Journal articles: 'Diversional Therapy'

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Casey, Norah. "Diversional therapy-Relieves the boredom." Nursing Standard 2, no. 7 (November 14, 1987): 27. http://dx.doi.org/10.7748/ns.2.7.27.s62.

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Westbrook, Mary T., C. Margaret Skropeta, and Varoe Legge. "Ethnic Clients in Diversional Therapy Programmes." Australian Occupational Therapy Journal 38, no. 1 (August 27, 2010): 251–58. http://dx.doi.org/10.1111/j.1440-1630.1991.tb01674.x.

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Quinney, Lee. "Diversional group therapy: a study of effectiveness." Nursing Standard 11, no. 47 (August 13, 1997): 34–37. http://dx.doi.org/10.7748/ns1997.08.11.47.34.c2471.

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Nwankwo, Ebele. "DIVERSIONAL THERAPY FOR PATIENTS WITH ADVANCED STAGE BREAST CANCER." Breast 48 (November 2019): S36. http://dx.doi.org/10.1016/s0960-9776(19)30649-6.

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Lee, CDR Colleen O., Jennifer Hunt, Kristen Haley, and Anita Reedy. "Part II: Making Each Moment Count: Building a Diversional Therapy Program." Clinical Journal of Oncology Nursing 7, no. 6 (November 1, 2003): 685–86. http://dx.doi.org/10.1188/03.cjon.685-686.

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Tamayo Mortera, Orquidea, and Nicola A. Hurst. "Diversional and Recreational Therapy in Aotearoa New Zealand: A Snap-Shot." Therapeutic Recreation Journal 53, no. 3 (2019): 284–88. http://dx.doi.org/10.18666/trj-2019-v53-i3-9621.

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Helmer, Margaret, Venkat Pulla, and Elizabeth Carter. "Social Work and Diversional Therapy: Common Threads from a Strengths Perspective." International Journal of Social Work and Human Services Practice 2, no. 6 (December 2014): 296–302. http://dx.doi.org/10.13189/ijrh.2014.020614.

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Parker, Jean. "Lourdes Pilgrimage from Burton House, 1984." British Journal of Occupational Therapy 48, no. 8 (August 1985): 241. http://dx.doi.org/10.1177/030802268504800805.

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Burton House is a geriatric unit with a purpose-built recreation unit, providing adult education facilities and daily time-tabled recreational facilities for long-stay patients. The recreation unit is an offshoot of the occupational therapy department with an activities organizer, a music therapist and an occupational therapy helper who work, along with others, to extend the role of diversional therapy with the elderly. This article is an example of the work that is being achieved to improve the quality of life for long-stay patients.

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Hoover, J. A. B. "Diversional Occupational Therapy in World War I: A Need for Purpose in Occupations." American Journal of Occupational Therapy 50, no. 10 (November 1, 1996): 881–85. http://dx.doi.org/10.5014/ajot.50.10.881.

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Lee, CDR Colleen O. "Part I: Expanded Psychosocial Interventions in Cancer Care: An Introduction to Diversional Therapy." Clinical Journal of Oncology Nursing 7, no. 6 (November 1, 2003): 682–84. http://dx.doi.org/10.1188/03.cjon.682-684.

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Hocking, Clare. "Early Perspectives of Patients, Practice and the Profession." British Journal of Occupational Therapy 70, no. 7 (July 2007): 284–91. http://dx.doi.org/10.1177/030802260707000703.

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This article draws on an analysis of the British Journal of Occupational Therapy and texts published in England from 1938 to 1951 to describe the ways in which early British occupational therapists perceived themselves and their practice. To give context, the impact of World War II, the medical advances of the time and the profession's overarching goals are outlined. Three themes are presented. First, therapists' use of craft activities, the knowledge that they held about the therapeutic application of craft and the demands of using craft activities in hospital environments are described. The therapists' efforts to articulate a theory base and to demonstrate the efficacy of occupational therapy are the second and third themes. The analysis reveals the circumstances that brought about a shift from craft activities to rehabilitation and workplace technologies, and how the diversional activities that characterised practice in mental health and long-stay physical settings lost ground to remedial and vocational outcomes.

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Wong Shee, Anna, Bev Phillips, Keith Hill, and Karen Dodd. "Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment." Geriatric Nursing 35, no. 4 (July 2014): 300–305. http://dx.doi.org/10.1016/j.gerinurse.2014.03.005.

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Umeaku, Obiefuna George, Ferguson Ayemere Ehimen, and Chinenye Opogah. "Case Report: A 10 Weeks Diversional Therapy as an Adjunct to Managing Chronic Pain Associated with Depression." Open Journal of Depression 10, no. 01 (2021): 14–27. http://dx.doi.org/10.4236/ojd.2021.101002.

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Dekate, Ms Priyanka. "To Assess the Knowledge Regarding Effect of Diversional Therapy on pain Management among Mother's of School Going Children." Asian Journal of Nursing Education and Research 8, no. 3 (2018): 415. http://dx.doi.org/10.5958/2349-2996.2018.00085.x.

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Walter, Mohita. "A Study to Assess the Psychosocial Problems and Happiness with a view to Develop a Video on Diversional Therapy among the Elderly Living in Selected Community in New Delhi." International Journal of Nursing & Midwifery Research 06, no. 2&3 (November 13, 2019): 33–39. http://dx.doi.org/10.24321/2455.9318.201917.

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Chokwueze, Wielfrid, and Kulechy Ịhenache. "Pain Evaluation and Treatment Techniques Designed Specially for Hospital Nurses in Order to Provide High-Quality Health Care Services." Journal Wetenskap Health 2, no. 2 (June 3, 2021): 1–7. http://dx.doi.org/10.48173/jwh.v2i2.102.

