scholarly journals 607 A Close Loop Audit on Proper Documentation of Ventriculo-Peritoneal (VP) Shunt Valve Settings in Operation Note

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Porag
Keyword(s):  
Sample Size ◽  
Medical Centre ◽  
Shunt Surgery ◽  
Shunt Valve ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Number Of Patients ◽  
Audit Result ◽  
Operation Note ◽  
Operative Notes

Abstract Aim Re-audit the practice of proper documentation of shunt type and settings in VP shunt surgery in Queen's Medical Centre, Nottingham for the period of 1st November 2019 – 31st October 2020. It is very important as programmable shunt setting could get changed during MRI, causing shunt failure. Method It was a retrospective collection of data of patients admitted to Queens medical Centre, Nottingham who had undergone VP shunt procedure. Exceptions: 4 files were excluded from study as they did not undergo VP shunt procedure. Results Total number of patients: 98. 4 patients were excluded. Actual sample size 94. Total VP shunt procedure done: 107. In 96 out of 107 procedures the shunt valve type and settings were properly documented. In 11 out of 107 procedures the shunt valve type and settings were not documented. In 33 out of 107 procedures programmable shunt valves were used. All 33 procedures had proper documentations. Previous audit result Duration of data collection: 2 years (from March 2016 to February 2018). Sample size 200. Total VP shunts done 247. Proper documentation of shunt valve type and settings were done in 209 out of 247 procedures. In 38 out of 247 procedures shunt valve type and settings were not documented. In 55 out of 247 procedures programmable shunt valves were used. 3 out of these 55 procedures (programmable shunt valves) lacked proper documentation. Conclusions There is an overall improvement in the practice of documentation of VP shunt valve type and settings in operative notes after implementing the plan of actions decided on first audit.

scholarly journals Unusual Gross Pneumocephalus and Pneumoperitoneum after VP Shunt Surgery: A Case Report

2015 ◽  
Vol 4 (2) ◽  
Author(s):  
A Khanolkar ◽  
YK Sarin
Keyword(s):  
Case Report ◽  
Unusual Case ◽  
Shunt Surgery ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Surgical Emphysema

We report an unusual case where a two-month infant developed a simultaneous and spontaneous pneumocephalus and gross pneumoperitoneum along with progressive surgical emphysema after VP shunt procedure.

scholarly journals Burr hole site acute extradural hematoma after ventriculoperitoneal shunt surgery: a rare case report and its pathogenesis

2017 ◽  
Vol 31 (3) ◽  
pp. 422-425
Author(s):  
Prajapati Hanuman Prasad ◽  
Singh Deepak Kumar ◽  
Singh Rakesh Kumar ◽  
Ahmed Faran ◽  
Chhabra Anuj
Keyword(s):  
Case Report ◽  
Ventriculoperitoneal Shunt ◽  
Rare Case ◽  
Burr Hole ◽  
Shunt Surgery ◽  
Extradural Hematoma ◽  
Neurosurgical Procedure ◽  
Vp Shunt ◽  
Shunt Procedure ◽  
Rare Case Report

Abstract Ventriculoperitoneal (VP) shunt, a common neurosurgical procedure, has a long list of known complications associated with it. A rare but dangerous complication of VP shunt procedure is extradural hematoma (EDH). It can be diagnosed and managed easily before it turns into a catastrophic complication.

The most frequently asked question to a statistician: The sample size

2017 ◽  
Vol 23 (5) ◽  
pp. 644-646 ◽  
Author(s):  
Maria Pia Sormani
Keyword(s):  
Clinical Study ◽  
Sample Size ◽  
Study Design ◽  
Treatment Effect ◽  
Sample Size Calculation ◽  
Ethical Implications ◽  
Number Of Patients ◽  
Reducing Costs ◽  
Correct Size

The calculation of the sample size needed for a clinical study is the challenge most frequently put to statisticians, and it is one of the most relevant issues in the study design. The correct size of the study sample optimizes the number of patients needed to get the result, that is, to detect the minimum treatment effect that is clinically relevant. Minimizing the sample size of a study has the advantage of reducing costs, enhancing feasibility, and also has ethical implications. In this brief report, I will explore the main concepts on which the sample size calculation is based.

