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Patient reported outcomes refer to, “Any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else” (US Food and Drug Administration, 2009) [1]. These outcomes can include anything that matters to patients including quality of life, pain, number of bowel movements. Patient reported outcome measures refer to tools or instruments that help to measure these outcomes. These measures can be done using validated tools, those that have undergone rigorous testing and psychometric validation, and non-validated tools such as may exist in a practice to rate practice or physician/staff care quality. For this paper, we will discuss the role of patient reported outcomes measures in colon and rectal surgery.

Background: Patients often desire restorative reconstruction following total mesorectal excision. Reconstruction has become synonymous with providing high-quality rectal cancer care. However, the bowel functional outcomes of restoration from presentation are unknown. We aimed to evaluate the bowel functional effects of rectal cancer treatment from presentation through surveillance. Methods: This was a retrospective cohort study from 2014 to 2019 using prospectively collected data. Patients underwent treatment for rectal adenocarcinoma including restorative reconstruction. Patients completed the validated Colorectal Functional Outcome questionnaire during clinic visits (1) at presentation, (2) after neoadjuvant therapy, (3) after restoration of continuity, and (4) at surveillance. Scores range from 0 to 100 with a higher score indicating worse bowel function. Results: Sixty-eight patients (age: 62 ± 12 years, 40% female) were included. The mean tumor height was 7 ± 4 cm with 85% symptomatic. Bowel function did not worsen from presentation to after neoadjuvant therapy in Total Colorectal Functional Outcome and most domain scores; there was improvement in frequency and stool-related aspects. Bowel function worsened in all scores from after neoadjuvant to restoration of continuity (mean anastomotic height: 5 ± 2 cm); there were similar findings between presentation and restoration of continuity. At surveillance, there was improvement in most domains compared with restoration of continuity. There remained significant worsening of incontinence, social impact, and need for medication scores at surveillance compared with presentation. Conclusion: Restorative reconstruction after total mesorectal excision is associated with significant bowel dysfunction. For some patients, restorative reconstruction may not be high-quality rectal cancer care.

The vibrations produced in a boring tool in internal turning deteriorate the machined surface quality and reduce the tool life, which results in a massive noise during the machining. Therefore, unwanted vibrations are necessary to be eliminated by improving the boring bar's dynamic stiffness and damping capacity. This paper investigates a passive constrained layer damping (CLD) boring bar with a hybrid damping layer to study the internal turning system's stability. Initially, the dynamic models of the conventional and CLD tools are thoroughly studied using Euler-Bernoulli beam theory (EBT) and validated them with finite element modelling (FEM). The frequency response functions (FRFs) obtained from the impact hammer tests are used to estimate the modal parameters. With modal parameters, the semi-analytical stability lobe diagrams (SLDs) are plotted for the boring system with the conventional and CLD boring bar. Tool-tip responses for various cutting conditions are simulated numerically to validate and to study stability. The cutting experiments with traditional and CLD boring bar are conducted for stability analysis and compared tool-tip responses with numerical results. It is observed that both the numerical and experimental results agree with the selected cutting conditions from SLDs. It is also observed that the CLD boring bar with a hybrid damping layer reduced the vibration displacements by five times compared to the conventional one.

PURPOSE: Stoma reversal sites are a common location for incisional hernias. We aim to evaluate fascial defects at previous stoma sites in patients with a history of colorectal cancer. METHODS: This was a retrospective cohort study from a single center. We included adult patients diagnosed with colorectal cancer, who underwent stoma reversal from 2011 to 2018 with at least one postoperative computed tomography scan. RESULTS: Of 92 patients, 40 (43%) were female, with a mean age of 58 years. Fascial defects were noted in 45 (49%) patients, with stoma-site hernias present in 24 (26%) patients. Posterior sheath defects were not associated with subsequent hernia development, and most hernias occurred within 2 years. Body mass index >30 was associated with increased risk of stoma-site hernia (odds ratio 11.9, P = 0.002), but smoking, hypertension, stoma type, pathologic stage, and chemotherapy within 90 days were not found to be significant. CONCLUSIONS: The incidence of stoma-site hernias is high. Obesity appears to be a significant risk factor for the development of these hernias and most hernias occur quickly following surgery.

