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Sample records for 30-day mortality postoperative

  1. Vitamin D Status Predicts 30 Day Mortality in Hospitalised Cats

    PubMed Central

    Titmarsh, Helen; Kilpatrick, Scott; Sinclair, Jennifer; Boag, Alisdair; Bode, Elizabeth F.; Lalor, Stephanie M.; Gaylor, Donna; Berry, Jacqueline; Bommer, Nicholas X.; Gunn-Moore, Danielle; Reed, Nikki; Handel, Ian; Mellanby, Richard J.

    2015-01-01

    Vitamin D insufficiency, defined as low serum concentrations of the major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), has been associated with the development of numerous infectious, inflammatory, and neoplastic disorders in humans. In addition, vitamin D insufficiency has been found to be predictive of mortality for many disorders. However, interpretation of human studies is difficult since vitamin D status is influenced by many factors, including diet, season, latitude, and exposure to UV radiation. In contrast, domesticated cats do not produce vitamin D cutaneously, and most cats are fed a commercial diet containing a relatively standard amount of vitamin D. Consequently, domesticated cats are an attractive model system in which to examine the relationship between serum 25(OH)D and health outcomes. The hypothesis of this study was that vitamin D status would predict short term, all-cause mortality in domesticated cats. Serum concentrations of 25(OH)D, together with a wide range of other clinical, hematological, and biochemical parameters, were measured in 99 consecutively hospitalised cats. Cats which died within 30 days of initial assessment had significantly lower serum 25(OH)D concentrations than cats which survived. In a linear regression model including 12 clinical variables, serum 25(OH)D concentration in the lower tertile was significantly predictive of mortality. The odds ratio of mortality within 30 days was 8.27 (95% confidence interval 2.54-31.52) for cats with a serum 25(OH)D concentration in the lower tertile. In conclusion, this study demonstrates that low serum 25(OH)D concentration status is an independent predictor of short term mortality in cats. PMID:25970442

  2. Predictors of 30-day mortality in patients with spontaneous primary intracerebral hemorrhage

    PubMed Central

    Safatli, Diaa A.; Günther, Albrecht; Schlattmann, Peter; Schwarz, Falko; Kalff, Rolf; Ewald, Christian

    2016-01-01

    Background: Intracerebral hemorrhage (ICH) is a life threatening entity, and an early outcome assessment is mandatory for optimizing therapeutic efforts. Methods: We retrospectively analyzed data from 342 patients with spontaneous primary ICH to evaluate possible predictors of 30-day mortality considering clinical, radiological, and therapeutical parameters. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. We also applied three widely accepted outcome grading scoring systems [(ICH score, FUNC score and intracerebral hemorrhage grading scale (ICH-GS)] on our population to evaluate the correlation of these scores with the 30-day mortality in our study. Results: From 342 patients (mean age: 67 years, mean Glasgow Coma Scale [GCS] on admission: 9, mean ICH volume: 62.19 ml, most common hematoma location: basal ganglia [43.9%]), 102 received surgical and 240 conservative treatment. The 30-day mortality was 25.15%. In a multivariate analysis, GCS (Odds ratio [OR] =0.726, 95% confidence interval [CI] =0.661–0.796, P < 0.001), bleeding volume (OR = 1.012 per ml, 95% CI = 1.007 – 1.017, P < 0.001), and infratentorial hematoma location (OR = 5.381, 95% CI = 2.166-13.356, P = 0.009) were significant predictors for the 30-day mortality. After receiver operating characteristics analysis, we defined a “high-risk group” for an unfavorable short-term outcome with GCS <11 and ICH volume >32 ml supratentorially or 21 ml infratentorially. Using Pearson correlation, we found a correlation of 0.986 between ICH score and 30-day mortality (P < 0.001), 0.853 between FUNC score and 30-day mortality (P = 0.001), and 0.924 between ICH-GS and 30-day mortality (P = 0.001). Conclusions: GCS score on admission together with the baseline volume and localization of the hemorrhage are strong

  3. Relationships between in-hospital and 30-day standardized hospital mortality: implications for profiling hospitals.

    PubMed Central

    Rosenthal, G. E.; Baker, D. W.; Norris, D. G.; Way, L. E.; Harper, D. L.; Snow, R. J.

    2000-01-01

    OBJECTIVE: To examine the relationship of in-hospital and 30-day mortality rates and the association between in-hospital mortality and hospital discharge practices. DATA SOURCES/STUDY SETTING: A secondary analysis of data for 13,834 patients with congestive heart failure who were admitted to 30 hospitals in northeast Ohio in 1992-1994. DESIGN: A retrospective cohort study was conducted. DATA COLLECTION: Demographic and clinical data were collected from patients' medical records and were used to develop multivariable models that estimated the risk of in-hospital and 30-day (post-admission) mortality. Standardized mortality ratios (SMRs) for in-hospital and 30-day mortality were determined by dividing observed death rates by predicted death rates. PRINCIPAL FINDINGS: In-hospital SMRs ranged from 0.54 to 1.42, and six hospitals were classified as statistical outliers (p <.05); 30-day SMRs ranged from 0.63 to 1.73, and seven hospitals were outliers. Although the correlation between in-hospital SMRs and 30-day SMRs was substantial (R = 0.78, p < .001), outlier status changed for seven of the 30 hospitals. Nonetheless, changes in outlier status reflected relatively small differences between in-hospital and 30-day SMRs. Rates of discharge to nursing homes or other inpatient facilities varied from 5.4 percent to 34.2 percent across hospitals. However, relationships between discharge rates to such facilities and in-hospital SMRs (R = 0.08; p = .65) and early post-discharge mortality rates (R = 0.23; p = .21) were not significant. CONCLUSIONS: SMRs based on in-hospital and 30-day mortality were relatively similar, although classification of hospitals as statistical outliers often differed. However, there was no evidence that in-hospital SMRs were biased by differences in post-discharge mortality or discharge practices. PMID:10737447

  4. Measuring hospital mortality rates: are 30-day data enough? Ischemic Heart Disease Patient Outcomes Research Team.

    PubMed Central

    Garnick, D W; DeLong, E R; Luft, H S

    1995-01-01

    OBJECTIVE. We compare 30-day and 180-day postadmission hospital mortality rates for all Medicare patients and those in three categories of cardiac care: coronary artery bypass graft surgery, acute myocardial infarction, and congestive heart failure. DATA SOURCES/COLLECTION. Health Care Financing Administration (HCFA) hospital mortality data for FY 1989. STUDY DESIGN. Using hospital level public use files of actual and predicted mortality at 30 and 180 days, we constructed residual mortality measures for each hospital. We ranked hospitals and used receiver operating characteristic (ROC) curves to compare 0-30, 31-180, and 0-180-day postadmission mortality. PRINCIPAL FINDINGS. For the admissions we studied, we found a broad range of hospital performance when we ranked hospitals using the 30-day data; some hospitals had much lower than predicted 30-day mortality rates, while others had much higher than predicted mortality rates. Data from the time period 31-180 days postadmission yield results that corroborate the 0-30 day postadmission data. Moreover, we found evidence that hospital performance on one condition is related to performance on the other conditions, but that the correlation is much weaker in the 31-180-day interval than in the 0-30-day period. Using ROC curves, we found that the 30-day data discriminated the top and bottom fifths of the 180-day data extremely well, especially for AMI outcomes. CONCLUSIONS. Using data on cumulative hospital mortality from 180 days postadmission does not yield a different perspective from using data from 30 days postadmission for the conditions we studied. PMID:7860319

  5. Hyperkalemia is Associated with Increased 30-Day Mortality in Hip Fracture Patients.

    PubMed

    Norring-Agerskov, Debbie; Madsen, Christian Medom; Abrahamsen, Bo; Riis, Troels; Pedersen, Ole B; Jørgensen, Niklas Rye; Bathum, Lise; Lauritzen, Jes Bruun; Jørgensen, Henrik L

    2017-02-17

    Abnormal plasma concentrations of potassium in the form of hyper- and hypokalemia are frequent among hospitalized patients and have been linked to poor outcomes. In this study, we examined the prevalence of hypo- and hyperkalemia in patients admitted with a fractured hip as well as the association with 30-day mortality in these patients. A total of 7293 hip fracture patients (aged 60 years or above) with admission plasma potassium measurements were included. Data on comorbidity, medication, and death was retrieved from national registries. The association between plasma potassium and mortality was examined using Cox proportional hazards models adjusted for age, sex, and comorbidities. The prevalence of hypo- and hyperkalemia on admission was 19.8% and 6.6%, respectively. The 30-day mortality rates were increased for patients with hyperkalemia (21.0%, p < 0.0001) compared to normokalemic patients (9.5%), whereas hypokalemia was not significantly associated with mortality. After adjustment for age, sex, and individual comorbidities, hyperkalemia was still associated with increased risk of death 30 days after admission (HR = 1.93 [1.55-2.40], p < 0.0001). After the same adjustments, hypokalemia remained non-associated with increased risk of 30-day mortality (HR = 1.06 [0.87-1.29], p = 0.6). Hyperkalemia, but not hypokalemia, at admission is associated with increased 30-day mortality after a hip fracture.

  6. Relationship between obstructive sleep apnea and 30-day mortality among patients with pulmonary embolism

    PubMed Central

    Ghiasi, Farzin; Ahmadpoor, Amin; Amra, Babak

    2015-01-01

    Background: Pulmonary embolism (PE) is the most life-threatening form of venous thrombosis which causes the majority of mortalities in this category. Obstructive sleep apnea (OSA) has been indicated as one of the risk factors for thromboembolism because of hemostatic alterations. The present study was designed to seek for the relationship between OSA and 30-day mortality of patients with PE. Materials and Methods: This prospective cohort study was conducted among 137 consecutive patients referred to hospital with symptoms of PE and preliminary stable hemodynamic. Confirmation of PE was made by multislice computed tomography pulmonary angiography and in the case of contraindication; V/Q lung scan and Doppler sonography were done. A STOP-Bang Questionnaire was used to determine patients with high- and low-risk of OSA. Patients were followed up for 1-month, and their survivals were recorded. Results: This study showed that there was no relationship between OSA and 30-day mortality (P = 0.389). Chronic kidney disease (P = 0.004), hypertension (P = 0.003), main thrombus (P = 0.004), and segmental thrombus (P = 0.022) were associated with 30-day mortality. In the logistic regression analysis, history of chronic kidney disease was diagnosed as a risk factor for 30-day mortality among the PE patients (P = 0.029, odds ratio = 4.93). Conclusion: Results of this study showed 30-day mortality was not affected by OSA directly. In fact, it was affected by complications of OSA such as hypertension and thrombus. Also, positive history of chronic kidney disease increased the risk of 30-day mortality. PMID:26622255

  7. Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplasty

    PubMed Central

    2013-01-01

    Introduction Serious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis (RA). Whether RA affects the risk for these complications after total joint arthroplasty (TJA) is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis (OA) patients undergoing hip or knee TJA. Methods Analyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors. Results The 34,524 patients (839 RA, 33,685 OA) underwent knee (65.9%) or hip TJA. Patients were 95.7% men with a mean (SD) age of 64.4 (10.7) years and had 3,764 deaths over a mean follow-up of 3.7 (2.3) years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room (odds ratio (OR), 1.45 (95% CI, 1.08 to 1.94), but had similar rates of 30-day postoperative infection, OR 1.02 (0.72 to 1.47), cardiovascular events, OR 0.69 (0.37 to 1.28), and mortality, OR 0.94 (0.38 to 2.33). RA was associated with a significantly higher long-term mortality; hazard ratio (HR), 1.22 (1.00 to 1.49). Conclusion In this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality. PMID:24252350

  8. New consensus definition for acute kidney injury accurately predicts 30-day mortality in cirrhosis with infection

    PubMed Central

    Wong, Florence; O’Leary, Jacqueline G; Reddy, K Rajender; Patton, Heather; Kamath, Patrick S; Fallon, Michael B; Garcia-Tsao, Guadalupe; Subramanian, Ram M.; Malik, Raza; Maliakkal, Benedict; Thacker, Leroy R; Bajaj, Jasmohan S

