieve biliary access. The steps for the procedure are reviewed, and key technical tips and anatomic landmarks are illustrated in the video.ResultsSuccessful biliary access is obtained using fistulotomy in 3 cases. In each case, the anatomic landmarks of the papilla and intraduodenal biliary segment are reviewed. The first case illustrates a large papilla in which initial incision followed by careful exposure reveals a clear "onion ring" structure corresponding to the bile duct. The second case requires stepwise incision, each guided by anatomic landmarks before the biliary adventitia is identified, leading to biliary cannulation. In the third case, the utility of fistulotomy in a duodenal diverticulum is illustrated. Recognition of the distorted anatomy allowed precise, careful incision leading to biliary access.ConclusionsAccess fistulotomy is an invaluable technique to aid in biliary access. Knowledge of key landmarks and careful evaluation of the incision are critical to successful biliary access when performing fistulotomy.
| S-EPMC7806498 | biostudies-literature
Project description:Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory. Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients. Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R). Results: Forty-five (30 male, 15 female) cases, 18-69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone (N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was -3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = -0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70-0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58-0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg. Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect.
| S-EPMC8415882 | biostudies-literature
Project description:In thoracic surgery, extracorporeal life support (ECLS) techniques are performed to (I) provide a short to mid term extracorporeal mechanical support; (II) realize the gas exchanges; and (III)-depending the configuration of the circuit-substitute the failed heart function. The objective of this review is to describe the rational of the different ECLS techniques used in thoracic surgery and lung transplantation (LTx) with a specific attention to the vascular access. Venovenous extracorporeal membrane oxygenation (VV ECMO) is the most common ECLS technique used in thoracic surgery and represents the best strategy to support the lung function. VV ECMO needs peripheral vascular access. The selection between his double-site or single-site configuration should be decided according the level of O2 requirements, the nosological context, and the interest to perform an ECLS ambulatory strategy. Venoarterial (VA) ECMO uses peripheral and/or central cannulation sites. Central VA ECMO is mainly used in LTx instead a conventional cardiopulmonary bypass (CPB) to decrease the risk of hemorrhagic issues and the rate of primary graft dysfunction (PGD). Peripheral VA ECMO is traditionally realized in a femoro-femoral configuration. Femoro-femoral VA ECMO allows a cardiocirculatory support but does not provide an appropriate oxygenation of the brain and the heart. The isolated hypercapnic failure is currently supported by extracorporeal CO2 removal (ECCO2R) devices inserted in jugular or subclavian veins. The interest of the Novalung (Novalung GmbH, Hechingen, Germany) persists due to his central configuration indicated to bridge to LTx patients suffering from pulmonary hypertension. The increasing panel of ECLS technologies available in thoracic surgery is the results of a century of clinical practices, engineering progress, and improvements of physiological knowledges. The selection of the ECLS technique-and therefore the vascular access to implant the device-for a given nosological context trends to be defined according an evidence-based medicine.
| S-EPMC4856850 | biostudies-other
Project description:Intranasal esketamine for treatment-resistant depression has been introduced and approved by the FDA and EMA in 2019 and 2020, respectively. Since then, the administration practices were found different among countries. Major depression has a high impact on many humans lives worldwide and more than a third of treated people are not responding after several treatment attempts. Additional administration with esketamine closed this gap for more than the half of these non-responders. Guidelines for the treatment of major depression recommend starting with add-on esketamine after 2-4 serious attempts of treatment with standard antidepressants (SSRI/SNRI) irrespective of augmentation with others, e.g., second generation antipsychotics or lithium. Thus, intranasal esketamine became an important role in the evidence-based treatment of major depression. The authors review and critically evaluated published articles focusing on preparation, management and observation of intranasal esketamine treatment. There exists a clear recommendation for administrating intranasal esketamine in a medical environment, not limited to a clinical setting for selecting the dose, monitoring the improvements and managing adverse events. The administration of intranasal esketamine is considered as safe during the application itself and long-lasting or severe adverse events during long-term treatment are very rare. Since this is a new approach for treatment application psychiatrists face new different but not difficult treatment procedures compared to prescribing only a medication.