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The purpose of this research was to examine the pain evaluation and treatment procedures used by practicing nurses. The research is a descriptive cross-sectional research that was conducted on 146 nurses who were directly engaged in patient care, were not on leave throughout the data collecting period, and volunteered to participate in the research using the convenience sample methodology. The data collection instrument was a pretested self-structured questionnaire with a 0.9 reliability value. Sorting, coding, entering, and analyzing data were performed using the SPSS version 23.0 software program at a 5% level of significance. The majority of respondents, 136 (93.1 percent), were female, while just 10 (6.9 percent) were male. 48 (23.9 percent) of respondents were SNOs, 86 (58.9 percent) of respondents had 6–10 years of experience, 120 (82.2 percent) were married, and 140 (95.9 percent ) were Christians. Concerning respondents' degree of knowledge regarding pain assessment techniques, 28 (19.2 percent) had inadequate knowledge, 44 (30.1 percent) had acceptable knowledge, and 74 (50.7 percent) had enough information. Self-reported pain management strategies included patient positioning and movement, massage, breathing exercises, diversional therapy, the use of warm or hot compresses, encouraging rest and relaxation, the use of both weak and strong opioid analgesics, and the administration of non-opioid analgesics. Using chi-square analysis, it was shown that there is no statistically significant relationship between nurses' knowledge and use of pain assessment instruments (p-value =0.15).

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Girgin, Cengiz, Akif Sezer, Kutan Ozer, Huseyin Tarhan, Ahmet Bolukbasi, and Gozen Gurel. "Comparison of Three Types of Continent Urinary Diversions in a Single Center." Scientific World JOURNAL 4 (2004): 135–41. http://dx.doi.org/10.1100/tsw.2004.59.

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The results including the complication and continence rates for 3 types of continent urinary diversion were evaluated. From 1992 to 1998 we performed 58 continent urinary diversions after radical cystectomy for invasive transitional cell carcinoma (TCC) of the urinary bladder. All three types of continent diversions and ileal loop procedures were discussed and patient preferences were determined. The patient preference rate for continent urinary diversion was 96.6%, and half of these patients wanted to be completely dry. Mean age of the patients was 58.2 years. Of the 58 patients, 9 (15.5%) had a Kock pouch, 15 (25.8%) had a Kock neobladder and 34 (58.6%) had sigmoidorectal pouch (Mainz-II pouch). Early and late complication rates of the three different continent diversions were evaluated. The number of complications, such as urine leakage, pyelonephritis, hydronephrosis, reflux and stone formation, were similar in all three types of diversions. Two (5.9%) Mainz pouch II patients who had stopped oral alkalinization demonstrated severe hyperchloremic acidosis. Spontaneous pouch rupture occurred in 1 of the Kock pouches. Reoperation rates were higher with the Kock pouch and Kock neobladder cases. Daytime continence rates for the Kock pouch, Kock neobladder and Mainz II pouch were 77.7%, 86.7% and 100% respectively. Even though complete dryness may not be achieved in every patient, orthotopic bladder substitution appears to be the best choice after radical cystectomy. Although it carries the risk of life-long oral alkalinization therapy, the Mainz pouch II is associated with an excellent continence rate and may be a good alternative for patients who desire to be dry.

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Tonetti, Daniel A., Brian T. Jankowitz, and Bradley A. Gross. "Antiplatelet Therapy in Flow Diversion." Neurosurgery 86, Supplement_1 (December 16, 2019): S47—S52. http://dx.doi.org/10.1093/neuros/nyz391.

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Abstract Dual antiplatelet therapy is typically employed as a means to mitigate thromboembolic complications after deployment of flow diverters, most commonly consisting of aspirin with either clopidogrel, prasugrel, or ticagrelor. Recent studies have demonstrated at least similar efficacy for ticagrelor as compared to clopidogrel in the form of periprocedural complications and angiographic results. Though controversial, systematic reviews of platelet function assay usage have demonstrated greater rates of thrombotic complications in antiplatelet hyporesponders and greater rates of hemorrhagic complications in hyperresponders. Though in its infancy, the management of antiplatelet therapy for acutely ruptured aneurysms treated with flow diversion is not yet standardized, with approaches including intravenous glycoprotein IIb-IIIa inhibitors and subsequent antiplatelet loading vs antiplatelet loading, response assessment, and subsequent treatment.

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Cherian, Jacob, Robert L. Atmar, and Shankar P. Gopinath. "Shunting in cryptococcal meningitis." Journal of Neurosurgery 125, no. 1 (July 2016): 177–86. http://dx.doi.org/10.3171/2015.4.jns15255.

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OBJECT Patients with cryptococcal meningitis often develop symptomatic intracranial hypertension. The need for permanent CSF diversion in these cases remains unclear. METHODS Cases of cryptococcal meningitis over a 5-year period were reviewed from a single, large teaching hospital. Sources of identification included ICD-9 codes, operative logs, and microscopy laboratory records. RESULTS Fifty cases of cryptococcal meningitis were identified. Ninety-eight percent (49/50) of patients were HIV positive. Opening pressure on initial lumbar puncture diagnosing cryptococcal meningitis was elevated (> 25 cm H2O) in 33 cases and normal (≤ 25 cm H2O) in 17 cases. Thirty-eight patients ultimately developed elevated opening pressure over a follow-up period ranging from weeks to years. Serial lumbar punctures for relief of intracranial hypertension were performed in 29 cases. Thirteen of these patients ultimately had shunting procedures performed after failing to improve clinically. Two factors were significantly associated with the need for shunting: patients undergoing shunt placement were more likely to be women (5/13 vs 0/16; p = 0.01) and to have a pattern of increasing CSF cryptococcal antigen (10/13 vs 3/16 cases; p = 0.003). All patients re-presenting with mycological relapse either underwent or were offered shunt placement. CONCLUSIONS Neurosurgeons are often asked to consider CSF diversion in cases of cryptococcal meningitis complicated by intracranial hypertension. Most patients do well with serial lumbar punctures combined with antifungal therapy. When required, shunting generally provided sustained relief from intracranial hypertension symptoms. Ventriculoperitoneal shunts are the favored method of diversion. To the authors’ knowledge, the present study is the largest series on diversionary shunts in primarily HIV-positive patients with this problem.