    2015-01-01

    Background & Aims A consensus conference proposed that cirrhosis-associated acute kidney injury (AKI) be defined as an increase in serum creatinine by >50% from the stable baseline value in <6 months or by ≥0.3mg/dL in <48 hrs. We prospectively evaluated the ability of these criteria to predict mortality within 30 days among hospitalized patients with cirrhosis and infection. Methods 337 patients with cirrhosis admitted with or developed an infection in hospital (56% men; 56±10 y old; model for end-stage liver disease score, 20±8) were followed. We compared data on 30-day mortality, hospital length-of-stay, and organ failure between patients with and without AKI. Results 166 (49%) developed AKI during hospitalization, based on the consensus criteria. Patients who developed AKI had higher admission Child-Pugh (11.0±2.1 vs 9.6±2.1; P<.0001), and MELD scores (23±8 vs17±7; P<.0001), and lower mean arterial pressure (81±16mmHg vs 85±15mmHg; P<.01) than those who did not. Also higher amongst patients with AKI were mortality in ≤30 days (34% vs 7%), intensive care unit transfer (46% vs 20%), ventilation requirement (27% vs 6%), and shock (31% vs 8%); AKI patients also had longer hospital stays (17.8±19.8 days vs 13.3±31.8 days) (all P<.001). 56% of AKI episodes were transient, 28% persistent, and 16% resulted in dialysis. Mortality was 80% among those without renal recovery, higher compared to partial (40%) or complete recovery (15%), or AKI-free patients (7%; P<.0001). Conclusions 30-day mortality is 10-fold higher among infected hospitalized cirrhotic patients with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure. PMID:23999172

  9. Analysis of weekend effect on 30-day mortality among patients with acute myocardial infarction

    PubMed Central

    Noad, Rebecca; Stevenson, Michael; Herity, Niall A

    2017-01-01

    Objectives Several publications have demonstrated increased 30-day mortality in patients admitted on Saturdays or Sundays compared with weekdays. We sought to determine whether this was true for two different cohorts of patients admitted with acute myocardial infarction (MI). Methods and results Thirty-day mortality data were obtained for 3757 patients who had been admitted to the Belfast Health and Social Care Trust with acute MI between 2009 and 2015. They were subdivided into those presenting with ST elevation MI (n=2240) and non-ST elevation MI (n= 1517). We observed no excess 30-day mortality in those admitted over weekends. Conclusion Excess mortality in patients admitted at weekends is not a universal finding. This may mean that that there are patient subgroups with proportionately greater weekend hazard and points to the need for more detailed understanding of the weekend effect.

  10. A Comprehensive Analysis of the Causes and Predictors of 30-Day Mortality Following Hip Fracture Surgery

    PubMed Central

    Hossain, Fahad Siddique; Aqil, Adeel; Akinbamijo, Babawande; Mushtaq, Vhaid; Kapoor, Harish

    2017-01-01

    Background A fracture neck of femur is the leading cause of injury-related mortality in the elderly population. The 30-day mortality figure is a well utilised marker of clinical outcome following a fracture neck of femur. Current studies fail to analyse all patient demographic, biochemical and comorbid parameters associated with increased 30-day mortality. We aimed to assess medical risk factors for mortality, which are easily identifiable on admission for patients presenting with a fractured neck of femur. Methods A retrospective review of a prospectively populated database was undertaken to identify all consecutive patients with a fracture neck of femur between October 2008 and March 2011. All factors related to the patient, injury and surgery were identified. The primary outcome of interest was 30-day mortality. Univariate and subsequent multivariate analyses using a backward stepwise likelihood ratio Cox regression model were performed in order to establish all parameters that significantly increased the risk of death. Results A total of 1,356 patients were included in the study. The 30-day mortality was 8.7%. The most common causes of death included pneumonia, sepsis and acute myocardial infarction. Multiple regression analysis revealed male gender, increasing age, admission source other than the patient's own home, admission haemoglobin of less than 10 g/dL, a history of myocardial infarction, concomitant chest infection during admission, increasing Charlson comorbidity score and liver disease to be significant predictors of mortality. Conclusions This study has elucidated risk factors for mortality using clinical and biochemical information which are easily gathered at the point of hospitalization. These results allow for identification of vulnerable patients who may benefit from a prioritisation of resources. PMID:28261422

  11. Surgeon volume and 30 day mortality for brain tumours in England

    PubMed Central

    Williams, Matt; Treasure, Peter; Greenberg, David; Brodbelt, Andrew; Collins, Peter

    2016-01-01

    Background: There is evidence that surgeons who perform more operations have better outcomes. However, in patients with brain tumours, all of the evidence comes from the USA. Methods: We examined all English patients with an intracranial neoplasm who had an intracranial resection in 2008–2010. We included surgeons who performed at least six operations over 3 years, and at least one operation in the first and last 6 months of the period. Results: The analysis data set comprised 9194 operations, 163 consultant neurosurgeons and 30 centres. Individual surgeon volumes varied widely (7–272; median=46). 72% of operations were on the brain, and 30 day mortality was 3%. A doubling of surgeon load was associated with a 20% relative reduction in mortality. Thirty day mortality varied between centres (0·95–8·62%) but was not related to centre workload. Conclusions: Individual surgeon volumes correlated with patient 30 day mortality. Centres and surgeons in England are busier than surgeons and centres in the USA. There is no relationship between centre volume and 30 day mortality in England. Services in the UK appear to be adequately arranged at a centre level, but would benefit from further surgeon sub-specialisation. PMID:27764843

  12. Integrated systems of stroke care and reduction in 30-day mortality

    PubMed Central

    Ganesh, Aravind; Lindsay, Patrice; Fang, Jiming; Kapral, Moira K.; Côté, Robert; Joiner, Ian; Hakim, Antoine M.

    2016-01-01

    Objective: To evaluate the association between the presence of integrated systems of stroke care and stroke case-fatality across Canada. Methods: We used the Canadian Institute of Health Information's Discharge Abstract Database to retrospectively identify a cohort of stroke/TIA patients admitted to all acute care hospitals, excluding the province of Quebec, in 11 fiscal years from 2003/2004 to 2013/2014. We used a modified Poisson regression model to compute the adjusted incidence rate ratio (aIRR) of 30-day in-hospital mortality across time for provinces with stroke systems compared to those without, controlling for age, sex, stroke type, comorbidities, and discharge year. We conducted surveys of stroke care resources in Canadian hospitals in 2009 and 2013, and compared resources in provinces with integrated systems to those without. Results: A total of 319,972 patients were hospitalized for stroke/TIA. The crude 30-day mortality rate decreased from 15.8% in 2003/2004 to 12.7% in 2012/2013 in provinces with stroke systems, while remaining 14.5% in provinces without such systems. Starting with the fiscal year 2009/2010, there was a clear reduction in relative mortality in provinces with stroke systems vs those without, sustained at aIRR of 0.85 (95% confidence interval 0.79–0.92) in the 2011/2012, 2012/2013, and 2013/2014 fiscal years. The surveys indicated that facilities in provinces with such systems were more likely to care for patients on a stroke unit, and have timely access to a stroke prevention clinic and telestroke services. Conclusion: In this retrospective study, the implementation of integrated systems of stroke care was associated with a population-wide reduction in mortality after stroke. PMID:26850979

  13. Nonclinical Factors Associated with 30-Day Mortality after Lung Cancer Resection: An Analysis of 215,000 Patients Using the National Cancer Data Base

    PubMed Central

    Melvan, John N; Sancheti, Manu S; Gillespie, Theresa; Nickleach, Dana C; Liu, Yuan; Higgins, Kristin; Ramalingam, Suresh; Lipscomb, Joseph; Fernandez, Felix G

    2015-01-01

    Background Clinical variables associated with 30-day mortality after lung cancer surgery are well known. However, the effects of non-clinical factors, including insurance coverage, household income, education, type of treatment center, and area of residence, on short term survival are less appreciated. We studied the National Cancer Data Base (NCDB), a joint endeavor of the Commission on Cancer of the American College of Surgeons and the American Cancer Society, to identify disparities in 30-day mortality after lung cancer resection based on these non-clinical factors. Study Design We performed a retrospective cohort analysis of patients undergoing lung cancer resection from 2003-2011, using the NCDB. Data were analyzed using a multivariable logistic regression model to identify risk factors for 30-day mortality. Results 215,645 patients underwent lung cancer resection during our study period. We found that clinical variables such as age, gender, comorbidity, cancer stage, preoperative radiation, extent of resection, positive surgical margins, and tumor size were associated with 30-day mortality after resection. Non-clinical factors including living in lower income neighborhoods with a lesser proportion of high school graduates, and receiving cancer care at a non-academic medical center were also independently associated with increased 30-day postoperative mortality. Conclusions This study represents the largest analysis of 30-day mortality for lung cancer resection to date from a generalizable national cohort. Our results demonstrate that, in addition to known clinical risk factors, several non-clinical factors are associated with increased 30-day mortality after lung cancer resection. These disparities require further investigation to improve lung cancer patient outcomes. PMID:26206651

  14. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke

    PubMed Central

    Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M.; Ko, Sang-Bae; Yoon, Byung-Woo

    2017-01-01

    Background Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. Aim In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. Methods We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Results Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46–3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00–1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10–8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. Conclusions D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer. PMID:28282388

  15. Preadmission use of SSRIs alone or in combination with NSAIDs and 30-day mortality after peptic ulcer bleeding.

    PubMed

    Gasse, Christiane; Christensen, Steffen; Riis, Anders; Mortensen, Preben B; Adamsen, Sven; Thomsen, Reimar W

    2009-01-01

    OBJECTIVE. Use of selective serotonin reuptake inhibitors (SSRIs) increases the risk of upper gastrointestinal bleeding and this risk is amplified by concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs). The aim of the study was to examine the impact of SSRI use alone or in combination with NSAIDs on 30-day mortality after peptic ulcer bleeding (PUB). MATERIAL AND METHODS. A population-based cohort study of patients with a first hospitalization with PUB in three Danish counties was carried out between 1991 and 2005 using medical databases. We calculated 30-day mortality rate ratios (MRRs) associated with the use of SSRIs, alone or in combination with NSAIDs, adjusted for important covariates. RESULTS. Of 7415 patients admitted with PUB, 5.9% used SSRIs only, and 3.8% used SSRIs in combination with NSAIDs, with a 30-day mortality of 11.8% and 11.3%, respectively. Compared with patients who used neither SSRIs nor NSAIDs, the adjusted 30-day MRR was 1.02 (95% CI: 0.76-1.36) for current users of SSRIs and 0.89 (0.62-1.28) for the combined use of SSRIs with NSAIDs. There was a 2.11-fold (95% CI 1.35-3.30) increased risk of death associated with SSRI use starting within 60 days of admission; for those younger than 80 years, the adjusted MRR was 1.54 (0.72-3.29), and 2.57 (1.47-4.49) for those older than 80 years. CONCLUSIONS. Use of SSRIs, alone or in combination with NSAIDs, was not associated with increased 30-day mortality following PUB. However, increased mortality was found in patients who started SSRI therapy, particularly among those older than 80 years. We can only speculate on whether this finding is due to pharmacological action or confounding factors.

  16. Hypotension During Hospitalization for Acute Heart Failure Is Independently Associated With 30-Day Mortality: Findings from ASCEND-HF

    PubMed Central

    Patel, Priyesh A.; Heizer, Gretchen; O’Connor, Christopher M.; Schulte, Phillip J.; Dickstein, Kenneth; Ezekowitz, Justin A.; Armstrong, Paul W.; Hasselblad, Vic; Mills, Roger M.; McMurray, John J.; Starling, Randall C.; Wilson Tang, W. H.; Califf, Robert M.; Hernandez, Adrian F.

    2015-01-01

    Background Outcomes associated with episodes of hypotension while hospitalized are not well understood. Methods and Results Using data from ASCEND-HF, we assessed factors associated with inhospital hypotension and subsequent 30-day outcomes. Patients were classified as having symptomatic or asymptomatic hypotension. Multivariable logistic regression was used to determine factors associated with in-hospital hypotension, and Cox proportional hazards models were used to assess the association between hypotension and 30-day outcomes. We also tested for treatment interaction with nesiritide on 30-day outcomes and the association between inhospital hypotension and renal function at hospital discharge. Overall, 1555/7141 (21.8%) patients had an episode of hypotension, of which 73.1% were asymptomatic and 26.9% were symptomatic. Factors strongly associated with in-hospital hypotension included randomization to nesiritide (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.76–2.23; p<0.001), chronic metolazone therapy (OR 1.74, 95% CI 1.17–2.60; p<0.001), and baseline orthopnea (OR 1.31, 95% CI 1.13–1.52; p=0.001) or S3 gallop (OR 1.21, 95% CI 1.06–1.40; p=0.006). In-hospital hypotension was associated with increased hazards of 30-day mortality (hazard ratio [HR] 2.03, 95% CI 1.57–2.61; p<0.001), 30-day heart failure (HF) hospitalization or mortality (HR 1.58, 95% CI 1.34–1.86; p<0.001), and 30-day all-cause hospitalization or mortality (HR 1.40, 95% CI 1.22–1.61; p<0.001). Nesiritide had no interaction on the relationship between hypotension and 30-day outcomes (interaction p=0.874 for death, p=0.908 for death/HF hospitalization, p=0.238 death/all-cause hospitalization). Conclusions Hypotension while hospitalized for acute decompensated HF is an independent risk factor for adverse 30-day outcomes, and its occurrence highlights the need for modified treatment strategies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT

  17. Factors associated with 30-day mortality in elderly inpatients with community acquired pneumonia during 2 influenza seasons.