scholarly journals A study on Complications of ventriculoperitoneal shunt surgery in Bir Hospital, Kathmandu, Nepal

2012 ◽  
Vol 1 (2) ◽  
pp. 119-122 ◽  
Author(s):  
BG Karmacharya ◽  
P Kumar
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Shunt Infection ◽  
Shunt Surgery ◽  
Inclusion Criteria ◽  
Medical Sciences ◽  
Referral Centre ◽  
Neurosurgical Procedure ◽  
Ventriculoperitoneal Shunts ◽  
Shunt Procedure ◽  
A Prospective Study

Background: Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. However this procedure is dreaded because of complications. There is lack of prospective studies on complications of shunt procedure. In this study, the indications for shunt, the types used and complications of ventriculoperitoneal shunts were studied. Methods: This was a prospective study carried out in the national neurosurgical referral centre, Bir hospital, Kathmandu from April 2004 to March 2005. Results: There were 109 ventriculoperitoneal shunt procedures during the study period. Among them 60 consecutive patients who fulfilled the inclusion criteria were enrolled for the study. There were 43 male and 17 female patients, with age ranging from 4 months to 75 years. Fourteen patients (23.3%) developed complications which included shunt block, shunt infection, over drainage and shunt extrusion. Conclusion: About one fourth all patients who underwent ventriculoperitoneal shunt surgery developed complications. Shunt block and infections were the major complications. DOI: http://dx.doi.org/10.3126/njms.v1i2.6612 Nepal Journal of Medical Sciences. 2012;1(2): 119-22

scholarly journals Brain Studded with Innumerable Larger Stones: Starry Sky at Night Appearance: Multiple Calcified Giant Tuberculoma with 15 Years of Follow-up

2017 ◽  
Vol 06 (02) ◽  
pp. 155-158
Author(s):  
Guru Satyarthee ◽  
P. Chandra ◽  
A. Mahapatra
Keyword(s):  
Central Nervous System Involvement ◽  
Definitive Diagnosis ◽  
Shunt Surgery ◽  
Unique Case ◽  
Major Health Problem ◽  
Major Health ◽  
Vp Shunt ◽  
Cranial Ct ◽  
Rising Incidence

AbstractTuberculosis is rapidly reemerging as a major health problem due to rising incidence of HIV cases across the globe. Central nervous system involvement is rare, but rarely multiple intracerebral granulomas can occur or occasional solitary tuberculoma also develops. The authors report a unique case of 24-year-old woman suffering from pulmonary tuberculosis developed headache and vomiting. Cranial CT scan revealed multiple widespread deposit of intracranial granuloma of sizeable lesion mimicking starry sky at night appearance. Excision of one tuberculoma was done for confirmation of definitive diagnosis, and histopathology was suggestive of tuberculoma. The patient also underwent VP shunt surgery. At last follow-up at 15 years following surgery, she was doing well.

Abstract 16: Early Use of Aspirin is Critical for Improving Outcomes Following Systemic to Pulmonary Artery Shunting

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Sayna Norouzi ◽  
Giv Heidari Bateni ◽  
Matthew Hall ◽  
Pirooz Eghtesady
Keyword(s):  
Mortality Rate ◽  
Pulmonary Artery ◽  
Congenital Heart ◽  
Critical Role ◽  
Health Information System ◽  
Perioperative Period ◽  
Shunt Revision ◽  
Shunt Surgery ◽  
Shunt Procedure ◽  
Artificial Graft