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Eiden, Céline, Yves Léglise, Lisa Bertomeu, Vivianne Clavel, Jean-Luc Faillie, Pierre Petit, and Hélène Peyrière. "New Formulation of Methadone for Opioid Dependence in France: Acceptability and Diversion/Misuse Liability." Therapies 68, no. 2 (March 2013): 107–11. http://dx.doi.org/10.2515/therapie/2013020.

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Rosen, Alan. "Return from the vanishing point: a clinician's perspective on art and mental illness, and particularly schizophrenia." Epidemiologia e Psichiatria Sociale 16, no. 2 (June 2007): 126–32. http://dx.doi.org/10.1017/s1121189x00004747.

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SUMMARYAims - To examine earlier uses and abuses of artworks by individuals living with severe mental illnesses, and particularly schizophrenia by both the psychiatric and arts communities and prevailing stereotypes associated with such practices. Further, to explore alternative constructions of the artworks and roles of the artist with schizophrenia and other severe mental illnesses, which may be more consistent with amore contemporary recovery orientation, encompassing their potentials for empowerment, social inclusion as citizens and legitimacy of their cultural role in the community. Results - Earlier practices with regardto the artworks of captive patients of psychiatrists, psychotherapists, art therapists, occupational and diversional therapists, often emphasised diagnostic or interpretive purposes, or were used to gauge progress or exemplify particular syndromes. As artists and art historians began to take an interest in such artworks, they emphasised their expressive, communicative and aesthetic aspects, sometimes in relation to primitive art. These efforts to ascribe value to these works, while well-meaning, were sometimes patronising and vulnerable to perversion by totalitarian regimes, which portrayed them as degenerate art, often alongside the works of mainstream modernist artists. This has culminated in revelations that the most prominent European collection of psychiatric art still contains, and appears to have only started to acknowledge since these revelations, unattributed works by hospital patients who were exterminated in the so-called “euthanasia” program in the Nazi era. Conclusions - Terms like Psychiatric Art, Art Therapy, Art Brut and Outsider Art may be vulnerable to abuse and are a poor fit with the aspirations of artists living with severe mental illnesses, who are increasingly exercising their rights to live and work freely, without being captive, or having others controlling their lives, or mediating and interpreting their works. They sometimes do not mind living voluntarily marginal lives as artists, but they prefer to live as citizens, without being involuntarily marginalised by stigma. They also prefer to live with culturally valued roles which are recognised as legitimate in the community, where they are also more likely to heal and recover.Declaration of Interest: This paper was completed during a Visiting Fellowship, Department of Social Medicine, School of Public Health, & Department of Medical Anthropology, Faculty of Arts & Sciences, Harvard University, Cambridge, Mass, USA. A condensed version of this paper is published in “For Matthew & Others: Journeys with Schizophrenia”, Dysart, D, Fenner, F, Loxley, A, eds. Sydney, University of New South Wales Press in conjunction with Campbelltown Arts Centre & Joan Sutherland Performing Arts Centre, Penrith, 2006, to accompany with a large exhibition of the same name, with symposia & performances, atseveral public art galleries in Sydney & Melbourne, Australia. The author is also a printmaker, partly trained at Ruskin School, Oxford, Central St. Martin's School, London, and College of Fine Arts, University of New South Wales, Sydney.

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Maragkos, Georgios A., and Ajith J. Thomas. "Commentary: Antiplatelet Therapy in Flow Diversion." Neurosurgery 86, Supplement_1 (December 16, 2019): S53—S54. http://dx.doi.org/10.1093/neuros/nyz416.

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Mohanty, Alina, Aditya Srivatsan, and Peter Kan. "Commentary: Antiplatelet Therapy in Flow Diversion." Neurosurgery 86, no. 2 (December 17, 2019): E229—E230. http://dx.doi.org/10.1093/neuros/nyz458.

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Wipplinger, Christoph, and Christoph J. Griessenauer. "Commentary: Antiplatelet Therapy in Flow Diversion." Neurosurgery 86, no. 2 (December 17, 2019): E231—E233. http://dx.doi.org/10.1093/neuros/nyz462.

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May, Paul L., Susan I. Blaser, Harold J. Hoffman, Robin P. Humphreys, and Derek C. Harwood-Nash. "Benign intrinsic tectal “tumors” in children." Journal of Neurosurgery 74, no. 6 (June 1991): 867–71. http://dx.doi.org/10.3171/jns.1991.74.6.0867.

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✓ A specific group of intrinsic dorsal midbrain tumors was identified in six children by computerized tomography (CT) and magnetic resonance (MR) imaging. Each patient presented with raised intracranial pressure as a result of hydrocephalus due to obstruction of the sylvian aqueduct. No patient had brain-stem signs referable to the tectal tumor initially or subsequently. All six children underwent cerebrospinal fluid (CSF) diversionary procedures. The radiological features were consistent and specific, with all patients showing tectal calcification or primary increased attenuation of the tectal plate on CT scans. In addition, lack of contrast enhancement was noted initially in four patients and eventually in all six patients. In all patients MR imaging showed a focal tectal tumor distorting the colicular plate with no cystic component and increased signal intensity on T2-weighted images. There has been no evidence of progression in these six patients in the follow-up period ranging from 8 months to 17 years (8 months and 2½, 4½, 5½, 8, and 17 years). Diversion of CSF has been the only surgical treatment and no patient underwent deep x-ray therapy. Five patients have had normal intellectual development. In contrast to the majority of previously described periaqueductal and tectal tumors, this group of lesions appeared to be truly benign. The authors suggest that patients presenting with these clinical and radiological features may be managed by CSF diversion, serial examination, and MR imaging.

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McDonald, Robert J., Jennifer S. McDonald, David F. Kallmes, Giuseppe Lanzino, and Harry J. Cloft. "Periprocedural safety of Pipeline therapy for unruptured cerebral aneurysms: Analysis of 279 Patients in a multihospital database." Interventional Neuroradiology 21, no. 1 (February 2015): 6–10. http://dx.doi.org/10.1177/1591019915576289.