    PubMed

    Torner, Núria; Izquierdo, Conchita; Soldevila, Núria; Toledo, Diana; Chamorro, Judith; Espejo, Elena; Fernández-Sierra, Amelia; Domínguez, Angela

    2017-02-01

    Community-acquired pneumonia (CAP) refers to pneumonia unrelated to hospitals or extended-care facilities. The aim of this study was to determine factors associated with 30-day mortality in patients with CAP aged ≥ 65 y admitted to 20 hospitals in 7 Spanish regions during the 2013-14 and 2014-15 influenza seasons. Logistic regression was used to identify factors associated with 30-day mortality. The adjusted model included variables selected by backward elimination with a cut off of < 0.02. A total of 1928 CAP cases were recorded; 60.7% were male, 46.67% were aged 75-84 years, and 30-day mortality was 7.6% (n = 146). Pneumococcal vaccination had a significant protective effect (OR 0.68, 95% CI, 0.48-0.96; p = 0.03) and influenza vaccination in any 3 preceding seasons slight protective effect against CAP (OR 0.72, 95% CI, 0.51-1.02;p = 0.06). Factors significantly associated with 30-day mortality were having a degree of dependence (aOR 3.67, 95% CI, 2.34-5.75; p < 0,001); age ≥ 85 y (OR 3.01, 95% CI, 1.71-5.30; p < 0.001), liver impairment (aOR 2.41, 95% CI, 1.10-5.31; p = 0.03); solid organ neoplasm (aOR 2.24, 95% CI, 1.46-3.45; p < 0.001), impaired cognitive function (aOR 1.93, 95% CI, 1.22-3.05; p = 0.005), and ICU admittance (aOR2.56, 95% CI, 1.27-5.16; p = 0.009); length of stay (aOR 1.56, 95% CI, 1.02 - 2.40; p = 0.04) and cardio-respiratory resuscitation (aOR 7.75, 95% CI, 1.20 - 49.98; p = 0.03). No association was observed for other comorbidities such as chronic pulmonary obstructive disease (COPD) or heart conditions in the adjusted model. Offering both pneumococcal and influenza vaccination to the elderly may improve 30-day mortality in patients with CAP.

  18. 30-Day Mortality and Late Survival with Reinterventions and Readmissions after Open and Endovascular Aortic Aneurysm Repair in Medicare Beneficiaries

    PubMed Central

    Giles, Kristina A; Landon, Bruce E; Cotterill, Philip; O'Malley, A. James; Pomposelli, Frank B; Schermerhorn, Marc L

    2010-01-01

    Objectives Late survival is similar after EVAR and open AAA repair despite a perioperative benefit with EVAR. AAA-related reinterventions are more common after EVAR while laparotomy related reinterventions are more common after open repair. The impact of reinterventions on survival, however, is unknown. We therefore evaluate the rate of reinterventions and readmission after initial AAA repair along with 30-day mortality and the effect upon long term survival. Methods We identified AAA and laparotomy-related reinterventions for propensity score matched cohorts of Medicare beneficiaries (n=45,652) undergoing EVAR and open repair from 2001-2004. Follow-up was up to 6 years. Hospitalizations for ruptured AAA without repair and for bowel obstruction or ventral hernia without abdominal surgery were also recorded. Event rates were calculated per year and are also presented through 6 years of follow-up as events per 100 person years. Thirty day mortality was calculated for each reintervention or readmission. Results Through 6 years, overall reinterventions or readmissions were similar between repair methods but slightly more common after EVAR (7.6 vs. 7.0 per 100 person years, RR 1.1, P < .001). Overall 30 day mortality with any reintervention or readmission was 9.1%. EVAR patients had more ruptures (0.50 vs. 0.09, RR 5.7, P < .001) with a mortality of 28%, but these were uncommon. EVAR patients also had more AAA-related reinterventions through 6 years (3.7 vs. 0.9, RR 4.0, P < .001) (mortality 5.6%), the majority of which were minor endovascular reinterventions (2.4 vs. 0.2, RR 11.4, P < .001) with a 30 day mortality of 3.0%. However, minor open (0.8 vs. 0.5, RR 1.4, P < .001) (mortality 6.9%) and major reinterventions (0.4 vs. 0.2, RR 2.4, P < .001) (mortality 12.1%) were also more common after EVAR than open repair. Conversely, EVAR patients had fewer laparotomy related reinterventions than open patients (1.4 vs. 3.0, RR 0.5, P < .001) (mortality 8.1%) and readmissions

  19. Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study

    PubMed Central

    Guerrero, Mónica; Crisafulli, Ernesto; Liapikou, Adamantia; Huerta, Arturo; Gabarrús, Albert; Chetta, Alfredo; Soler, Nestor; Torres, Antoni

    2016-01-01

    Background and Objective Twenty per cent of chronic obstructive pulmonary disease (COPD) patients are readmitted for acute exacerbation (AECOPD) within 30 days of discharge. The prognostic significance of early readmission is not fully understood. The objective of our study was to estimate the mortality risk associated with readmission for acute exacerbation within 30 days of discharge in COPD patients. Methods The cohort (n = 378) was divided into patients readmitted (n = 68) and not readmitted (n = 310) within 30 days of discharge. Clinical, laboratory, microbiological, and severity data were evaluated at admission and during hospital stay, and mortality data were recorded at four time points during follow-up: 30 days, 6 months, 1 year and 3 years. Results Patients readmitted within 30 days had poorer lung function, worse dyspnea perception and higher clinical severity. Two or more prior AECOPD (HR, 2.47; 95% CI, 1.51–4.05) was the only variable independently associated with 30-day readmission. The mortality risk during the follow-up period showed a progressive increase in patients readmitted within 30 days in comparison to patients not readmitted; moreover, 30-day readmission was an independent risk factor for mortality at 1 year (HR, 2.48; 95% CI, 1.10–5.59). In patients readmitted within 30 days, the estimated absolute increase in the mortality risk was 4% at 30 days (number needed to harm NNH, 25), 17% at 6-months (NNH, 6), 19% at 1-year (NNH, 6) and 24% at 3 years (NNH, 5). Conclusion In conclusion a readmission for AECOPD within 30 days is associated with a progressive increased long-term risk of death. PMID:26943928

  20. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales

    PubMed Central

    McAllister, Katherine S.L.; Ludman, Peter F.; Hulme, William; de Belder, Mark A.; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A.; Sperrin, Matthew; Buchan, Iain E.

    2016-01-01

    Background The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. Methods and results The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. Conclusion We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. PMID:26942330

  1. Extent of Surgery Does Not Influence 30-Day Mortality in Surgery for Metastatic Bone Disease: An Observational Study of a Historical Cohort.

    PubMed

    Sørensen, Michala Skovlund; Hindsø, Klaus; Hovgaard, Thea Bechmann; Petersen, Michael Mørk

    2016-04-01

    Estimating patient survival has hitherto been the main focus when treating metastatic bone disease (MBD) in the appendicular skeleton. This has been done in an attempt to allocate the patient to a surgical procedure that outlives them. No questions have been addressed as to whether the extent of the surgery and thus the surgical trauma reduces survival in this patient group. We wanted to evaluate if perioperative parameters such as blood loss, extent of bone resection, and duration of surgery were risk factors for 30-day mortality in patients having surgery due to MBD in the appendicular skeleton. We retrospectively identified 270 consecutive patients who underwent joint replacement surgery or intercalary spacing for skeletal metastases in the appendicular skeleton from January 1, 2003 to December 31, 2013. We collected intraoperative (duration of surgery, extent of bone resection, and blood loss), demographic (age, gender, American Society of Anesthesiologist score [ASA score], and Karnofsky score), and disease-specific (primary cancer) variables. An association with 30-day mortality was addressed using univariate and multivariable analyses and calculation of odds ratio (OR). All patients were included in the analysis. ASA score 3 + 4 (OR 4.16 [95% confidence interval, CI, 1.80-10.85], P = 0.002) and Karnofsky performance status below 70 (OR 7.34 [95% CI 3.16-19.20], P < 0.001) were associated with increased 30-day mortality in univariate analysis. This did not change in multivariable analysis. No parameters describing the extent of the surgical trauma were found to be associated with 30-day mortality. The 30-day mortality in patients undergoing surgery for MBD is highly dependent on the general health status of the patients as measured by the ASA score and the Karnofsky performance status. The extent of surgery, measured as duration of surgery, blood loss, and degree of bone resection were not associated with 30-day mortality.

  2. Radiologic Findings and Patient Factors Associated with 30-Day Mortality after Surgical Evacuation of Subdural Hematoma in Patients Less Than 65 Years Old

    PubMed Central

    Han, Myung-Hoon; Ryu, Je Il; Kim, Choong Hyun; Kim, Jae Min; Cheong, Jin Hwan; Yi, Hyeong-Joong

    2017-01-01

    Objective The purpose of this study is to evaluate the associations between 30-day mortality and various radiological and clinical factors in patients with traumatic acute subdural hematoma (SDH). During the 11-year study period, young patients who underwent surgery for SDH were followed for 30 days. Patients who died due to other medical comorbidities or other organ problems were not included in the study population. Methods From January 1, 2004 to December 31, 2014, 318 consecutive surgically-treated traumatic acute SDH patients were registered for the study. The Kaplan–Meier method was used to analyze 30-day survival rates. We also estimated the hazard ratios of various variables in order to identify the independent predictors of 30-day mortality. Results We observed a negative correlation between 30-day mortality and Glasgow coma scale score (per 1-point score increase) (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.52–0.70; p<0.001). In addition, use of antithrombotics (HR, 2.34; 95% CI, 1.27–4.33; p=0.008), history of diabetes mellitus (HR, 2.28; 95% CI, 1.20–4.32; p=0.015), and accompanying traumatic subarachnoid hemorrhage (hazard ratio, 2.13; 95% CI, 1.27–3.58; p=0.005) were positively associated with 30-day mortality. Conclusion We found significant associations between short-term mortality after surgery for traumatic acute SDH and lower Glasgow Coma Scale scores, use of antithrombotics, history of diabetes mellitus, and accompanying traumatic subarachnoid hemorrhage at admission. We expect these findings to be helpful for selecting patients for surgical treatment of traumatic acute SDH, and for making accurate prognoses. PMID:28264246

  3. Predictors of 30-Day Mortality and 90-Day Functional Recovery after Primary Intracerebral Hemorrhage : Hospital Based Multivariate Analysis in 585 Patients

    PubMed Central

    2009-01-01

    Objective The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. Methods Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. Results Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. Conclusion The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decision-making, when advising patients or family members about the prognosis of PICH and when planning intervention trials. PMID:19609417

  4. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  5. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    PubMed

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-03-02

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates.

  6. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

    PubMed Central

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

  7. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    PubMed Central

    Gebauer, Katrin; Diller, Gerhard-Paul; Kaleschke, Gerrit; Kerckhoff, Gregor; Malyar, Nasser; Meyborg, Matthias; Reinecke, Holger; Baumgartner, Helmut

    2012-01-01

    Background. Transcatheter aortic valve implantation (TAVI) is widely used in high risk patients (pts) with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI). We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%). AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%). Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P = 0.09). Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P < 0.0001) and long-term mortality (43% versus 18%, P < 0.0001) were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P = 0.03). Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P = 0.32) and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential. PMID:23365748

  8. 90-day postoperative mortality is a legitimate measure of hepatopancreatobiliary surgical quality

    PubMed Central

    Mise, Yoshihiro; Vauthey, Jean-Nicolas; Zimmitti, Giuseppe; Parker, Nathan H.; Conrad, Claudius; Aloia, Thomas A.; Lee, Jeffery E.; Fleming, Jason B.; Katz, Matthew H. G.