Objective:. To evaluate long-term changes to bowel function after elective sigmoidectomy for diverticular disease. Background:. For patients with diverticular disease, choosing surgery is often based on the presumption of improvement in preoperative symptoms. Our group previously reported bowel function does not change in the early perioperative period; however, studies of long-term outcomes are limited. Methods:. This is an observational study of patients that underwent elective sigmoidectomy for diverticular disease and completed the Colorectal Functional Outcome (COREFO) questionnaire before surgery. Patients were stratified into two groups based on presence or absence of a preoperative symptomatic score (i.e., total COREFO ≥ 15). Long-term bowel function (>1 year from surgery) was assessed using the COREFO questionnaire via telephone or subsequent clinic visit. Paired t-tests compared mean preoperative scores to mean long-term scores. Results:. Fifty-one patients met inclusion criteria (21 symptomatic, 30 asymptomatic). All symptomatic patients had uncomplicated disease, whereas 90% of asymptomatic patients had complicated disease. Median time from operation to questionnaire completion was 23 months (IQR = 13–34). Asymptomatic patients demonstrated impaired bowel function, predominantly driven by changes in the social impact domain. Symptomatic patients demonstrated improved bowel function, driven by changes in the incontinence, social impact, stool-related aspects, and need for medication domains. Conclusions:. In the long-term after elective sigmoidectomy for diverticular disease, patients with symptomatic bowel function preoperatively improve substantially, while those with asymptomatic preoperative scores demonstrate statistically significant impairment. Patients determined to be symptomatic with patient-reported outcomes likely benefit long-term from sigmoid resection. Mini-Abstract: In this manuscript, long-term changes to patient-reported bowel function were assessed using a validated questionnaire after sigmoidectomy for diverticular disease. We found that in patients with symptomatic preoperative bowel function, long-term bowel function improved after elective resection. Alternatively, patients with asymptomatic preoperative bowel function demonstrated long-term impairment in bowel function.

Opioids are commonly used for management of pain. The term opioids include compounds that are extracted from the poppy seed as well as semi synthetic and synthetic compounds. Their regular non-medical use, Prolonged use, misuse and the use without medical supervision can lead to opioid dependence and other health related problems. Opiate dependence is the disorder of regulation of opioid use arising from repeated or continuous use of opioids. In worldwide, about 275 million people or {5.5 percentage of global population aged 15 to 64 yrs.} Used drugs At least once in 2019. Among them about 62 million people used opioids. Opioid use can lead to death due to effects of opioids on the part of the brain which regulates breathing. The number of opioid overdoses has increased in recent years in several countries in part due to the increased use of opioids in the management of chronic pain. Males, People of older age and people with low social economic status are at higher risk of opioid overdose than women. In this article we highlighted about various types of opioids, how it causes effects and symptoms for acute poisoning and chronic poisoning and suggested some of the safety measures and treatment guidelines regarding the opioid overdose condition. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of this study was to determine and compare the voluntary acceptance of two oral liquid formulations of ciclosporin, investigational Atopica® oral solution (Elanco Animal Health) and Cyclavance® Oral Solution (Virbac), when given orally via syringe or offered freely after mixing with food to dogs. Twenty-five adult mixed breed dogs were selected for this two-phase study. In Phase 1, 12 (Group I) and 13 (Group II) dogs received Atopica® oral solution and Cyclavance® Oral Solution, respectively, daily for 7 days via an oral syringe. After a 3-day washout period, the dosing was switched for a further 7 days. For Phase 2, dosing was by acceptance from freely offered test article mixed in a small amount of food, approximately 6 h after the routine morning feeding. During the first part of this phase, normal daily ration of food offered in the morning was continuously left in the cage. Group I was offered Atopica® oral solution and Group II was offered Cyclavance® Oral Solution mixed with ~ 25 g of food for 3 days. After another 2-day washout period, the test articles were switched for another 3 days but the animals received food for only 1 h in the morning. Five hours after the food was removed, the test articles with food were offered in the same manner as in the first part of Phase 2. Animals were also monitored for adverse events (AEs). Results During Phase I, voluntary acceptance rates of 100 and 98.9% were noted for Atopica® oral solution and Cyclavance® Oral Solution, respectively. The corresponding immediate prehension rates during Phase 2 (Period 1) were 61.1 and 56.4%, respectively. During Phase 2 (Period 2), the immediate prehension rates were 69.2, 69.4 and 92.0% for Atopica® oral solution, Cyclavance® Oral Solution and the positive control (DYNE®; High Calorie Liquid Dietary Supplement), respectively. Two adverse events of diarrhea and vomiting, with a probable relationship to the test articles, were reported. Conclusion There was no significant difference in acceptance of the two oral ciclosporin solutions, the investigational Atopica® oral solution (Elanco) and Cyclavance® (Virbac) for dogs.