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The relative safety of unruptured aneurysm treatment with coiling versus flow diversion therapy is unknown. Most data available on flow diversion reflect highly focused patient groups and very experienced operators. We evaluated a national, multihospital patient database to examine periprocedural morbidity and mortality in patients treated with endovascular flow diversion therapy. The Premier Perspective database was used to identify patients hospitalized between May 2011 and March 2013 for unruptured aneurysm who underwent flow diversion therapy with a Pipeline embolization device. The risk of in-hospital mortality and morbidity was determined using ICD 9 codes. A total of 279 unruptured aneurysm patients at 18 medical centers underwent endovascular therapy with a Pipeline device. Adverse outcomes included in-hospital mortality in two cases (0.7%), discharge to long-term care in 22 cases (7.9%), ischemic complications in 14 cases (5.0%), hemorrhagic complications in four cases (1.4%), and postoperative neurological complications in nine cases (3.2%). This study of a large cohort of patient hospitalizations in the United States provides preliminary data on flow diversion in a “real world” scenario and demonstrates that the periprocedural morbidity and mortality is not negligible and must be considered in the context of the natural history of the aneurysms that are being treated.

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Bonney, Phillip A., Michelle Connor, Tatsuhiro Fujii, Parampreet Singh, Matthew J. Koch, Christopher J. Stapleton, William J. Mack, and Brian P. Walcott. "Failure of Flow Diverter Therapy: Predictors and Management Strategies." Neurosurgery 86, Supplement_1 (December 16, 2019): S64—S73. http://dx.doi.org/10.1093/neuros/nyz305.

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Abstract Flow diversion is a safe and effective treatment for many types of brain aneurysms. Even so, there remain some aneurysms that persist despite initial treatment. In studies with the longest follow-up (5 yr), at least 5% of aneurysms persist with this treatment modality. As the cumulative experience and clinical indications for flow diversion continue to expand, the anatomic and functional characteristics that are associated with aneurysm persistence are increasingly described. Identification of these factors preoperatively can help to guide initial treatment decisions, enhance monitoring protocols in the follow-up period, and establish best practices for re-treatment when necessary. Herein, we review published clinical series and provide examples to highlight variables implicated in aneurysm persistence after treatment with flow diversion.

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Moriana, Miriam, Juncal Martinez-Ibañez, Miguel Civera, José Francisco Martínez-Valls, and Juan Francisco Ascaso. "Hyperammonemic encephalopathy after urinary diversion. Diet therapy." Endocrinología y Nutrición (English Edition) 63, no. 6 (June 2016): 306–8. http://dx.doi.org/10.1016/j.endoen.2016.06.004.

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Zhou, Xiaozhou, Huixiang Ji, Heng Zhang, Tailin Xiong, Jinhong Pan, and Zhiwen Chen. "Treatment and outcomes of urethral recurrence after orthotopic neobladder replacement in patients with bladder cancer — practice in a single centre." Journal of International Medical Research 46, no. 9 (June 25, 2018): 3928–37. http://dx.doi.org/10.1177/0300060518782015.

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Objectives To report on the treatment of urethral recurrence after orthotopic urinary diversion at our institution. Methods We retrospectively reviewed clinical information of urethral recurrence in patients who underwent radical cystectomy and orthotopic urinary diversion between January 1998 and January 2013. Results Of 341 patients, 282 presented for follow-up (median follow-up: 56 months; range: 1–174 months). Eight patients developed local recurrence of urothelial cancer after radical cystectomy. The rate of urethral recurrence (1.4%) in female patients who underwent orthotopic urinary diversion was lower than in male patients (3.3%). The median (range) time to recurrence was 33 (6–120) months after radical cystectomy and orthotopic urinary diversion. Recurrences were treated by transurethral resection of tumour, urethrectomy, neobladder resection, revision of urinary diversion, adjuvant chemotherapy, or radiation therapy, based on individual circumstances. Survival analysis showed that 5-year cancer-specific survival was significantly higher in patients with urethral recurrence alone (83.3%), compared with patients with other recurrences, including pelvic/abdomen recurrence and distant metastasis (26.8%). Conclusions En bloc urethrectomy and revision of urinary diversion remain the principle surgical choices. Selection of transurethral tumour resection was based on tumour stage and was used in carefully chosen patients. Cancer-specific survival might depend on multidisciplinary therapy.

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Hüseyinoglu, Zeynep, Marvin D. Oppong, Andrew S. Griffin, and Erik Hauck. "Treatment of direct carotid-cavernous fistulas with flow diversion – does it work?" Interventional Neuroradiology 25, no. 2 (October 31, 2018): 135–38. http://dx.doi.org/10.1177/1591019918808468.

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Direct carotid-cavernous fistulas (CCFs) are high flow lesions that can be challenging to treat. A number of recent reports suggest that flow diversion may be a viable treatment option. We present a case of a post-traumatic CCF successfully treated with flow diversion and provide a review of the literature. Our results suggest that flow diversion is a potentially effective treatment option for CCFs and is most successful when used as an adjunctive therapy.

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Anderson, Brandon J., Elizabeth G. Hill, Robert E. Sweeney, Amy E. Wahlquist, David T. Marshall, Kevin F. Staveley O'Carroll, David J. Cole, and Ernest Ramsay Camp. "The Impact of Surgical Diversion Before Neoadjuvant Therapy for Rectal Cancer." American Surgeon 81, no. 5 (May 2015): 444–49. http://dx.doi.org/10.1177/000313481508100522.