    2015-01-01

    Objective To investigate the legitimacy of 90-day mortality as a measure of hepatopancreatobiliary quality. Summary Background Data The 90-day mortality rate has been increasingly but not universally reported after hepatopancreatobiliary surgery. The legitimacy of this definition as a measure of surgical quality has not been evaluated. Methods We retrospectively reviewed the causes of all deaths that occurred within 365 postoperative days in patients undergoing hepatectomy (n = 2811) and/or pancreatectomy (n = 1092) from January 1997 through December 2012. The rates of surgery-related, disease-related, and overall mortality within 30 days, within 30 days or during the index hospitalization, within 90 days, and within 180 days following surgery were calculated. Results Seventy-nine (3%) surgery-related deaths and 92 (3%) disease-related deaths occurred within 365 days after hepatectomy. Twenty (2%) surgery-related deaths and 112 (10%) disease-related deaths occurred within 365 days after pancreatectomy. The overall mortality rates at 99 day and 118 days optimally reflected surgery-related mortality following hepatobiliary and pancreatic operations, respectively. The 90-day overall mortality rate was a less sensitive but equivalently specific measure of surgery-related death. Conclusions and Relevance The 99-day and 118-day definitions of postoperative mortality optimally reflected surgery-related mortality following hepatobiliary and pancreatic operations, respectively. However, among commonly reported metrics, the 90-day overall mortality rate represents a legitimate measure of surgical quality. PMID:25590497

  9. [Postoperative peritonitis: pronostic factors of mortality].

    PubMed

    Marzougui, Y; Missaoui, K; Hannachi, Z; Dhibi, Y; Kouka, J; Dziri, C; Houissa, M

    2014-01-01

    The postoperative peritonitis (POP) remains formidable conditions due to a high mortality rate of between 20 and 80%. The purpose of this study is to identify risk factors for mortality. This study is a retrospective, descriptive analysis carried out over a period of 09 years (1/1/2003 - 30/11/2011) and interesting 102 patients supported for POP following general surgery. Achieved in department of General Surgery B Charles Nicolle hospital Tunis. The parameters measured included epidemiological data, data related to the Initial Surgical Intervention and reoperation for POP, terms of management and evolution. Bacteriological data were also seized. The incidence of POP was 0.90%. The average age of our patients was 58 +/- 19 years with a sex ratio of 1.08. Forty-seven percent of our patients belonged to the ASAII class. The initial operation was performed urgently in 49 patients (48%) with a majority belonging to the class II Altemeier (49.01%). Colorectal pathology (373%) and hepatobiliay (176%) were the most frequent reasons for the initial intervention. The frequency of clinical signs were fever (75.5%), hypothermia (6.9%), abdominal pain (725%), abdominal distension (46.1%), productive gastric aspiration (30.4%), abdominal defense (25.5%), externalizing the digestive fluid (25.5%), vomiting (19.6%), diarrhea (12.7%), tachycardia (569%), oliguria (42.2%), respiratory failure (40.2%), hypotension (35.3%), neuropsychiatric disorders ( 23.5%) and jaundice (69%). The treatment period was 2.95 +/- 3.16 days. The surgical recovery time was 78 days +/- 5.66. At the time of reoperation, the APACHE II score was 8.43 +/- 6.26 and 25.1 +/- MPI score 8.53. The POP was generalized in 52.9% of cases with purulent peritoneal fluid in 51% of cases. The most common cause was the dropping of the anastomosis (59.8%). Empirical antibiotic therapy was appropriate in 69.44 % of cases. The mortality rate was 39.2%. Multivariate analysis using multiple logistic regression identified the

  10. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  11. Obstructive Sleep Apnea Screening and Postoperative Mortality in a Large Surgical Cohort

    PubMed Central

    Willingham, Mark D.; Abdallah, Arbi Ben; Helsten, Daniel L.; Bedair, Bahaa A.; Thomas, James; Duntley, Stephen; Avidan, Michael S.

    2015-01-01

    Objective A recent investigation at Barnes-Jewish Hospital located in St. Louis, Missouri, found that an estimated 22% of adults presenting for inpatient surgery screened as high risk for obstructive sleep apnea (OSA). Surgical patients with OSA have multiple comorbidities and are at increased risk for perioperative complications. Our objective was to determine whether a prior diagnosis of OSA, or a positive screen for OSA is associated with increased risk for 30 days and one year mortality. Methods B-J APNEAS (Barnes-Jewish Apnea Prevalence in Every Admission Study) was a prospective cohort study. Unselected adult surgical patients at Barnes Jewish Hospital were prospectively enrolled between February 2006 and April 2010. All patients completed preoperative OSA screening and those who were at risk for OSA according to a combination of the Berlin and Flemons screening tools received targeted postoperative interventions. STOP and STOP-BANG scores were also obtained. Results Overall, the sample included 14,962 patients, of whom 1,939 (12.9%) reported a history of OSA. All four screening tools identified a high prevalence of undiagnosed patients at risk for OSA (9.5% to 41.6%), but agreement among screens was not strong with Kappa ranging from 0.225 to 0.611. There was no significant difference in 30 day postoperative mortality between patients with possible OSA (based on their history or on a positive OSA screen with any of the four instruments) and the rest of the surgical population. Significant differences in one-year mortality were noted between the low and high-risk groups as identified by the Flemons’ (4.96% versus 6.91%; p <0.0001), STOP (5.28% versus 7.57%; p <0.0001) and STOP-BANG (4.13% versus 7.45%; p <0.0001) screens. After adjusting for risk factors, none of the OSA screening tools independently predicted mortality rate up to one year postoperatively. Conclusion Neither a prior diagnosis of OSA, or a positive screen for OSA risk was associated with

  12. Central Venous Pressure After Coronary Artery Bypass Surgery: Does it Predict Postoperative Mortality or Renal Failure?

    PubMed Central

    Williams, Judson B.; Peterson, Eric D.; Wojdyla, Daniel; Ferguson, T. Bruce; Smith, Peter K.; Milano, Carmelo A.; Lopes, Renato D.

    2015-01-01

    Background While hemodynamic monitoring is often performed following coronary artery bypass grafting (CABG), the relationship between postoperative central venous pressure (CVP) measurement and clinical outcomes is unknown. Methods Detailed clinical data were analyzed from 2,390 randomly selected patients undergoing high risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database from 2004 to 2005. Eligible patients underwent elective/urgent isolated CABG with an ejection fraction < 40%, or elective/urgent CABG at age ≥65 years with diabetes or a glomerular filtration rate 60 mL/min per 1.73 m2. Correlation between post-operative CVP and in-hospital / 30-day mortality and renal failure was assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling. Results Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients’ CVP 6 hours post-operation was strongly associated with in-hospital and 30 day mortality: odds ratio (OR) 1.5 (95% confidence interval [CI] 1.23, 1.87) for every 5 mmHg increase in CVP, p<0.0001. This association remained significant after risk-adjustment for cardiac index: adjusted OR 1.44 (95% CI 1.10, 1.89), p<0.01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR 1.5 (95% CI 1.28, 1.86) for every 5 mmHg increase in CVP, p<0.0001. Conclusion Patients’ central venous pressure at 6 hours following CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether post-operative CVP can be used to guide intervention and improve outcomes. PMID:25035048

  13. Advancing Age and 30-Day Adverse Outcomes Following Non-Emergent General Surgical Operations

    PubMed Central

    Gajdos, Csaba; Kile, Deidre; Hawn, Mary T.; Finlayson, Emily; Henderson, William G.; Robinson, Thomas N.

    2014-01-01

    Background While some single center studies have demonstrated that major surgical operations are safe to perform in older adults, most multicenter database studies find advancing age to independently predict adverse postoperative outcomes. We hypothesized that thirty-day postoperative mortality, complications, failure to rescue rates and postoperative length of stay will increase with advancing age. Design Retrospective cohort study. Setting Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participants Patients undergoing non-emergent major general surgical operations between 2005 and 2008 were studied. Measures Postoperative outcomes of interest were complications occurring within 30 days of the index operation, return to OR within 30 days, failure to rescue after a postoperative complication, post-surgical length of stay and 30 day mortality. Results A total of 165,600 patients were studied. The rates of postoperative mortality, overall morbidity, and each type of postoperative complication increased as age increased. The rates of failure to rescue after each type of postoperative complication also increased with age. Mortality rates in patients ≥80 following renal insufficiency (43.3%), stroke (36.5%), myocardial infarction (35.6%), and pulmonary complications (25-39%) were particularly high. Median postoperative length of stay increased with age following surgical site infection, UTI, pneumonia, return to OR, and overall morbidity, but not after venous thromboembolism, stroke, myocardial infarction, renal insufficiency, failure to wean from the ventilator or reintubations. Conclusion Thirty-day mortality, complications and failure to rescue rates increase with advancing age following non-emergent general surgical operations. Patients over 80 years of age have especially high mortality following renal, cardiovascular, and pulmonary complications. As patient age advances, surgeons need to be

  14. Association between day of the week of elective surgery and postoperative mortality

    PubMed Central

    Dubois, Luc; Vogt, Kelly; Vinden, Chris; Winick-Ng, Jennifer; McClure, J. Andrew; Roshanov, Pavel S.; Bell, Chaim M.; Garg, Amit X.

    2017-01-01

    BACKGROUND: In prior studies, higher mortality was observed among patients who had elective surgery on a Friday rather than earlier in the week. We investigated whether mortality after elective surgery was associated with day of the week of surgery in a Canadian population and whether the association was influenced by surgeon experience and volume. METHODS: We conducted a population-based retrospective cohort study in the province of Ontario, Canada. We included adults who underwent 1 of 12 elective daytime surgical procedures from Apr. 1, 2002, to Dec. 31, 2012. The primary outcome was 30-day mortality. We used generalized estimating equations to compare outcomes for surgeries performed on different days of the week, adjusting for patient and surgeon factors. RESULTS: A total of 402 899 procedures performed by 1691 surgeons met our inclusion criteria. The median length of hospital stay was 6 (interquartile range 5–8) days. Surgeon experience varied significantly by day of week (p < 0.001), with surgeons operating on Fridays having the least experience. Nearly all of the patients who had their procedure on a Friday had postoperative care on the weekend, as compared with 49.1% of those whose surgery was on a Monday (p < 0.001). We found no difference in the 30-day mortality between procedures performed on Fridays and those performed on Mondays (adjusted odds ratio 1.08, 95% confidence interval 0.97–1.21). INTERPRETATION: Although surgeon experience differed across days of the week, the risk of 30-day mortality after elective surgery was similar regardless of which day of the week the procedure took place. PMID:27754897

  15. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians

    PubMed Central

    Kim, Young Wan; Kim, Ik Yong

    2016-01-01

    Purpose To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69−14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8−9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13−8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07−18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43−9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15−6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44−8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39−14.09], P=0.012) were significant prognostic factors for 1-year mortality. Conclusion Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality. PMID:27279741

  16. Predictive value of NT-proBNP for 30-day mortality in patients with non-ST-elevation acute coronary syndromes: a comparison with the GRACE and TIMI risk scores

    PubMed Central

    Schellings, Dirk AAM; Adiyaman, Ahmet; Dambrink, Jan-Henk E; Gosselink, AT Marcel; Kedhi, Elvin; Roolvink, Vincent; Ottervanger, Jan Paul; van’t Hof, Arnoud WJ

    2016-01-01

    Background The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts outcome in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Whether NT-proBNP has incremental prognostic value beyond established risk strategies is still questionable. Purpose To evaluate the predictive value of NT-proBNP for 30-day mortality over and beyond the Global Registry of Acute Coronary Events (GRACE) and Thrombolysis In Myocardial Infarction (TIMI) risk scores in patients with NSTE-ACS. Methods Patients included in our ACS registry were candidates. NT-proBNP levels on admission were measured and the GRACE and TIMI risk scores were assessed. We compared the predictive value of NT-proBNP to both risk scores and evaluated whether NT-proBNP improves prognostication by using receiver operator curves and measures of discrimination improvement. Results A total of 1324 patients were included and 50 patients died during follow-up. On logistic regression analysis NT-proBNP and the GRACE risk score (but not the TIMI risk score) both independently predicted mortality at 30 days. The predictive value of NT-proBNP did not differ significantly compared to the GRACE risk score (area under the curve [AUC]) 0.85 vs 0.87 p=0.67) but was considerably higher in comparison to the TIMI risk score (AUC 0.60 p<0.001). Adjustment of the GRACE risk score by adding NT-proBNP did not improve prognostication: AUC 0.86 (p=0.57), integrated discrimination improvement 0.04 (p=0.003), net reclassification improvement 0.12 (p=0.21). Conclusion In patients with NSTE-ACS, NT-proBNP and the GRACE risk score (but not the TIMI risk score) both have good and comparable predictive value for 30-day mortality. However, incremental prognostic value of NT-proBNP beyond the GRACE risk score could not be demonstrated. PMID:27920547

  17. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery.