A quality metric for centers performing rectal cancer surgery is a high percentage of sphincter sparing procedures. These procedures often involve temporary bowel diversion to minimize the complications of an anastomotic leak. The most common strategy is a diverting loop ileostomy which is then closed after completion of adjuvant therapy or the patient recovers from surgery. Loop ileostomy is not without complications and the closure is complicated by a one in three chance of incisional hernia development. Strategies to prevent this problem have been designed using a variety of techniques with and without mesh placement. This proposed pilot study will test the safety and efficacy of a novel stoma closure technique involving permanent mesh in the retro rectus position during ileostomy closure. The study will prospectively follow 20 patients undergoing ileostomy closure using this technique and evaluate for safety of the procedure, quality of life, and feasibility for a larger randomized controlled trial. Patients will be followed post procedurally and evaluated for 30-day complications, as well as followed up with routine cancer surveillance computed tomography every 6 months in which the presence of stoma site incisional hernias will be evaluated. The results of this pilot study will inform the design of a multiple center, blinded randomized controlled trial to evaluate the utility of permanent mesh placement to decrease the incidence of prior stoma site incisional hernias.

Introduction: Chronic kidney disease (CKD) is confirmed chronic abnormalities of kidney structure or function, present for > 3 months with implications for health (albuminuria or proteinuria). With increasing prevalence and risk factors, there is progressive loss of kidney function, cardiovascular morbidity and premature mortality, decreased quality of life. In a CKD patient, the problems of malnutrition also encompass the economic status and pattern of diet, in addition to that imposed by the disease per se. Sub optimal nutritional intake is common among the population of CKD and ESRD posing a direct risk for protein malnutrition. Objectives: To study the socio-demographic profile, the co-morbid conditions and assess the nutrition status of CKD patients undergoing hemodialysis. Methods: A total of 105 patients participated in the study. A pre-tested semi-structured questionnaire will be administered to the study population. Data regarding socio-demographic profile, dietary practices etc. will be collected. The PG-SGA score and anthropometric measurements like height, weight, BMI, will be used to assess the nutritional status. Other variables like age, gender, socio-economic status, height, weight, BMI, metabolic demand, chronic energy deficiency, nutritional triage etc. are taken into consideration. Results: Based on the study conducted, education and occupation status were significantly associated with nutrition status of CKD patient. With the higher levels of education, the number of subjects decreased and was found to have suspect/moderate malnutrition. With higher levels of occupation status, the number of subjects decreased and was found to have suspect/moderate malnutrition. Conclusion: According to the demographic study of CKD patients - low literacy rate, poor income, tobacco use, alcohol consumption, older age are some of the reasons for malnutrition that are independently associated with CKD. Co-morbidities such as hypertension are predictors for chronic kidney disease. Nutritional status is observed to be at baseline with linear progression towards deterioration in > 3/4 patients under study. Thus, malnutrition continues to be an under diagnosed condition in CKD. [ABSTRACT FROM AUTHOR]