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Up-front fecal diversion can palliate emergent symptoms related to locally advanced rectal cancer (LARC) allowing patients to receive neoadjuvant chemoradiation therapy (nCRT). We analyzed outcomes of pretreatment-diverted LARC patients relative to nondiverted patients to define the impact of this management strategy. We retrospectively collected data on 103 LARC patients treated with nCRTand surgery. Medical records were reviewed for patient characteristics, staging, treatment plan, and outcomes. Thirteen LARC patients underwent pretreatment diversion for urgent symptoms and 90 LARC patients proceeded directly to nCRT. In all, 50 per cent of diverted patients presented with T4 tumor compared with 14 per cent in the nondiverted patients ( P = 0.003). Diverted patients experienced a delay in time-to-treatment initiation of 12 days, although this difference was not statistically significant. Similar rates of chemoradiation and surgical toxicities were observed. Even though diverted patients demonstrated less pathologic response to nCRT compared with nondiverted patients ( P = 0.04), there was no significant difference in overall survival. In conclusion, our study demonstrates the effectiveness of up-front fecal diversion at managing emergent obstructive symptoms related to advanced rectal cancer without additional complications, allowing patients to proceed with nCRT followed by radical surgery.

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Franklyn, Joshua, Gigi Varghese, Rajat Rghunath, Tunny Sebastian, and Mark Ranjan Jesudason. "Oncological outcomes of obstructed locally advanced rectal cancer in the era of multi-modal therapy." International Surgery Journal 5, no. 11 (October 26, 2018): 3695. http://dx.doi.org/10.18203/2349-2902.isj20184647.

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Background: The management of locally advanced rectal cancer is multi-modal. In India, a number of patients present with features of intestinal obstruction and are diverted prior to initiation of chemo-radiation therapy. The purpose of this paper is to study the demographics and oncological outcomes of obstructed locally advanced rectal cancer (OLARC) requiring pre-therapy diversion colostomy in comparison with patients who did not need pre-treatment diversion (non-obstructed group).Methods: This is a retrospective analysis of a prospective data-base. Patients diagnosed with non-metastatic locally advanced adenocarcinoma of the rectum in a colorectal unit of a tertiary care teaching hospital between August 2012 and December 2014 were analyzed. Data was collected from hospital records and telephonic interviews.Results: Two hundred and thirteen patients were diagnosed to have locally advanced rectal cancer. One hundred and fifty patients (70.4%) did not have features of intestinal obstruction and received NACRT upfront and 63 (29.6%) required pre-therapy diversion colostomy. Thirty-nine patients (61.9%) completed therapy (neo-adjuvant chemo-radiotherapy followed by Surgery and adjuvant chemotherapy) in the obstructed group, compared to 127(84.7%) in the non-obstructed group (0<0.05) who completed all components of cancer directed therapy. The 3-year overall survival (OS) of the obstructed and non-obstructed groups was 59% vs 90% (p<.001) and the disease-free survival (DFS) was 51% and 76% (p<0.01) respectively.Conclusions: In the era of multi-modal therapy, patients with obstructed locally advanced rectal cancer have worse oncological outcomes with respect to overall and disease-free survival.

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Dvoretski, L. I., Y. I. Yashkov, and Olga V. Ivleva. "Anemia after biliopancreatic diversion." Clinical Medicine (Russian Journal) 95, no. 8 (September 26, 2017): 742–48. http://dx.doi.org/10.18821/0023-2149-2017-95-8-742-748.

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At present, biliopancreatic diversion (BPD) is one of the most effective surgery for the treatment of morbid obesity. However, long-term complications, including different types of anemia are known to occur after such intervention. Objective of the study. To investigate pathogenetic mechanisms of anemia and clinical condition of the patients undergone BPD taking into account risk factors of anemia development, its therapy and prevention. Material and methods. Eighty patients who had undergone BPD surgery were included in the study. Postoperative oral administration of iron medications (IMs) was recommended to all patients. 49 of them regularly received IMs, 31 patients were not given IMs or took them for no more than 2 months after surgery. The follow-up was 3-7 years. Results. A reliable decrease of hemoglobin levels was observed in all patients after BPD. This reduction began as early as month 3 after surgery and progressed during the 7 year follow-up. Iron deficiency anemia (IDA) was diagnosed in 30% of the patients after BPD. Mean levels of hemoglobin, ferritin and serum iron after BPD were significantly lower in patients having risk factors of IDA as well as in patients not receiving iron therapy. Iron deficiency anemia was revealed in 33.3% of the patients regularly receiving IMs in doses containing 100 mg elemental iron per day. There was no significant decrease of vitamin B12 and folic acid levels during 7 years of follow-up. Only one case (1.25%) of B12 deficiency anemia was registered. Normochromic normocytic anemia characterized by normal serum iron and increased ferritin and C-reactive protein levels, was diagnosed after BPD in 7.85% of the patients. Conclusion. BPD surgery is the important risk factor of anemia (especially IDA) development. In compliant patients. Continuous intake of IMs makes up for iron deficiency but in some others IDA occurred despite regular IMs administration. Normochromic normocytic anemia after BPD may be due to chronic inflammation.

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Kim, Jason, Yiping Li, and Azam Ahmed. "Predictors of Impaired Cerebral Perfusion After Flow Diversion Therapy." World Neurosurgery 127 (July 2019): e556-e560. http://dx.doi.org/10.1016/j.wneu.2019.03.203.

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Pryme, Ian F., and Susan Bardocz. "Anti-cancer therapy: diversion of polyamines in the gut." European Journal of Gastroenterology & Hepatology 13, no. 9 (September 2001): 1041–46. http://dx.doi.org/10.1097/00042737-200109000-00007.

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Pickett, Gwynedd E., and Lara Hazelton. "Electroconvulsive Therapy After Flow Diversion Stenting of Intracranial Aneurysm." Journal of ECT 35, no. 2 (June 2019): e17-e19. http://dx.doi.org/10.1097/yct.0000000000000576.

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van der Holst, A. M., T. Otten, A. R. P. K. M. van Renterghem, G. Dijkstra, E. S. van Loo, E. M. van Praag, C. J. Buskens, and L. P. S. Stassen. "P184 Temporary defunctioning ileostomy in therapy refractory Crohn’s colitis: A viable alternative to immediate colorectal resection?" Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S230—S231. http://dx.doi.org/10.1093/ecco-jcc/jjz203.313.