    PubMed

    Sherrod, Brandon A; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients

  18. Worse Prognosis in Heart Failure Patients with 30-Day Readmission

    PubMed Central

    Tung, Ying-Chang; Chou, Shing-Hsien; Liu, Kuan-Liang; Hsieh, I-Chang; Wu, Lung-Sheng; Lin, Chia-Pin; Wen, Ming-Shien; Chu, Pao-Hsien

    2016-01-01

    Background Heart failure (HF) readmission results in substantial expenditure on HF management. This study aimed to evaluate the readmission rate, outcome, and predictors of HF readmission. Methods Patients with reduced left ventricular ejection fraction (LVEF < 40%) who were admitted for acute decompensation of de novo HF were enrolled to analyze readmission rate, mortality and predictors of readmission. Results A total of 433 de novo HF patients with LVEF < 40% were enrolled during the period August 2013 to December 2014. The in-hospital and 6-month mortality rates were 3.9% and 15.2%, respectively. In those patients surviving the index HF hospitalization, the 30-day and 6-month readmission rates were 10.9% and 27%, respectively. At the end of the 6-month follow-up, the readmission group had higher mortality than the non-readmission group (27.66% vs. 10.36%; p = 0.001). The survivors of the 30-day readmission had similar mortality rates at 6 months, regardless of the cause of readmission (cardiovascular vs. non-cardiovascular: 25% vs. 30.43%, p = 0.677). Among all the parameters, prescription of beta blockers independently reduced the risk of 30-day readmission (odds ratio 0.15; 95% confidence interval 0.02-0.99; p = 0.049). Conclusions Those HF patients who suffered from 30-day readmission had worse prognosis at the 6-month follow-up. Regardless of the readmission causes, the patients surviving the 30-day readmission had similar mortality rates at 6-month follow-up. These results underscored the importance of reducing readmission as a means to improve HF outcome. PMID:27899857

  19. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit

    PubMed Central

    Özbilgin, Şule; Hancı, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-01-01

    Abstract The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality. At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed. A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality. The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group. PMID

  20. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

    PubMed

    Özbilgin, Şule; Hanc, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-10-01

    The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

  1. Comparing three clinical prediction rules for primarily predicting the 30-day mortality of patients with pulmonary embolism: The “Simplified Revised Geneva Score,” the “Original PESI,” and the “Simplified PESI”

    PubMed Central

    Tamizifar, Babak; Fereyduni, Farid; Esfahani, Morteza Abdar; Kheyri, Saeed

    2016-01-01

    Background: Patients with suspected pulmonary embolism (PE) should be evaluated for the clinical probability of PE using an applicable risk score. The Geneva prognostic score, the PE Severity Index (PESI), and its simplified version (sPESI) are well-known clinical prognostic scores for PE. The purpose of this study was to analyze these clinical scores as prognostic tools. Materials and Methods: A historical cohort study was conducted on patients with acute PE in Al-Zahra Teaching Hospital, Isfahan, Iran, from June 2013 to August 2014. To compare survival in the 1-month follow-up and factor-analyze mortality from the survival graph, Kaplan–Meier, and log-rank logistic regression were applied. Results: Two hundred and twenty four patients were assigned to two “low risk” and “high risk” groups using the three versions of “Simplified PESI, Original PESI, and Simplified Geneva.” They were followed for a period of 1 month after admission. The overall mortality rate within 1 month from diagnosis was about 24% (95% confidence interval, 21.4–27.2). The mortality rate of low risk PE patients was about 4% in the PESI, 17% in the Geneva, and <1% in the simplified PESI scales (P < 0.005). The mortality rate among high risk patients was 33%, 33.5%, and 27.5%, respectively. Conclusions: Among patients with acute PE, the simplified PESI model was able to accurately predict mortality rate for low risk patients. Among high risk patients, however, the difference between the three models in predicting prognosis was not significant. PMID:27656606

  2. Risk factors for mortality in postoperative peritonitis in critically ill patients

    PubMed Central

    Launey, Yoann; Duteurtre, Benjamin; Larmet, Raphaëlle; Nesseler, Nicolas; Tawa, Audrey; Mallédant, Yannick; Seguin, Philippe

    2017-01-01

    AIM To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP). METHODS This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded. RESULTS A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P < 0.001), postoperative medical complications (OR = 6.02; 95%CI: 1.95-18.55, P < 0.001) and the number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality. CONCLUSION The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality. PMID:28224107

  3. Ares I-X 30 Day Report

    NASA Technical Reports Server (NTRS)

    Ess, Bob; Smith, Marshall

    2009-01-01

    This slide presentation represents the 30 day report on the Ares I-X test flight. Included in the review is information on the following areas: (1) Ground Systems, (2) Guidance, Navigation and Control, (3) Roll Response, (4) Vehicle Response, (5) Control System Performance, (6) Structural Damping, (7) Thrust Oscillation, (8) Stage Separation, (9) Connector Assessment, (10) USS Splashdown, (11) Data Recorder and (12) FS Hardware Assessment.

  4. [Reducing postoperative morbidity and mortality with preoperative risk evaluation and with refined perioperative medical care].

    PubMed

    Uchida, Kanji

    2012-05-01

    Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.

  5. Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

    PubMed Central

    Rotevatn, Torill A.; Bøggild, Henrik; Olesen, Christinna R.; Torp-Pedersen, Christian; Mortensen, Rikke N.; Jensen, Per F.; Overgaard, Charlotte

    2017-01-01

    Objective To investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty. Methods A total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0–168 g/week, >168–252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis. Results We identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0–168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0–168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers. Conclusions This study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations. PMID:28306737

  6. Analysis of hyponatraemia associated post-operative mortality in 3897 hip fracture patients.

    PubMed

    Tinning, Craig G; Cochrane, Lynda A; Singer, Brian R

    2015-07-01

    Hyponatraemia is common in hospitalised patients. In recent years the relationship between hyponatraemia and bone metabolism, falls and fractures has become more established. This study evaluates the prevalence of hyponatraemia (plasma sodium<135mmol/l) in 3897 patients undergoing operative treatment for hip fracture and the relationship between hyponatraemia and mortality in these patients. Hyponatraemia was an independent risk factor for increased post-operative mortality on multivariate analysis. Median age at admission was 83 years. Hyponatraemia was present in 19.1% of patients with hip fracture on admission, 29.5% of patients in the first 24h post-operatively and 20% of patients at discharge. There was a significant association between hyponatraemia and time from admission to surgery indicating that patients admitted with hyponatraemia waited longer. The median follow-up time was 863 (range 0-4352) days. There were 2460 deaths (63.1% of the original 3897 patients) prior to the censor date. A total of 1144 patients (29.4% of the original 3897 patients) died within 12 months of discharge. Median time to death for patients with and without hyponatraemia on admission was 34 months (SE 1.7 months) and 41 months (SE 2.5 months) respectively (p=0.003). Median time to death for patients with and without hyponatraemia within 24h post-operatively was 35 months (SE 2.5 months) and 42 months (SE 1.7 months) respectively (p=0.004). Following elimination of other independent variables associated with increased mortality, hyponatraemia on admission was associated with an increased risk of death (adjusted HR 1.15, p=0.005). Post-operative hyponatraemia was also associated with an increased risk of death (adjusted HR 1.15, p=0.006). Trends suggested that hyponatraemia within 48h of discharge was associated with an increased risk of death (adjusted HR 1.15, p=0.636). Hyponatraemia is common in elderly patients with hip fractures both at initial presentation and during

  7. Impact of right-handedness on anaesthetic sensitivity, intra-operative awareness and postoperative mortality.

    PubMed

    Rao, S; Huverserian, A R; Ben Abdallah, A; Lees, K; Willingham, M D; Burnside, B A; Villafranca, A J; Glick, D B; Jacobsohn, E; Avidan, M S

    2014-08-01

    Anatomical, neurological and behavioural research has suggested differences between the brains of right- and non-right-handed individuals, including differences in brain structure, electroencephalogram patterns, explicit memory and sleep architecture. Some studies have also found decreased longevity in left-handed individuals. We therefore aimed to determine whether handedness independently affects the relationship between volatile anaesthetic concentration and the bispectral index, the incidence of definite or possible intra-operative awareness with explicit recall, or postoperative mortality. We studied 5585 patients in this secondary analysis of data collected in a multicentre clinical trial. There were 4992 (89.4%) right-handed and 593 (10.6%) non-right-handed patients. Handedness was not associated with (a) an alteration in anaesthetic sensitivity in terms of the relationship between the bispectral index and volatile anaesthetic concentration (estimated effect on the regression relationship -0.52 parallel shift; 95% CI -1.27 to 0.23, p = 0.17); (b) the incidence of intra-operative awareness with 26/4992 (0.52%) right-handed vs 1/593 (0.17%) non-right-handed (difference = 0.35%; 95% CI -0.45 to 0.63%; p = 0.35); or (c) postoperative mortality rates (90-day relative risk for non-right-handedness 1.19, 95% CI 0.76-1.86; p = 0.45). Thus, no change in anaesthetic management is indicated for non-right-handed patients.

  8. Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support.

    PubMed Central

    Mullen, J L; Buzby, G P; Matthews, D C; Smale, B F; Rosato, E F

    1980-01-01

    A previously developed and validated predictive nutritional assessment model (Prognostic Nutritional Index) was applied to a heterogenous surgical population. Without knowledge of the then undeveloped PNI, adequate preoperative nutritional repletion (TPN) was provided on clinical indications alone to 50 of 145 patients with the remaining 95 patients receiving no preoperative total parenteral nutrition. Analysis of the two groups found no baseline differences in nutritional status, type and severity of disease and/or operative therapy, and other potentially important variables. In the high-risk stratified group as defined by admission nutritional assessment and calculated PNI (greater than or equal to 50%), adequate preoperative TPN reduced postoperative complications 2.5-fold (p < 0.01), postoperative major sepsis six-fold (p < 0.005) and mortality five-fold (p < 0.01). Clinical "eyeball" evaluation of nutritional status cannot identify high-risk individuals. This nutritional assessment predictive model (PNI) identifies the subset of operative candidates in whom adequate preoperative nutritional support significantly reduces operative morbidity and/or mortality. PMID:6776917

  9. Do Elderly Patients Experience Increased Perioperative or Postoperative Morbidity or Mortality When Given Neoadjuvant Chemoradiation Before Esophagectomy?

    SciTech Connect

    Fogh, Shannon E.; Yu, Anthony; Kubicek, Gregory J.; Scott, Walter; Mitchell, Edith; Rosato, Ernest L.; Berger, Adam C.

    2011-08-01

    Background: The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications. Methods and Materials: We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy. The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers. Results: Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2). Conclusion: No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients.

  10. Prediction of Mortality and Postoperative Complications using the Hip-Multidimensional Frailty Score in Elderly Patients with Hip Fracture

    PubMed Central

    Choi, Jung-Yeon; Cho, Kwan-Jae; Kim, Sun-wook; Yoon, Sol-Ji; Kang, Min-gu; Kim, Kwang-il; Lee, Young-Kyun; Koo, Kyung-Hoi; Kim, Cheol-Ho

    2017-01-01

    High mortality and dependent living after hip fracture pose a significant public health concern. Retrospective study was conducted with 481 hip fracture patients (≥65 years of age) undergoing surgery from March 2009 to May 2014. The Hip-MFS was calculated by Comprehensive Geriatric Assessment (CGA). The primary outcome was the 6-month all-cause mortality rate. The secondary outcomes were 1-year all-cause mortality, postoperative complications and prolonged hospital stay, and institutionalization. Thirty-five patients (7.3%) died within 6 months after surgery (median [interquartile range], 2.9 [1.4–3.9] months). The fully adjusted hazard ratio per 1 point increase in Hip-MFS was 1.458 (95% confidence interval [CI]: 1.210–1.758) for 6-months mortality and odds ratio were 1.239 (95% CI: 1.115–1.377), 1.156 (95% CI: 1.031–1.296) for postoperative complications and prolonged total hospital stay, respectively. High-risk patients (Hip-MFS > 8) showed higher risk of 6-month mortality (hazard ratio: 3.545, 95% CI: 1.466–8.572) than low-risk patients after adjustment. Hip-MFS successfully predict 6-month mortality, postoperative complications and prolonged hospital stay in elderly hip fracture patients after surgery. Hip-MFS more precisely predict 6-month mortality than age or existing tools (P values of comparison of ROC curve: 0.002, 0.004, and 0.044 for the ASA classification, age and NHFS, respectively). PMID:28233870

  11. Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery.