| S-EPMC10701548 | biostudies-literature
Project description:Vein line positioning represents one of the first diagnostic and therapeutic steps in Pediatric Emergency Department (PED); however, the outcome of this maneuver is frequently not as expected, especially for difficult-to-access (DIVA) patients. The standard technique (visual-palpatory) has a low success rate; hence ultrasound (US) assistance has been suggested for DIVA patients, although controversial results have been obtained. Our study compared the success rate of an intravascular (IV) access procedure at the first attempt, with and without ultrasound assistance, in pediatric DIVA patients. Secondary objectives were the global success rate, the mean procedural time, the IV device's life span, and the complications rate. We conducted an observational, prospective, monocentric, no-profit cohort study enrolling 110 patients presenting to our ED, aged 0-21 years. All the patients were considered difficult-to-access patients according to the DIVA score (≥4) or history of previous difficult intravascular access. They were randomized into two homogeneous groups: 50 patients with the standard and 60 with the US-assisted technique. We obtained a significantly higher success rate at first attempt with the US-guided technique (90% vs 18%, p ≤ .00001). Moreover, the overall success rate was higher in the US group (95% vs 46%, p < .00001). The mean procedural time resulted significantly less in the US group (2.7 ± 2.2 min vs 10 ± 6.4 min, p < .0001), as well as the overall number of attempts to obtain a stable IV line (1.09 ± 0.34 attempts vs 2.38 ± 1.09 attempts, p < .0001). We experienced some post-procedural complications without differences in the two groups, although none were severe. Our study showed that bedside ultrasound assisting implantation of peripheral venous access in pediatric DIVA patients improves first-time success rate, overall success rate, procedural time, and patient comfort, reducing the number of attempts to obtain a stable IV line.
| S-EPMC10845837 | biostudies-literature
Project description:As mitigating car traffic in cities has become paramount to abate climate change effects, fostering public transport in cities appears ever-more appealing. A key ingredient in that purpose is easy access to mass rapid transit (MRT) systems. So far, we have however few empirical estimates of the coverage of MRT in urban areas, computed as the share of people living in MRT catchment areas, say for instance within walking distance. In this work, we clarify a universal definition of such a metrics - People Near Transit (PNT) - and present measures of this quantity for 85 urban areas in OECD countries - the largest dataset of such a quantity so far. By suggesting a standardized protocol, we make our dataset sound and expandable to other countries and cities in the world, which grounds our work into solid basis for multiple reuses in transport, environmental or economic studies.
| S-EPMC7479604 | biostudies-literature
Project description:Metagenomic analysis of the gut microbiome of advanced liver disease patients
| PRJEB76665 | ENA
Project description:IntroductionPsoriasis is a common chronic, immune-mediated, inflammatory skin disease that in certain localization results difficult to treat. Psoriatic lesions in difficult-to-treat areas might be hardly managed as no standardized therapeutic approach and the application of topical treatments might have great limitations. Systemic agents, including biologic therapies, have been proven effective in treating this subgroup of patients. In particular, current evidence has shown beneficial effects with the use of brodalumab, a fully human IgG2 monoclonal antibody antagonizing the IL-17 receptor A subunit (IL-17RA).ObjectivesThe aim of this narrative review was to collect published data about efficacy and safety of brodalumab in the treatment of psoriasis occurring in difficult-to-treat areas.MethodsData on brodalumab effectiveness and safety deriving from both trials and real-world setting that had been published in the last 15 years were collected for this review, together with clinical findings issued during international meetings.ResultsIn phase 3 trials, brodalumab demonstrated to be effective in promoting a rapid response in scalp psoriasis as well as in generalized pustular psoriasis and erythrodermic psoriasis. Nail psoriasis demonstrated marked clinical improvement after treatment with brodalumab. Amelioration of palmoplantar psoriasis was also described in brodalumab-treated patients. Various retrospective real-world studies reported a complete clearance of psoriatic lesions in difficult-to-treat areas, including genitalia, through short-term brodalumab treatment.ConclusionsBrodalumab, combining rapid and sustained efficacy with a favorable safety profile, may be a valid therapeutic option for severe variants of psoriasis as well as for psoriasis localized in difficult-to-treat areas.
| S-EPMC10412049 | biostudies-literature
Project description:Protected area management often depends heavily on law enforcement to secure compliance with rules. However, this can contribute to conflict between protected area authorities and local people, negatively affecting both human well-being and conservation outcomes. Compliance is affected by many factors, including whether those who enforce rules are perceived to do so fairly, as well as the perceived rule-related behavior of others. We used factorial survey experiments to explore how fair respondents living around protected areas in Indonesia and Tanzania perceive sanctions distributed by law enforcers to be. We presented scenarios to respondents to assess how crime type, offender characteristics, and corruption influenced their judgments regarding the fairness of administered sanctions. We also assessed how descriptive norms and corruption influenced individuals' willingness to obey protected area rules. Data were collected from 229 people in Indonesia and 217 in Tanzania. Results showed that in both locations, lawful sanctions, such as arrests or warnings, were perceived as fairer, and sanctions that involved corruption were perceived as least fair. Attitudes toward protected area rules, corruption, and descriptive norms all influenced people's willingness to comply, whereas multidimensional poverty did not. Our results highlight the need for conservation policy and practice to move beyond narratives that focus on the need for more law enforcement. To improve protected area compliance and secure better outcomes for people and nature, conservation must focus on ensuring the fair administration of rules and enhancing the legitimacy of rules themselves.
| S-EPMC7617185 | biostudies-literature