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Abstract Background The faecal stream is one of many factors influencing the pathogenesis of Crohn’s disease. Previous research demonstrated some Crohn’s patients benefit from temporary faecal diversion. This study aims to determine the role of temporary faecal diversion by means of a defunctioning ileostomy in treating patients with therapy refractory Crohn’s colitis. Methods Data were retrieved by retrospectively assessing patient records. All patients receiving a temporary ileostomy for therapy refractory Crohn’s colitis from three Dutch hospitals between 2010 and 2018 were included. Patients with previous colorectal resection or malignancy were excluded. Stoma reversal, permanent stoma and extension of colorectal resection at follow-up were determined as primary outcomes. Results Thirty-six patients received a temporary defunctioning ileostomy for therapy refractory Crohn’s colitis. Stoma reversal was attempted in 20 (56%) patients after a mean period of 1 year of which nine underwent additional resection during stoma reversal. After a mean follow-up of 4.2 years, resection was performed in 29 (81%) patients of which 14 (39%) had reduced resection in comparison with the necessary resection at the time of faecal diversion. Among the 14 (39%) patients with restored continuity, three patients remained with full preservation of the colon. Moreover, the presence of proctitis was associated with low stoma reversal rates (p = .007). Conclusion Temporary faecal diversion is associated with reduced resection and reduced risk of permanent ileostomy; therefore, it may be a decent alternative for immediate colorectal resection for patients with isolated Crohn’s colitis. Unfortunately, temporary defunctioning ileostomy is not a viable alternative for resection in Crohn’s patients suffering from proctitis.

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Ronconi, C. "Infiltrating Bladder Cancer: Surgery and Chemotherapy." Urologia Journal 65, no. 4 (August 1998): 515–18. http://dx.doi.org/10.1177/039156039806500407.

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Various surgical options, both partial and radical, are considered as well as chemotherapeutic protocols and a brief literature review is presented. Radical cystectomy associated with various urinary diversions remains the choice therapy for infiltrating bladder cancer whenever feasible.

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Meyer, Jonathan M. "Monitoring and improving antipsychotic adherence in outpatient forensic diversion programs." CNS Spectrums 25, no. 2 (May 23, 2019): 136–44. http://dx.doi.org/10.1017/s1092852919000865.

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Outpatient diversion programs present an opportunity for severely mentally ill defendants to receive psychiatric treatment and have alleged offenses dismissed by the court. Moreover, the successful completion of pretrial diversion is associated with fewer post-program arrest and jail days. The target patient population for such programs is typically people with schizophrenia spectrum disorders, but the care of such patients in outpatient settings presents challenges for monitoring treatment fidelity, specifically antipsychotic adherence, as low adherence rates are associated with increased rates of recidivism. Presented here is a review of evidence-based strategies that must be employed to track antipsychotic adherence in outpatient diversion programs, including pill counts, use of long-acting injectable antipsychotics, and determination of plasma antipsychotic levels to assess adherence and the adequacy of antipsychotic treatment. Antipsychotic therapy remains the foundation of schizophrenia treatment, but only through the use of all available modalities can clinicians maximize the odds that schizophrenia patients in pretrial diversion maintain psychiatric stability and successfully complete mental health court mandates.

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Djurasic, Ljubomir, Dragan Crnomarkovic, Tomislav Pejcic, Mirko Jovanovic, Ivan Palibrk, Mirko Grajic, Aleksandar Vuksanovic, and Cane Tulic. "The importance of physical therapy in the postoperative period after total cystectomy of bladder carcinoma." Acta chirurgica Iugoslavica 58, no. 1 (2011): 103–5. http://dx.doi.org/10.2298/aci1101103d.

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The aim of this study is to evaluate the results and complications after radical cystectomy due to carcinoma of the bladder and to point out the significance of post-operative physical treatment and rehabilitation of these patients. Material and method: In the period of 3 years (2007.-2010.), at the Urological Clinic in Belgrade, we performed 195 total cystectomies for invasive bladder carcinoma with the use of different types of urinary diversion. The operation was performed in 162 men (83%) and 33 women (17% ). Results: Survival, complications and postoperative recovery was dependent on the type of urinary diversion which was used, stage of disease and general condition of patients before surgery. The worst result was achieved in patients who underwent ureterocutaneostomy and the complications were represented in 30% of patients. In the group of patients where the ileal conduit was applied, complications were recorded in 10% of patients, while mortality was 5%. In the group of patients where the continent urinary diversion was performed, complications were recorded in 5% of patients in mind of stecoral fistulas, urinary fistulas and ileus. Conclusion: The timely application of the physical therapy and rehabilitation in these patients is of great importance, because it reduces complications and allows faster recovery and release from the hospital.

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Srinivasan, Visish M., Maxim Mokin, Edward A. M. Duckworth, Stephen Chen, Ajit Puri, and Peter Kan. "Tourniquet parent artery occlusion after flow diversion." Journal of NeuroInterventional Surgery 10, no. 2 (March 6, 2017): 122–26. http://dx.doi.org/10.1136/neurintsurg-2016-012937.

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BackgroundThe Pipeline Embolization Device (PED) is increasingly used for both on- and off-label purposes for treatment of intracranial aneurysms. The device gradually slows flow of blood into the aneurysm, but the high metal coverage of PED promotes endothelialization of the device. Occasionally, this leads to in-stent stenosis that is clinically well tolerated. We present a multi-institutional Pipeline series that includes three cases of gradual asymptomatic occlusion within the PED and parent vessel.MethodsInstitutional databases at each participating center were searched for patients treated with the PED. Patients with at least 50% stenosis or occlusion were selected and all relevant clinical and radiographic data were reviewed.ResultsA total of 326 cases performed by five neurointerventionalists across four institutions were reviewed. Among these there were three cases of complete occlusion and two cases of stenosis of more than 50%, for an occlusion rate of 0.9%. All patients were clinically asymptomatic.ConclusionsA gradual tourniquet-like occlusion can occur following placement of the PED, leading to vessel occlusion. This has been clinically well tolerated by patients in our series due to the formation of pial collaterals as the stenosis progresses, likely due to ischemic preconditioning. Small parent vessel, pre-existing stenosis, fusiform pathology, overlapping devices, and suboptimal antiplatelet therapy seem to be predisposing factors. Further experience and follow-up will allow us to characterize the risk factors and optimize post-procedural therapy for these patients.