    PubMed

    Bokshan, Steven L; Han, Alex L; DePasse, J Mason; Eltorai, Adam E M; Marcaccio, Stephen E; Palumbo, Mark A; Daniels, Alan H

    2016-11-01

    Sarcopenia is the loss of muscle mass associated with aging and advanced disease. This study retrospectively examined patients older than 55 years (N=46) who underwent thoracolumbar spine surgery between 2003 and 2015. Each patient's comorbidity burden was determined using the Charlson Comorbidity Index, and the Mirza Surgical Invasiveness Index was used to measure procedural complexity. Sarcopenia was diagnosed by measuring the total cross-sectional area of the psoas muscle at the L4 vertebrae using perioperative computed tomography scans. Of the 46 patients assessed, 16 were in the lowest third for L4 total psoas area (sarcopenic). Average follow-up time was 5.2 years (range, 6 days to 12.7 years). The cohort of patients with sarcopenia was significantly older than the cohort without sarcopenia (mean age, 76.4 vs 69.9 years; P=.01) but did not have a significantly different mean Charlson Comorbidity Index (3.3 vs 2.0; P=.32) or mean Mirza Surgical Invasiveness Index (7.1 vs 7.0; P=.49). Patients with sarcopenia had a hospital length of stay 1.7-fold longer than those without sarcopenia (8.1 vs 4.7 days; P=.02) and a 3-fold increase in postoperative in-hospital complications (1.2 vs 0.4; P=.02), and they were more likely to require discharge to a rehabilitation or nursing facility (81.2% vs 43.3%; P=.006). Patients with sarcopenia had a significantly lower cumulative survival (log rank=0.007). All 4 deaths occurred among patients with sarcopenia. Patients with sarcopenia have a significantly increased risk of in-hospital complications, longer length of stay, increased rates of discharge to rehabilitation facilities, and increased mortality following thoracolumbar spinal surgery, making sarcopenia a useful perioperative risk stratification tool. [Orthopedics. 2016; 39(6):e1159-e1164.].

  12. Association between Postoperatively Developed Atrial Fibrillation and Long-Term Mortality after Esophagectomy in Esophageal Cancer Patients: An Observational Study

    PubMed Central

    Chin, Ji-Hyun; Moon, Young-Jin; Jo, Jun-Young; Han, Yun A.; Kim, Hyeong Ryul; Choi, In-Cheol

    2016-01-01

    Background Newly developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. However, the clinical implications of AF have not been fully elucidated in these patients. This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy. Methods This study evaluated 583 patients undergoing esophagectomy, from January 2005 to April 2012. AF was defined as newly developed postoperative AF requiring treatment. The risk factors for AF and the association between AF and mortality were evaluated. The long-term mortality was the all-cause mortality, for which the cutoff date was May 31, 2014. Results AF developed in 63 patients (10.8%). Advanced age (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.056–1.144, P < 0.001), preoperative calcium channel blocker (CCB) (OR 2.339, 95% CI 1.143–4.786, P = 0.020), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR 0.206, 95% CI 0.067–0.635, P = 0.006) were associated with the incidence of AF. The Kaplan-Meier curve showed a significantly lower survival rate in the AF group compared to the non-AF group (P = 0.045), during a median follow-up of 50.7 months. The multivariable analysis revealed associations between AF and the 1-year mortality (hazard ratio [HR] 2.556, 95% CI 1.430–4.570, P = 0.002) and between AF and the long-term mortality (HR 1.507, 95% CI 1.003–2.266, P = 0.049). Conclusions In esophageal cancer patients, the advanced age and the preoperative medications (CCB, ACEI or ARB) were associated with the incidence of AF. Furthermore, postoperatively developed AF was associated with mortality in esophageal cancer patients after esophagectomy, suggesting that a close surveillance might be required in patients who showed AF during postoperative period. PMID:27148877

  13. The AFC Score: Validation of a 4-Item Predicting Score of Postoperative Mortality After Colorectal Resection for Cancer or Diverticulitis

    PubMed Central

    Alves, Arnaud; Panis, Yves; Mantion, Georges; Slim, Karem; Kwiatkowski, Fabrice; Vicaut, Eric

    2007-01-01

    Objective: The aim of the present prospective study was to validate externally a 4-item predictive score of mortality after colorectal surgery (the AFC score) by testing its generalizability on a new population. Summary Background Data: We have recently reported, in a French prospective multicenter study, that age older than 70 years, neurologic comorbidity, underweight (body weight loss >10% in <6 months), and emergency surgery significantly increased postoperative mortality after resection for cancer or diverticulitis. Patients and Methods: From June to September 2004, 1049 consecutive patients (548 men and 499 women) with a mean age of 67 ± 14 years, undergoing open or laparoscopic colorectal resection, were prospectively included. The AFC score was validated in this population. We assessed also the predictive value of other scores, such as the “Glasgow” score and the ASA score. To express and compare the predictive value of the different scores, a receiver operating characteristic curve was calculated. Results: Postoperative mortality rate was 4.6%. Variables already identified as predictors of mortality and used in the AFC score were also found to be associated with a high odds ratio in this study: emergency surgery, body weight loss >10%, neurologic comorbidity, and age older than 70 years in a multivariate logistic model. The validity of the AFC score in this population was found very high based both on the Hosmer-Lemeshow goodness of fit test (P = 0.37) and on the area under the ROC curve (0.89). We also found that discriminatory capacity was higher than other currently used risk scoring systems such as the Glasgow or ASA score. Conclusion: The present prospective study validated the AFC score as a pertinent predictive score of postoperative mortality after colorectal surgery. Because it is based on only 4 risk factors, the AFC score can be used in daily practice. PMID:17592296

  14. 77 FR 62518 - Submission for OMB Review; Comment Request (30-Day FRN); Prostate, Lung, Colorectal and Ovarian...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-15

    ... their full effect if received within 30 days of the date of this publication. Proposed Collection... ovarian cancer can reduce mortality from these cancers which currently cause an estimated 255,700 deaths... term effects of the screening on cancer incidence and mortality for the four targeted cancers....

  15. Minor Postoperative Increases of Creatinine Are Associated with Higher Mortality and Longer Hospital Length of Stay in Surgical Patients

    PubMed Central

    Kork, Felix; Balzer, Felix; Spies, Claudia D.; Wernecke, Klaus-Dieter; Ginde, Adit A.; Jankowski, Joachim; Eltzschig, Holger K.

    2015-01-01

    Background Surgical patients frequently experience postoperative increases in creatinine levels. The authors hypothesized that even small increases in postoperative creatinine levels are associated with adverse outcomes. Methods The authors examined the association of postoperative changes from preoperative baseline creatinine with all-cause in-hospital mortality and hospital length of stay (HLOS) in a retrospective analysis of surgical patients at a single tertiary care center between January 2006 and June 2012. Results The data of 39,369 surgical patients (noncardiac surgery n = 37,345; cardiac surgery n = 2,024) were analyzed. Acute kidney injury (AKI)—by definition of the Kidney Disease: Improving Global Outcome group—was associated with a five-fold higher mortality (odds ratio [OR], 4.8; 95% CI, 4.1 to 5.7; P < 0.001) and a longer HLOS of 5 days (P < 0.001) after adjusting for age, sex, comorbidities, congestive heart failure, preoperative hemoglobin, preoperative creatinine, exposure to radiocontrast agent, type of surgery, and surgical AKI risk factors. Importantly, even minor creatinine increases (Δcreatinine 25 to 49% above baseline but < 0.3 mg/dl) not meeting AKI criteria were associated with a two-fold increased risk of death (OR, 1.7; 95% CI, 1.3 to 2.4; P < 0.001) and 2 days longer HLOS (P < 0.001). This was more pronounced in noncardiac surgery patients. Patients with minor creatinine increases had a five-fold risk of death (OR, 5.4; 95% CI, 1.5 to 20.3; P < 0.05) and a 3-day longer HLOS (P < 0.01) when undergoing noncardiac surgery. Conclusions Even minor postoperative increases in creatinine levels are associated with adverse outcomes. These results emphasize the importance to find effective therapeutic approaches to prevent or treat even mild forms of postoperative kidney dysfunction to improve surgical outcomes. PMID:26492475

  16. 78 FR 29147 - 30-Day Notice and Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-17

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    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... CONTROL POLICY Paperwork Reduction Act; 30-Day Notice AGENCY: Office of National Drug Control Policy. ] The Office of National Drug Control Policy (ONDCP) proposes the collection of information concerning... of the President, Office of National Drug Control Policy, Research & Data Analysis, Washington,...

  18. 75 FR 160 - Paperwork Reduction Act; 30-Day Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-04

    ... [Federal Register Volume 75, Number 1 (Monday, January 4, 2010)] [Notices] [Page 160] [FR Doc No: E9-31132] OFFICE OF NATIONAL DRUG CONTROL POLICY Paperwork Reduction Act; 30-Day Notice AGENCY: Office of National Drug Control Policy. The Office of National Drug Control Policy (ONDCP) proposes...

  19. Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

    PubMed Central

    AlHilli, Mariam; Langstraat, Carrie; Tran, Christine; Martin, Janice; Weaver, Amy; McGree, Michaela; Mariani, Andrea; Cliby, William; Bakkum-Gamez, Jamie

    2015-01-01

    Background To identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery. Methods Patients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection. Results In total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89; P = 0.007), ascites [1.76 (1.11–2.81); P = 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21); P = 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33; P = 0.04). Conclusions Clinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce

  20. Analysis of 30-Day Postdischarge Morbidity and Readmission after Radical Gastrectomy for Gastric Carcinoma: A Single-Center Study of 2107 Patients With Prospective Data

    PubMed Central

    Jeong, Oh; Kyu Park, Young; Ran Jung, Mi; Yeop Ryu, Seong

    2015-01-01

    Abstract PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system. Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care. No previous studies have extensively investigated PD complications after gastric cancer surgery. We investigated the incidence, types, treatment, and risk factors of 30-day postdischarge (PD) complications after gastric cancer surgery. Between 2010 and 2013, data concerning complications and readmission within 30 days of hospital discharge were prospectively collected in 2107 patients undergoing gastric cancer surgery. In total, 1642 patients (77.9%) underwent distal gastrectomy, 418 (19.8%) total gastrectomy, and 47 (2.3%) other procedures. Postoperative morbidity and mortality were 17.4% and 0.6%, respectively, with a mean 8.8-day hospital stay. Sixty-one patients (2.9%) developed 30-day PD morbidity (58 local and 3 systemic complications), accounting for 16.6% of overall morbidity; 47 (2.2%) were readmitted; and 7 (0.3%) underwent a reoperation. The mean time to PD complications was 9.5 days after index hospital discharge. The most common complication was intra-abdominal abscess (n = 14), followed by wound, ascites, and anastomosis leakage. No mortality occurred resulting from PD complications. In the univariate and multivariate analyses, underlying comorbidity (hypertension and liver cirrhosis) and obesity were independent risk factors for developing PD complications. The early PD period is a vulnerable time for surgical patients with substantial risk of complication and readmission. Tailored discharge plans along with appropriate PD patient support are essential for improving the quality of patient care. PMID:25789945

  1. Discharge to a rehabilitation facility is associated with decreased 30-day readmission in elective spinal surgery.

    PubMed

    Abt, Nicholas B; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Murphy, Meghan; Rinaldo, Lorenzo; Fogelson, Jeremy; Nassr, Ahmad; Currier, Bradford L; Bydon, Mohamad

    2017-02-01

    The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.

