Hemipelvic amputations for recalcitrant pelvic osteomyelitis.
80 and over; Adult; Aged; Anti-Bacterial Agents/*therapeutic use; Cohort Studies; Female; Hemipelvectomy/*methods/psychology; Humans; Male; Middle Aged; Osteomyelitis/drug therapy/microbiology/*surgery; Palliative Care/methods; Paraplegia/psychology; Pelvic Bones/*surgery; Retrospective Studies; Secondary Prevention; Treatment Outcome; Wound Infection/*drug therapy/microbiology
OBJECTIVE: To evaluate the outcome of recalcitrant deep pelvic infection that required a hemipelvic amputation. STUDY DESIGN: Retrospective cohort. SETTING: Tertiary referral centre; Level I trauma. PATIENTS: There were 20 patients with an infection of the pelvic girdle who developed life-threatening sepsis or had an intolerable existence due to putrefied tissues that prevented end of life care. All patients failed other more conservative treatments such as limited debridement and local wound care. The indication for amputation was life-threatening sepsis (eight patients), intolerable state with putrid tissue (four patients), and both sepsis/putrefaction (eight patients). INTERVENTION: A hemipelvic amputation, multidrug antibiotic treatment, and long-term suppression. Ten internal hemipelvectomies, eight external hemipelvectomies, and two hemicorporectomies were performed. MAIN OUTCOME MEASURE: Survival and recurrence of infection. RESULTS: Six patients died within 6 months (mean time 17 weeks, range 2-24). The 14 surviving patients had a mean follow-up time of 28 weeks (9-48). Of these, 10 patients survived with no evidence of ongoing infection, and four patients had ongoing infection requiring suppressive antibiotics. All of the six deaths were in C-hosts with an average of six comorbidities each; mean age was 62 years old. Aetiologies of the infection were vasculopathy (5), spinal cord injury (4), post fracture (3), post abdominal surgery (2), gunshot wound (2), seeding from bacteraemia (4). Cierny-Mader host class was C (11) and B systemic/local (9) with an average of four (4) comorbidities each. Mean estimated blood loss=3100 cc and operative time=157 min. There were 11 cases of minor wound problems and no flap loss. Pathogens were polymicrobial (16 total pathogens) with mean of three per patient (most common was MRSA). Multi-agent antibiotic and suppression were used in all patients. In cases with putrefied tissues, appropriate nursing care was possible. CONCLUSION: Patients requiring hemipelvectomies usually present with sepsis or an intolerable state. Despite expected complications, we found that hemipelvectomy is an effective palliative tool in selected cases. Age and vascular disease seemed to be associated with worse outcomes.
Ziran Bruce H; Smith Wade R; Rao Nalini
Injury
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.injury.2007.12.002" target="_blank" rel="noreferrer noopener">10.1016/j.injury.2007.12.002</a>
Cognitive behavioral therapy for psychosis in clinical practice.
Adaptation; Affect; Cognitive Behavioral Therapy/*methods; Cognitive Therapy – Methods; Coping; Delusions; Descriptive Statistics; Effect Size; Funding Source; Hallucinations; Hallucinations/psychology/therapy; Human; Humans; Meta Analysis; Professional-Patient Relations; Psychological; Psychotic Disorders – Therapy; Psychotic Disorders/psychology/*therapy; Schizophrenia; Schizophrenia/therapy; Schizophrenic Psychology; Secondary Prevention; Systematic Review; Treatment Outcome; United Kingdom; United States
Across two continents, Cognitive-Behavioral Therapy for Psychosis (CBT-P) has been endorsed as an adjunctive treatment for individuals who experience persistent positive symptoms of schizophrenia. The moderate effect sizes reported in early studies and reviews were followed by better controlled studies indicating more limited effect sizes. This article provides a review of the literature that addresses the effectiveness of CBT-P, including particular areas of emphasis and practice elements associated with this approach. In addition, because the majority of research on CBT-P has been performed in the United Kingdom, implications for implementation and sustainability of this practice in the United States are presented.
Sivec Harry J; Montesano Vicki L
Psychotherapy (Chicago, Ill.)
2012
2012-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1037/a0028256" target="_blank" rel="noreferrer noopener">10.1037/a0028256</a>