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Modak, MD, DM, Tamoud, Siddharth Sarkar, MD, MRCPsych, and Yatan Pal Singh Balhara, MD. "A review of the evidence to explain pharmacological basis of injection (ab)use of buprenorphine–naloxone tablets." Journal of Opioid Management 17, no. 7 (August 1, 2021): 141–52. http://dx.doi.org/10.5055/jom.2021.0651.

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Opioid use disorder is a major public health problem, and opioid replacement therapy with buprenorphine (BPN) is a clinically effective and evidence-based treatment for it. To deter misuse of the tablet through the injecting route, BPN coformulated with naloxone (BNX) in 4:1 ratio is available in many countries. Despite this, significant diversion and injecting use of the BNX combination has been reported from across the world. In this article, the pharmacological properties of BPN and BNX and the evidence for their diversion are reviewed. Also, a critical examination is made of the evidence supporting the role of naloxone in reducing the agonist effects of BPN when used through the injecting route. Based on this evidence, a hypothesis explaining the continued diversion of BNX has been proposed.

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Mahdi, Jasia, Amish C. Shah, Aimee Sato, Stephanie M. Morris, Robert C. McKinstry, Robert Listernick, Roger J. Packer, Michael J. Fisher, and David H. Gutmann. "A multi-institutional study of brainstem gliomas in children with neurofibromatosis type 1." Neurology 88, no. 16 (March 22, 2017): 1584–89. http://dx.doi.org/10.1212/wnl.0000000000003881.

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Objective:To define the clinical and radiologic features of brainstem gliomas (BSGs) in children with neurofibromatosis type 1 (NF1).Methods:We performed a retrospective cross-sectional study of 133 children with NF1 and concurrent BSGs cared for at 4 NF1 referral centers. BSG was determined using radiographic criteria. Age at diagnosis, tumor location and appearance, clinical symptoms, treatment, and presence of a concurrent optic pathway glioma were assessed.Results:The average age at BSG diagnosis was 7.2 years, and tumors occurred most often in the midbrain and medulla (66%). The majority of children with NF1-BSGs were asymptomatic (54%) and were not treated (88%). Only 9 of the 72 asymptomatic children received treatment because of progressive tumor enlargement. In contrast, 61 children presented with clinical signs/symptoms attributable to their BSG; these individuals were older and more often had focal lesions. Thirty-one patients underwent treatment for their tumor, and 14 received CSF diversion only. Progression-free survival was ∼3 years shorter for children receiving tumor-directed therapy relative to those who had either no treatment or CSF diversion only. Overall survival was 85% for the tumor-directed therapy group, whereas no deaths were reported in the untreated or CSF diversion groups.Conclusions:Unlike children with sporadically occurring BSGs, most children with NF1-BSGs were asymptomatic, and few individuals died from complications of their tumor. Those requiring tumor-directed treatment tended to be older children with focal lesions, and had clinically more aggressive disease relative to those who were not treated or underwent CSF diversion only.

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Bennett, Carol J., and James K. Bennett. "Augmentation Cystoplasty and Urinary Diversion in Patients with Spinal Cord Injury." Physical Medicine and Rehabilitation Clinics of North America 4, no. 2 (May 1993): 377–89. http://dx.doi.org/10.1016/s1047-9651(18)30588-6.

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Smith, Ellyn A., Shaun C. Daly, Brian Smith, Marcelo Hinojosa, and Ninh T. Nguyen. "The Role of Endoscopic Stent in Management of Postesophagectomy Leaks." American Surgeon 86, no. 10 (October 2020): 1411–17. http://dx.doi.org/10.1177/0003134820964495.

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Introduction Anastomotic leak is a dreaded complication following esophagectomy. Conventional management for leaks includes invasive reoperation and even gastrointestinal diversion. Objective The aim of this study was to examine our contemporary outcome of using endoscopic esophageal stenting as primary therapy for management of anastomotic leak following minimally invasive esophagectomy (MIE). Methods We reviewed data on 11 patients who developed an esophageal leak following 111 MIE between January 2011 and December 2019. Of the 11 anastomotic leaks, 10 patients had an anastomotic disruption and underwent endoscopic esophageal stenting as primary therapy for management of leaks, while 1 patient had an anastomotic disruption complicated by an associated tracheoesophageal fistula that required surgical reoperation and subsequent colonic interposition. Main outcome measures focused on the 10 patients who were managed with endoscopic stenting, including length of hospital stay following leak management, need for thoracotomy or gastrointestinal diversion for leak, stent complications, and leak-associated mortality. Results Of the 10 patients who underwent endoscopic esophageal stenting as primary therapy for management of leaks, there were 8 males with a median age of 66 years. The median time to diagnosis of anastomotic leak was 10 days postoperatively. One of the ten patients also underwent percutaneous drain placement, while none of the patients required thoracotomy. Median duration of stent placement was 39 (range, 29-105) days. Median length of stay after stent placement was 10 (range, 4-43) days. The median number of stent exchange was 1 (range, 1-3) stent. Gastrointestinal continuity was maintained in all patients. The 90-day leak-associated mortality was 9.1% (1 of 11 patients). Conclusions Endoscopic stenting is an effective primary therapy in the management of postesophagectomy leak and avoids the need for an invasive, reoperative thoracotomy or gastrointestinal diversion procedure.