  2. Postoperative start compared to preoperative start of low-molecular-weight heparin increases mortality in patients with femoral neck fractures

    PubMed Central

    Leer-Salvesen, Sunniva; Dybvik, Eva; Dahl, Ola E; Gjertsen, Jan-Erik; EngesæTer, Lars B

    2017-01-01

    Background and purpose — Controversies exist regarding thromboprophylaxis in orthopedic surgery. Using data in the nationwide Norwegian Hip Fracture Register (NHFR) with postoperative death and reoperation in the first 6 months after surgery as endpoints in the analyses, we determined whether the thromboprophylaxis in patients who undergo hemiarthroplasty for femoral neck fracture should start preoperatively or postoperatively. Patients and methods — After each operation for hip fracture in Norway, the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age, ASA score, gender, type of implant, length of surgery, and year of surgery. Results — During the period 2005–2014, 25,019 hemiarthroplasties as treatment for femoral neck fractures were reported to the registry. Antithrombotic medication was given to 99% of the patients. Low-molecular-weight heparin predominated with dalteparin in 57% of the operations and enoxaparin in 41%. Only operations with these 2 drugs and with known information on preoperative or postoperative start of the prophylaxis were included in the analyses (n = 20,241). Compared to preoperative start of thromboprophylaxis, postoperative start of thromboprophylaxis gave a higher risk of death (risk ratio (RR) = 1.13, 95% CI: 1.06–1.21; p < 0.001) and a higher risk of reoperation for any reason (RR =1.19, 95% CI: 1.01–1.40; p = 0.04), whereas we found no effect on reported intraoperative bleeding complication or on the risk of postoperative reoperation due to hematoma. The results did not depend on whether the initial dose of prophylaxis was the full dosage or half of the standard dosage. Interpretation — Postoperative start of thromboprophylaxis increased the mortality and risk of reoperation compared to preoperative start in femoral neck fracture patients operated with hemiprosthesis. The risks of bleeding and of reoperation due to

  3. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    PubMed Central

    Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

    2014-01-01

    Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID

  4. Nursing Home Medical Staff Organization and 30-Day Rehospitalizations

    PubMed Central

    Lima, Julie C.; Intrator, Orna; Karuza, Jurgis; Wetle, Terrie; Mor, Vincent; Katz, Paul

    2013-01-01

    Objectives To examine the relationship between features of nursing home (NH) medical staff organization and residents’ 30-day rehospitalizations. Design Cross-sectional study combining primary data collected from a survey of medical directors, NH resident assessment data (minimum data set), Medicare claims, and the Online Survey Certification and Reporting (OSCAR) database. Setting A total of 202 freestanding US nursing homes. Participants Medicare fee-for-service beneficiaries who were hospitalized and subsequently admitted to a study nursing home. Measurements Medical staff organization dimensions derived from the survey, NH residents’ characteristics derived from minimum data set data, hospitalizations obtained from Part A Medicare claims, and NH characteristics from the OSCAR database and from www.ltcfocus.org. Study outcome defined within a 30-day window following an index hospitalization: rehospitalized, otherwise died, otherwise survived and not rehospitalized. Results Thirty-day rehospitalizations occurred for 3788 (20.3%) of the 18,680 initial hospitalizations. Death was observed for 884 (4.7%) of residents who were not rehospitalized. Adjusted by hospitalization, resident, and NH characteristics, nursing homes having a more formal appointment process for physicians were less likely to have 30-day rehospitalization (b = −0.43, SE = 0.17), whereas NHs in which a higher proportion of residents were cared for by a single physician were more likely to have rehospitalizations (b = 0.18, SE = 0.08). Conclusion This is the first study to show a direct relationship between features of NH medical staff organization and resident-level process of care. The relationship of a more strict appointment process and rehospitalizations might be a consequence of more formalized and dedicated medical practice with a sense of ownership and accountability. A higher volume of patients per physician does not appear to improve quality of care. PMID:22682694

  5. 30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis

    PubMed Central

    Hassani, Sahar; Lindman, Anja Schou; Kristoffersen, Doris Tove; Tomic, Oliver; Helgeland, Jon

    2015-01-01

    Background The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator. Methods and Findings Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated

  6. Postoperative Mortality after Hip Fracture Surgery: A 3 Years Follow Up

    PubMed Central

    Un, Canan; Sacan, Ozlem; Gamli, Mehmet; Baskan, Semih; Baydar, Mustafa

    2016-01-01

    Background and Aims To determine mortality rates and predisposing factors in patients operated for a hip fracture in a 3-year follow-up period. Methods The study included patients who underwent primary surgery for a hip fracture.The inclusion criteria were traumatic, non-traumatic, osteoporotic and pathological hip fractures requiring surgery in all age groups and both genders. Patients with periprosthetic fractures or previous contralateral hip fracture surgery and patients who could not be contacted by telephone were excluded. At 36 months after surgery, evaluation was made using a structured telephone interview and a detailed examination of the hospital medical records, especially the documents written during anesthesia by the anesthesiologists and the documents written at the time of follow-up visits by the orthopaedic surgeons. A total of 124 cases were analyzed and 4 patients were excluded due to exclusion criteria. The collected data included demographics, type of fracture, co-morbidities, American Society of Anesthesiologists (ASA) scores, anesthesia techniques, operation type (intramedullary nailing or arthroplasty; cemented-noncemented), peroperative complications, refracture during the follow-up period, survival period and mortality causes. Results The total 120 patients evaluated comprised 74 females(61.7%) and 46 males(38.3%) with a mean age of 76.9±12.8 years (range 23–95 years). The ASA scores were ASA I (0.8%), ASA II (21.7%), ASA III (53.3%) and ASA IV (24.2%). Mortality was seen in 44 patients (36.7%) and 76 patients (63.3%) survived during the 36-month follow-up period. Of the surviving patients, 59.1% were female and 40.9% were male.The survival period ranged between 1–1190 days. The cumulative mortality rate in the first, second and third years were 29.17%, 33.33% and 36.67% respectively. The factors associated with mortality were determined as increasing age, high ASA score, coronary artery disease, congestive heart failure, Alzheimer

  7. Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

    PubMed Central

    Baker, Dustin; Sherrod, Brandon; McGwin, Gerald; Ponce, Brent; Gilbert, Shawn

    2016-01-01

    Introduction The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures. Methods The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated. Results Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P = <0.001), pneumonia (P = <0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P = <0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died. Conclusion In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population. PMID:26855119

  8. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  9. Impact of Peri-Operative Acute Kidney Injury as a Severity Index for 30-day Readmission After Cardiac Surgery

    PubMed Central

    Brown, Jeremiah R.; Parikh, Chirag R.; Ross, Cathy S.; Kramer, Robert S.; Magnus, Patrick C.; Chaisson, Kristine; Boss, Richard A.; Helm, Robert E.; Horton, Susan R.; Hofmaster, Patricia; Desaulniers, Helen; Blajda, Pamela; Westbrook, Benjamin M.; Duquette, Dennis; LeBlond, Kelly; Quinn, Reed D.; Jones, Cheryl; DiScipio, Anthony W.; Malenka, David J.

    2014-01-01

    Background Of patients undergoing cardiac surgery in the United States, 15–20% are re-hospitalized within 30-days. Current models to predict readmission have not evaluated the association between severity of post-operative acute kidney injury (AKI) and 30-day readmissions. Methods We collected data from 2,209 consecutive patients who underwent either coronary artery bypass (CABG) or valve surgery at seven member hospitals of the Northern New England Cardiovascular Disease Study Group Cardiac Surgery Registry (NNE) between July 2008 and December 2010. Administrative data at each hospital was searched to identify all patients readmitted to the index hospital within 30 days of discharge. We defined AKI Stages by the AKI Network definition of 0.3 or 50% increase (Stage 1), 2-fold increase (stage 2) and a 3-fold or 0.5 increase if the baseline serum creatinine was at least 4.0 (mg/dL) or new dialysis (stage 3). We evaluate the association between stages of AKI and 30-day readmission using multivariate logistic regression. Results There were 260 patients readmitted within 30-days (12.1%). The median time to readmission was 9 (IQR 4–16) days. Patients not developing AKI following cardiac surgery had a 30-day readmission rate of 9.3% compared to patients developing AKI stage 1 (16.1%), AKI stage 2 (21.8%) and AKI stage 3 (28.6%, p <0.001). Adjusted odds ratios for AKI stage 1 (1.81; 1.35, 2.44), stage 2 (2.39; 1.38, 4.14) and stage 3 (3.47; 1.85–6.50). Models to predict readmission were significantly improved with the addition of AKI stage (c-statistic 0.65, p = 0.001) and net reclassification rate of 14.6% (95%CI: 5.05% to 24.14%, p = .003). Conclusions In addition to more traditional patient characteristics, the severity of post-operative AKI should be used when assessing a patient’s risk for readmission. PMID:24119985

  10. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  11. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale for... U.S.C. 1a(25)) for the first 30 days of trading, if: (1) Such index would not have been a...

  12. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 2 2014-01-01 2014-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  13. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... narrow-based security index under section 1a(35) of the Act (7 U.S.C. 1a(35)) for the first 30 days...

  14. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  15. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 2 2011-01-01 2011-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  16. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  17. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 26 Internal Revenue 15 2012-04-01 2012-04-01 false Special 30-day rules for certain reportable... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... certification of notified payee underreporting) within 30 days after the establishment or acquisition...

  18. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  19. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  20. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  1. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  2. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  3. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 2 2013-01-01 2013-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  4. 43 CFR 4.1186 - Waiver of the 30-day decision requirement.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Waiver of the 30-day decision requirement... Expedited Review of Section 521(a)(2) Or 521(a)(3) Orders of Cessation § 4.1186 Waiver of the 30-day decision requirement. (a) Any person qualified to receive a 30-day decision may waive that right— (1)...

  5. 17 CFR 41.12 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 41.12 Section 41.12 Commodity and Securities Exchanges COMMODITY... underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of sale for... U.S.C. 1a(25)) for the first 30 days of trading, if: (1) Such index would not have been a...

  6. 7 CFR 27.58 - Postponed classification; must be within 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 2 2012-01-01 2012-01-01 false Postponed classification; must be within 30 days. 27... Classification § 27.58 Postponed classification; must be within 30 days. If thereafter the classification of the cotton be desired, notice thereof shall be filed not later than the expiration of 30 days after the...

  7. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 26 Internal Revenue 15 2014-04-01 2014-04-01 false Special 30-day rules for certain reportable... COLLECTION OF INCOME TAX AT SOURCE Collection of Income Tax at Source § 31.3406(d)-3 Special 30-day rules for... certification of notified payee underreporting) within 30 days after the establishment or acquisition...

  8. 9 CFR 96.12 - Uncertified casings not disinfected in 30 days; disposition.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 30 days; disposition. 96.12 Section 96.12 Animals and Animal Products ANIMAL AND PLANT HEALTH... STATES § 96.12 Uncertified casings not disinfected in 30 days; disposition. Foreign animal casings... period of 30 days after arrival in the United States, subject to the ability of Division inspectors...

  9. A Model to Predict Duration of Ventilation and 30-Day Mortality in Patients with Traumatic Injuries

    DTIC Science & Technology

    2014-12-02

    Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per...2 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98...383 PATTERN OF HOSPITAL ADMISSIONS AND OUTCOME OF ACUTE ALUMINIUM PHOSPHIDE POISONING IN AN INDIAN ICU RANVIR SINGH1, diptimala agrawal2, vivek

  10. Mortality among recipients of the Merck V710 Staphylococcus aureus vaccine after postoperative S. aureus infections: an analysis of possible contributing host factors.

    PubMed

    McNeely, Tessie B; Shah, Najaf A; Fridman, Arthur; Joshi, Amita; Hartzel, Jonathan S; Keshari, Ravi S; Lupu, Florea; DiNubile, Mark J

    2014-01-01

    In a blinded randomized trial, preoperative receipt of the Merck V710 Staphylococcus aureus vaccine was associated with a higher mortality rate than placebo in patients who later developed postoperative S. aureus infections. Of the tested patients, all 12 V710 recipients (but only 1 of 13 placebo recipients) with undetectable serum IL2 levels prior to vaccination and surgery died after postoperative S. aureus infection. The coincidence of 3 factors (low prevaccination IL-2 levels, receipt of V710, and postoperative S. aureus infection) appeared to substantially increase mortality in our study population after major cardiothoracic surgery. Furthermore, 9 of the 10 V710 recipients with undetectable preoperative IL17a levels and postoperative S. aureus infections died. Although the current study is hypothesis-generating and the exact pathophysiology remains speculative, these findings raise concern that immune predispositions may adversely impact the safety and efficacy of staphylococcal vaccines actively under development. The potential benefits of an effective vaccine against S. aureus justify continued but cautious pursuit of this elusive goal.