Background and Objectives: The investigator is aimed to know the, socio-demographic factors, and to study the various risk factors associated with hypertension, and determine the prevalence of hypertension, among Kakathiya University Employees, at Warangal District, India. Also, aimed to address and educate about CNCD's diseases 'like hypertension in the community and its early identification, treatment and advice, appropriate preventive and primitive measures among the university employees. Methodology: A Cross sectional study was conducted among Kakathiya University Employees, at Warangal District, India, between June 2013 to April 2014. Where the investigator included employees 576 i.e. study population, after excluding the 259, of total employees i.e. 835A Pre structured & Pre tested questionnaire was used to assessthe factors associated with Hypertension, such as, sociodemographic factors (age, gender, education. occupation, marital status, type of family and size of family) and various other life style risk factors (obesity, smoking, alcohol, physical activity, diet, sleeping hours, mode of vehicle for transport, weekly working hours, and co-morbidity factors (family history, diabetes, CVD's); Measuring the Height, Weight and BP (according to JNC&WG-ASH classification). The collected data was statistically analyzed by using EXCEL 2007 version & SPSS 16.0. Results: In the present study, the investigator found following results; among total study population 297 (51.6%), are hypertensives, among them 96 (16.7%) are hypertension grade 1, and 48.4% were normotensives. Among the hypertensives majority of the hypertension is observed with, following study groups; age group 51 to 60 134 (23.4%), male population are 220 (38.1%), Hindureligion 219(38%), post graduates 116(20.1%), fourth class employees 83(14.4%), married people 247 (42.9%), third generation type of family 118 (20.8%), family size> 6 persons/family 112 (19.4.%), obesity grade 1 people 126 (22.2%), non-smokers 215 (37.3%), alcoholics164 (28.4%), mixed diet consumer's 269(46.7%), additional salt intakeuser's 200(34.8%), sleeping hours <8hrs 29(50.5%), lack of physical activity239(41.4%), mode of vehicle for transport i.e. scooter users 139 (24.2%), employees with weekly working hours >48hrs 166(28.8%), people without family history 172(29.8%), history of diabetics 154(26.8%) and history of CVD's 204(35.4%) respectively. Conclusions The investigator draws the following conclusions from the research participants' data. 51.6% have hypertension. Socio-demographic risk factors such as age 51 to 60, male gender, illiterates, post grads, married persons, third generation type of family, size of the family, and religion were statistically significant (p<0.05), whereas religion was not. Lifestyle risk factors-obesity grade 1, non-smokers, alcoholics, sleeping hours <8 hrs, not doing physical activity, weekly working hours >48hrs-were statistically significant (p<0.05), while diet, additional salt intake and scooter use were not significant. Co-morbidity risks DM and CVDs were statistically significant (p<0.05), although family history was not significant. [ABSTRACT FROM AUTHOR]

Aim and Objectives: To Assess the morbidity profile of the elderly population in the field practice area of Community Medicine Department, Andhra Medical College, Visakhapatnam. To know the socio demographic profile of elderly population, To Assess the morbidity among elderly population. Methods: This cross-sectional, observational study was carried out at Simhachalam Rural Health Training Center (RHTC), which is a part of the Andhra Medical College's Community Medicine Department. Population in Simhachalam rural health training centre between December 2013 to November 2015. Age of 60 years or older in the RHTC area, with a sample size of 600. Results: The study population has a mean age of 67.23 years and an SD of 6.8. Ages 60 to 65 made up the majority of the older population, 317 (52.8%). Only 2.3% of the participants in the study were beyond 85. The majority of study participants, 368 (61.4%), are from a backward caste, while 23.6% are from the Open category and 15% are from a scheduled caste. The survey participants showed no evidence of any other caste category. Hindus made up the majority of the study's 530 participants (88.3%). Muslims made up just 10 (1.6%) of the study participants. The majority of the 351 study participants (58.5%) were married. The majority of the women (59%) were widowed. This suggests that women generally live longer than men. About 71 (11.8%) of research participants had completed elementary school, and 64 (10.7%) had completed middle school. There were 98 or so illiterates (16.3%). The majority of participants in the current study (89.5%) were unemployed. 10% or so were employed. Conclusion: Morbidity was not significantly correlated with gender, education level, or socioeconomic situation. So, regardless of gender, education level, or socioeconomic status, health care for the elderly should be made available to everyone. The present study found no issues with daily living activities because 95-98% of participants could do them on their own. The majority of the female participants in instrumental daily living activities were still reliant on others for things like using the phone (80%), getting around (96%) and handling money (86%). Empowering elderly women in these areas is crucial. [ABSTRACT FROM AUTHOR]

Present work focuses on the use of electrorheological fluid (ERF) as a lubricant in the high speed turbocharger rotor supported on floating ring bearings. The rotor is analysed by finite element modelling with gyroscopic effects and bearing forces. The ERF contains one carrier fluid and active particles that react to external electric field, which induces a yield stress in the fluid increasing its viscosity. In order to control the rotor vibration amplitudes, the dynamic changes in the fluid viscosities at the inner and outer films of bearing are employed with external electric field. A case study of automotive turbocharger rotor is considered and the effect of semi-active control is illustrated on the dynamic response of the system.