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Cunico, S. Cosciani, C. Simeone, D. Zani, and S. E. Panizza. "Orthotopic neobladder in irradiated patients." Urologia Journal 63, no. 4 (August 1996): 530–33. http://dx.doi.org/10.1177/039156039606300423.

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Salvage cystectomy for the treatment of transitional cell carcinoma following radical external beam radiation therapy is a considerable surgical undertaking. The resulting fibrosis secondary to radiation causes welding of tissue planes, making surgical dissection more difficult. As the experience of urologists has increased over the last few decades, the high operative mortality seen in early experiences with salvage cystectomy has lessened. To define the nature and risk of complications associated with the type of urinary diversion we analyzed the clinical course of 77 patients. The urinary diversion chosen was the ileal conduit in 56 patients and cutaneous ureterostomy in 16. In accordance with literature, continent reservoirs were very limited due to a higher complication rate. Although continent cutaneous diversion, according to the Indiana pouch technique, may be performed safely in highly irradiated patients, orthotopic bladder replacement should still be considered critically.

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Brinjikji, Waleed, Mariangela Piano, Shanna Fang, Guglielmo Pero, David F. Kallmes, Luca Quilici, Luca Valvassori, et al. "Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion." Journal of Neurosurgery 125, no. 1 (July 2016): 120–27. http://dx.doi.org/10.3171/2015.6.jns151038.

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OBJECT Flow-diversion treatment has been shown to be associated with high rates of angiographic obliteration; however, the treatment is relatively contraindicated in the acute phase following subarachnoid hemorrhage (SAH) as these patients require periprocedural dual antiplatelet therapy. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured complex and giant aneurysms. In this study the authors report outcomes and complications of patients with ruptured aneurysms undergoing coiling in the acute phase followed by planned delayed flow diversion. METHODS This case series includes patients from 2 institutions. All patients underwent standard endovascular coiling in the acute phase after SAH with the intention and plan to proceed with flow diversion at a later date. Outcomes studied included angiographic occlusion, procedure-related complications, and long-term clinical outcome as measured using the modified Rankin Scale. RESULTS A total of 31 patients underwent coiling in the acute phase with the intention to undergo flow diversion at a later date. The mean aneurysm size was 15.8 ± 7.9 mm. Of the 31 patients undergoing coiling, 4 patients could not undergo further flow-diverter therapy: 3 patients (9.7%) died of complications of subarachnoid hemorrhage and 1 patient had permanent morbidity as a result of perioperative ischemic stroke (3.1%). Twenty-seven patients underwent staged placement of flow diverters after adequate recovery. The median time to treatment was 16 weeks. There was one case of aneurysm rebleeding following coil treatment. There were no cases of permanent morbidity or mortality resulting from flow-diverter treatment. Twenty-four patients underwent imaging follow-up; 18 of these patients had aneurysms that were completely or nearly completely occluded (58.1% on an intent-to-treat basis). At last follow-up (mean 18.3 months), 25 patients had mRS scores ≤ 2 (80.6% on an intent-to-treat basis). CONCLUSIONS Staged treatment of ruptured complex and giant intracranial aneurysms with coiling in the acute phase and flow-diverter treatment following recovery from SAH is both safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. This strategy should be considered as a valid option in patients presenting with these challenging ruptured aneurysms.

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Zhou, Geng, YanLing Yin, and MingHua Li. "Flow Diversion for Cerebral Aneurysms: A Promising Therapy Needs Full Evaluation." World Neurosurgery 91 (July 2016): 626–27. http://dx.doi.org/10.1016/j.wneu.2016.04.018.

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Rehg, Kellee L., Jaime E. Sanchez, Beth R. Krieger, and Jorge E. Marcet. "Fecal Diversion in Perirectal Fistulizing Crohn's Disease is an Underutilized and Potentially Temporary Means of Successful Treatment." American Surgeon 75, no. 8 (August 2009): 715–18. http://dx.doi.org/10.1177/000313480907500814.

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The purpose of this study was to determine the outcome of patients treated with fecal diversion for perirectal fistulizing Crohn's disease. Thirty-nine patients were identified and followed for an average of 60 months. Patients were divided into two groups based on surgical treatment: local surgical treatment only and fecal diversion in addition to local surgical therapy. Thirteen patients (33%) underwent fecal diversion due to the severity of their disease. Eleven of these patients (85%) had complete resolution of their fistulas and only two (15%) required proctectomy. In contrast, only five out of 26 patients (19%) who underwent local surgical procedures alone had complete perirectal disease resolution. Intestinal continuity was restored in six patients (46%) and three of these patients (50%) remained disease free. The remaining three patients had disease recurrence, which required additional local procedures in one patient (17%), but with eventual resolution; the other two patients (33%) necessitated rediversion. Our data suggest that fecal diversion is a viable treatment option for severe perirectal fistulizing Crohn's disease and may be associated with a higher rate of resolution than local surgical treatment alone. In addition, we demonstrate a higher rate of successful intestinal continuity restoration than is typically reported.

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Kim, Keri S., Justin F. Fraser, Stephen Grupke, and Aaron M. Cook. "Management of antiplatelet therapy in patients undergoing neuroendovascular procedures." Journal of Neurosurgery 129, no. 4 (October 2018): 890–905. http://dx.doi.org/10.3171/2017.5.jns162307.

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Neuroendovascular techniques for treating cerebral aneurysms and other cerebrovascular pathology are increasingly becoming the standard of care. Intraluminal stents, aneurysm coils, and other flow diversion devices typically require concomitant antiplatelet therapy to reduce thromboembolic complications. The variability inherent with the pharmacodynamic response to common antiplatelet agents such as aspirin and clopidogrel complicates optimal selection of antiplatelet agents by clinicians. This review serves to discuss the literature related to antiplatelet use in neuroendovascular procedures and provides recommendations for clinicians on how to approach patients with variable response to antiplatelet agents, particularly clopidogrel.

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Journal articles on the topic 'Diversional Therapy'

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