Objective: Systemic to pulmonary artery shunting (BT) is a common palliative procedure used in children with congenital heart disease. Despite the relatively simple nature of the procedure, the BT shunt procedure is associated with significant morbidity and mortality that is believed to be related perhaps to thrombosis of the artificial graft. The optimal postoperative anticoagulation regimen for this procedure is unknown. We compared the effectiveness of various anticoagulation regimens in patients undergoing BT shunt procedure, evaluating in particular the time of aspirin (ASA) initiation on BT shunt outcomes. Methods: The Pediatric Health Information System database (PHIS) was retrospectively queried (2000-2011) to identify patients (<30 days old) who underwent isolated BT shunts procedures. Postoperative anticoagulation regimens were categorized into: Heparin only, ASA and Heparin and ASA only regimens. The primary end point was mortality; secondary endpoints included the need for shunt revision, catheter-based investigation or intervention post procedure. The effect of aspirin supplementation on heparin regimen on the day of surgery and the day after was evaluated using GEE logistic regression to account for hospital clustering. All confounding factors were adjusted between groups. Cox proportional hazard analysis was performed in order to compare anticoagulation regimens after BT shunt surgery. Results: A total of 1746 patients were identified. Survival analysis revealed that ASA plus heparin is the best anticoagulation regimen after BT shunt surgery (p =0.001). Patients who survived to discharged, started ASA earlier than those died during hospitalization (mean day of start of 3.7±0.2 vs. 14.6±6.3 with interquartile range of 3 vs. 11 respectively, p= 0.001). Based on GEE modeling, administration of aspirin even on day one significantly decreased mortality rate (adjusted OR=0.21, CI 95%=0.04-0.97, p =0.04 compared to heparin only group). Conclusion: Our results demonstrate a critical role for ASA in lowering rates of mortality and complications in the immediate perioperative period after BT shunt surgery. Administration of ASA as early as first postoperative day can reduce the mortality rate for this common congenital heart procedure.

scholarly journals Design and analysis of a clinical trial using previous trials as historical control

2019 ◽  
Vol 16 (5) ◽  
pp. 531-538 ◽  
Author(s):  
David Alan Schoenfeld ◽  
Dianne M Finkelstein ◽  
Eric Macklin ◽  
Neta Zach ◽  
David L Ennist ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Amyotrophic Lateral Sclerosis ◽  
Sample Size ◽  
Standard Error ◽  
Controlled Trial ◽  
Sample Size Calculation ◽  
Control Group ◽  
Controlled Trials ◽  
Number Of Patients ◽  
Lateral Sclerosis

Background/AimsFor single arm trials, a treatment is evaluated by comparing an outcome estimate to historically reported outcome estimates. Such a historically controlled trial is often analyzed as if the estimates from previous trials were known without variation and there is no trial-to-trial variation in their estimands. We develop a test of treatment efficacy and sample size calculation for historically controlled trials that considers these sources of variation.MethodsWe fit a Bayesian hierarchical model, providing a sample from the posterior predictive distribution of the outcome estimand of a new trial, which, along with the standard error of the estimate, can be used to calculate the probability that the estimate exceeds a threshold. We then calculate criteria for statistical significance as a function of the standard error of the new trial and calculate sample size as a function of difference to be detected. We apply these methods to clinical trials for amyotrophic lateral sclerosis using data from the placebo groups of 16 trials.ResultsWe find that when attempting to detect the small to moderate effect sizes usually assumed in amyotrophic lateral sclerosis clinical trials, historically controlled trials would require a greater total number of patients than concurrently controlled trials, and only when an effect size is extraordinarily large is a historically controlled trial a reasonable alternative. We also show that utilizing patient level data for the prognostic covariates can reduce the sample size required for a historically controlled trial.ConclusionThis article quantifies when historically controlled trials would not provide any sample size advantage, despite dispensing with a control group.

scholarly journals Seasonal variations in the occurrence of acute appendicitis and their relationship with the presence of fecaliths in children

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yao-Jen Hsu ◽  
Yu-Wei Fu ◽  
Taiwai Chin
Keyword(s):  
Acute Appendicitis ◽  
Medical Records ◽  
Laboratory Data ◽  
Lymphoid Hyperplasia ◽  
Clinical Findings ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
Pathology Reports ◽  
Operative Notes ◽  
Surgical Condition

Abstract Background Acute appendicitis (AA) is the most common surgical condition in children. Although a higher incidence of AA in summer has been reported, the reason for this observation remains unclear. The purpose of this study was to compare the clinical findings of AA patients who underwent appendectomies during the summer months with those who underwent the procedure during the non-summer months. Methods The clinical data of 171 patients who underwent appendectomy from January 2013 to December 2016 were reviewed. The patients were divided into a summer group (from May to October) and a non-summer group (from November to April) based on the month when appendectomy was performed. All patients were under 18 years of age at the time of surgery. The medical records including laboratory data, computed tomography scans, pathology reports and operative notes were reviewed. Results The number of patients with AA was higher in the summer group than in the non-summer group (101 vs. 70 patients). No significant differences in the laboratory results between the two groups of patients were observed. The percentage of AA patients who presented with a fecalith was significantly lower in the summer group (33.6%) than in the non-summer group (55.7%). No significant differences in the incidence of appendiceal perforations and abscesses, as well as postoperative complications were observed between the two groups. Conclusions The percentage of AA patients with fecaliths in summer was lower than that in the non-summer months. The increase in the number of AA patients in summer may be due to the increased occurrence of lymphoid hyperplasia, which may be correlated with the yearly outbreak of enterovirus infection during this period.

scholarly journals Programmable shunt valve interactions with osseointegrated hearing devices

2017 ◽  
Vol 19 (4) ◽  
pp. 384-390
Author(s):  
Matthew J. Pierson ◽  
Daniel Wehrmann ◽  
J. Andrew Albers ◽  
Najib E. El Tecle ◽  
Dary Costa ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Field Strength ◽  
Magnetic Field Strength ◽  
Shunt Valve ◽  
Vp Shunt ◽  
Magnetic Attachment ◽  
Hearing Devices ◽  
Programmable Valves ◽  
The Magnetic Field ◽  
Field Strengths

OBJECTIVE Patients with ventriculoperitoneal (VP) shunts with programmable valves who would benefit from osseointegrated hearing devices (OIHDs) represent a unique population. The aim of this study was to evaluate the magnetic field strengths of 4 OIHDs and their interactions with 5 programmable VP shunt valves. METHODS Magnetic field strength was measured as a function of distance for each hearing device (Cochlear Baha 5, Cochlear Baha BP110, Oticon Ponto Plus Power, and Medtronic Sophono) in the following modes: inactive, active in quiet, and active in 60 decibels of background noise in the sound booth. The hearing devices were introduced to each shunt valve (Aesculap proGAV, Aesculap proGAV 2.0, Codman Hakim, Codman Certas, and Medtronic Strata II) also as a function of distance in these identical 3 settings. Each trial was repeated 5 times. Between each trial, the valves were assessed for a change in setting. Finally, using a skull model, the devices were introduced to each other in standard anatomical locations and the valves were assessed for a change in settings. RESULTS The maximum magnetic field strengths generated by the Cochlear Baha 5, BP110, and Oticon OIHDs were 1.1, 36.2, and 48.7 gauss (G), respectively. The maximum strength generated by the Sophono device was > 800 G. The magnetic field strength of the hearing devices decreased markedly with increasing distance from the device. The strength of the Sophono's magnetic attachment decreased to 34.8 G at 5 mm. The Codman Hakim, Codman Certas, and Medtronic Strata II valve settings changed when rotating the valves next to the Sophono abutment. No other changes in valve settings occurred in the distance or anatomical models for any other trials. CONCLUSIONS This is the first study evaluating the interaction between OIHDs and programmable VP shunt valves. The findings suggest that it is safe to use these devices together without having to switch to a nonprogrammable valve or move the shunt valve to a more distant location. Still, care should be taken if the Sophono device is used to ensure that the valve is ≥ 5 mm away from the magnetic attachment.

scholarly journals Wandering Distal End of Ventriculo-Peritoneal Shunt: Our Experience with Five Cases and Review of Literature

2013 ◽  
Vol 32 (3) ◽  
pp. 266-269 ◽  
Author(s):  
Vijay Kumar Kundal ◽  
Mufique Gajdhar ◽  
Chetan Sharma ◽  
Deepak Agrawal ◽  
Raksha Kundal
Keyword(s):  
Inguinal Hernia ◽  
The Other ◽  
Unusual Complication ◽  
Shunt Surgery ◽  
Review Of Literature ◽  
Hernia Sac ◽  
Vp Shunt ◽  
The Past ◽  
Shunt Removal ◽  
Ventriculo Peritoneal Shunt

Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6935 J. Nepal Paediatr. SocVol.32(3) 2012 266-269

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