  11. Postoperative Morbidity and Mortality of Perforated Peptic Ulcer: Retrospective Cohort Study of Risk Factors among Black Africans in Côte d'Ivoire

    PubMed Central

    Gona, Soro Kountele; Marcellin, Koffi Gnangoran; Adama, Coulibaly; Toussaint, Assohoun; Manuela, Ehua Adjoba; Sylvain, Seu Gagon; Anthony, Afum-Adjei Awuah; Francis, Ehua Somian

    2016-01-01

    Introduction. Surgical treatment of perforated peptic ulcer (PPU) is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male) operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5%) experienced complications and 31 (19.3%) died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9–8.0) per 100 person-days and 3.0 (95% CI: 1.9–4.0) per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P = 0.03), tachycardia (pulse rate > 100/minutes) (HR = 2.4, P = 0.02), purulent intra-abdominal fluid collection (HR = 2.1, P = 0.04), hyponatremia (median value ≤ 134 mEq/L) (HR = 2.3, P = 0.01), delayed time of hospital admission > 72 hours (HR = 2.6, P < 0.0001), and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P < 0.0001). Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU. PMID:26925099

  12. Relationship between platelet count and 30-day clinical outcomes after percutaneous coronary interventions. Pooled analysis of four ISAR trials.

    PubMed

    Iijima, Raisuke; Ndrepepa, Gjin; Mehilli, Julinda; Bruskina, Olga; Schulz, Stefanie; Schömig, Albert; Kastrati, Adnan

    2007-10-01

    Platelets play an important role in the development of major adverse cardiac events (MACE) following percutaneous coronary intervention (PCI). The impact of platelet count on the outcome of patients undergoing PCI after pre-treatment with clopidogrel is unknown. The study included 5,256 patients enrolled in four randomized trials - ISAR-REACT, ISAR-SMART2, ISAR-SWEET, and ISAR-REACT2 - which assessed the value of abciximab in patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. Platelet count was measured at baseline before PCI. Primary endpoint was the 30-day incidence of MACE, secondary endpoint was mortality. The tertiles of platelet counts were: lower tertile (<198 x 10(9)/L; n = 1,726), middle tertile (198-244 x 10(9)/L; n = 1,750) and upper tertile (>244 x 10(9)/L; n = 1,780). The 30-day incidence of MACE was 6.7% (n = 116) among patients of the lower tertile, 6.3% (n = 111) among patients of the middle tertile, and 7.0% (n = 124) among patients of the upper tertile (P = 0.76). The 30-day mortality was 1.2% (n = 22) among patients of the upper tertile, 0.5% (n = 9) among patients of middle tertile and 0.6% (n = 11) among patients of the lower tertile (P = 0.04). Q-wave myocardial infarction occurred in 1.3% of patients (n = 23) in the upper tertile, 0.7% of patients (n = 13) in the middle tertile and 0.5% of patients (n = 8) in the lower tertile (P = 0.02). Platelet count was an independent correlate of 30-day mortality (hazard ratio 2.69, 95% confidence interval 1.08-6.67; P = 0.033 for the third vs. the first tertile). In conclusion, in patients with CAD undergoing PCI after pre-treatment with 600 mg clopidogrel, baseline platelet count predicts 30-day mortality.

  13. Sex Differences in the Rate, Timing and Principal Diagnoses of 30-Day Readmissions in Younger Patients with Acute Myocardial Infarction

    PubMed Central

    Dreyer, Rachel P.; Ranasinghe, Isuru; Wang, Yongfei; Dharmarajan, Kumar; Murugiah, Karthik; Nuti, Sudhakar V.; Hsieh, Angela F.; Spertus, John A.; Krumholz, Harlan M.

    2016-01-01

    Background Young women (<65 years) experience a 2–3-fold greater mortality risk than younger men after acute myocardial infarction (AMI). However, it is unknown whether they are at higher risk for 30-day readmission, and if this association varies by age. We examined sex differences in the rate, timing and principal diagnoses of 30-day readmissions, including the independent effect of sex following adjustment for confounders. Methods and Results We included patients aged 18–64 years with a principal diagnosis of AMI. Data was utilized from the Healthcare Cost and Utilization Project-State Inpatient Database for California (07–09). Readmission diagnoses were categorized using an aggregated version of the Centers for Medicare and Medicaid Services’ Condition Categories, and readmission timing was determined from the day after discharge. Of 42,518 younger patients with AMI (26.4% female), 4,775 (11.2%) had at least one readmission. The 30-day all-cause readmission rate was higher for women (15.5% vs. 9.7%, P<0.0001). For both sexes, readmission risk was highest on days 2–4 after discharge and declined thereafter, and women were more likely to present with non-cardiac diagnoses (44.4% vs. 40.6%, P=0.01). Female sex was associated with a higher rate of 30-day readmission, which persisted after adjustment (HR=1.22, 95% CI 1.15, 1.30). There was no significant interaction between age and sex on readmission. Conclusions Compared with men, younger women have a higher risk for readmission, even after adjustment for confounders. The timing of 30-day readmission was similar in women and men, and both sexes were susceptible to a wide range of causes for readmission. PMID:26085455

  14. 78 FR 52005 - 30-Day Notice of Proposed Information Collection: Multifamily Project Construction Contract...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... August 21, 2013 Part IV Department of Housing and Urban Development 30-Day Notice of Proposed Information...; ] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily... Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at...

  15. 77 FR 48160 - Division of Cardiovascular Devices 30-Day Notices and Annual Reports; Public Workshop; Request...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-13

    ... following public workshop entitled ``Division of Cardiovascular Devices 30-Day Notices and Annual Reports... requirements applicable to premarket approval applications (PMAs), 30-day notices and annual reports... periodic (annual) report. This workshop is intended to focus on manufacturing method and procedure...

  16. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Procedure if 30-day decision requirement is...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  17. 78 FR 64141 - 30-Day Notice of Proposed Information Collection: Certificate of Housing Counseling...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... October 25, 2013 Part III Department of Housing and Urban Development 30-Day Notice of Proposed... / Notices#0;#0; ] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Certificate of Housing Counseling: Homeownership and Certificate of Housing Counseling:...

  18. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Procedure if 30-day decision requirement...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  19. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  20. 43 CFR 4.1187 - Procedure if 30-day decision requirement is not waived.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Procedure if 30-day decision requirement...-day decision requirement is not waived. If the applicant does not waive the 30-day decision... a response to the application for review shall file a written response within 5 working days...

  1. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  2. 19 CFR 158.42 - Abandonment by importer within 30 days after entry.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Abandonment by importer within 30 days after entry... days after entry. Allowance in duties for merchandise abandoned to the Government in accordance with... which the merchandise being abandoned appears. (b) Application within 30 days. The importer shall...

  3. Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

    PubMed

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.

  4. 78 FR 64143 - 30-Day Notice of Proposed Information Collection: Contractor's Requisition-Project Mortgages

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Contractor's Requisition--Project..., 2013. A. Overview of Information Collection Title of Information Collection: Contractor's...

  5. 78 FR 44579 - 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program Evaluation

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-24

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Fellowship Placement Pilot Program.... A. Overview of Information Collection Title of Information Collection: Fellowship Placement Pilot.... Description of the need for the information and proposed use: The Fellowship Placement Program places...

  6. 78 FR 64234 - 30-Day Notice of Proposed Information Collection: Environmental Review Procedures for Entities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-28

    ... (NEPA), the regulations of the Council on Environmental Quality, related federal environmental laws... compliance with all applicable environmental laws and authorities. HUD (or the State for certain State... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Environmental Review Procedures...

  7. 78 FR 59046 - 30-Day Notice of Proposed Information Collection: Federal Labor Standards Questionnaire(s...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Federal Labor Standards..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  8. 78 FR 69103 - 30-Day Notice of Proposed Information Collection: Quality Control for Rental Assistance Subsidy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Quality Control for Rental... Information Collection: Quality Control for Rental Assistance Subsidy Determinations. OMB Approval Number... Quality Control process involves selecting a nationally representative sample of assisted households...

  9. 78 FR 36561 - 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal Advisory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: The Housing Counseling Federal... Information Collection: The Housing Counseling Federal Advisory Committee Membership Application. OMB Approval... for the information and proposed use: The Housing Counseling Federal Advisory Committee (HCFAC)...

  10. Effect of feeding in 30-day bioaccumulation assays using Hyalella azteca in fluoranthene-dosed sediment

    SciTech Connect

    Harkey, G.A.; Landrum, P.F.

    1995-12-31

    Current protocols for conducting freshwater sediment bioaccumulation tests require that food be added to exposures. To determine effects of adding food, 30-day bioaccumulation assays were conducted with H. azteca exposed to sediment dosed with four concentrations (0.05 to 1,267 nmol/g dry weight) of fluoranthene. Accumulation was significantly greater in fed versus non-fed animals at all dose levels after 96 and 240 hours of exposure and continued to be greater after 30 days in the low dose levels. At sediment concentrations above 634 nmol/g dw, survival of unfed animals dropped to 34% after 30 days, However, after 30 days, reproduction was observed in fed animals exposed to sediment concentrations > 16 times the expected LC50 calculated for fluoranthene in sediment. These data raise questions concerning the interpretation of standard toxicity and bioaccumulation tests when food is routinely added.

  11. Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease

    PubMed Central

    Nahab, Fadi; Takesaka, Jennifer; Mailyan, Eugene; Judd, Lilith; Culler, Steven; Webb, Adam; Frankel, Michael; Choi, Dennis; Helmers, Sandra

    2012-01-01

    Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease. PMID:23983857

  12. Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

    PubMed Central

    Mentz, Robert J.; Hernandez, Adrian F.; Stebbins, Amanda; Ezekowitz, Justin A.; Felker, G. Michael; Heizer, Gretchen M.; Atar, Dan; Teerlink, John R.; Califf, Robert M.; Massie, Barry M.; Hasselblad, Vic; Starling, Randall C.; O'Connor, Christopher M.; Ponikowski, Piotr

    2013-01-01

    Aims To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes. Methods and results ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68–0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74–0.99), but similar mortality. Conclusion Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes. PMID:23159547

  13. Half of 30-Day Hospital Readmissions Among HIV-Infected Patients Are Potentially Preventable

    PubMed Central

    Kitchell, Ellen; Etherton, Sarah Shelby; Duarte, Piper; Halm, Ethan A.; Jain, Mamta K.

    2015-01-01

    Abstract Thirty-day readmission rates, a widely utilized quality metric, are high among HIV-infected individuals. However, it is unknown how many 30-day readmissions are preventable, especially in HIV patients, who have been excluded from prior potentially preventable readmission analyses. We used electronic medical records to identify all readmissions within 30 days of discharge among HIV patients hospitalized at a large urban safety net hospital in 2011. Two independent reviewers assessed whether readmissions were potentially preventable using both published criteria and detailed chart review, how readmissions might have been prevented, and the phase of care deemed suboptimal (inpatient care, discharge planning, post-discharge). Of 1137 index admissions, 213 (19%) resulted in 30-day readmissions. These admissions occurred among 930 unique HIV patients, with 130 individuals (14%) experiencing 30-day readmissions. Of these 130, about half were determined to be potentially preventable using published criteria (53%) or implicit chart review (48%). Not taking antiretroviral therapy (ART) greatly increased the odds of a preventable readmission (OR 5.9, CI:2.4–14.8). Most of the preventable causes of readmission were attributed to suboptimal care during the index hospitalization. Half of 30-day readmission in HIV patients are potentially preventable. Increased focus on early ART initiation, adherence counseling, management of chronic conditions, and appropriate timing of discharge may help reduce readmissions in this vulnerable population. PMID:26154066

  14. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect

    PubMed Central

    Kozak, Marcelo Felipe; Kozak, Ana Carolina Leiroz Ferreira Botelho Maisano; Marchi, Carlos Henrique De; Hassem Sobrinho Junior, Sirio; Croti, Ulisses Alexandre; Moscardini, Airton Camacho

    2015-01-01

    Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of surgical repair of complete atrioventricular septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger presenting with complete atrioventricular septal defect that were operated on at our practice between 2002 and 2010. The following variables were considered: age, weight, absence of Down syndrome, grade of preoperative atrioventricular valve regurgitation, abnormalities on the left atrioventricular valve and the use of annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down syndrome. At the time of preoperative evaluation, there were 26 cases with moderate or severe left atrioventricular valve regurgitation (49.1%). Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or severe left atrioventricular valve regurgitation (39.6%). After performing a multivariate analysis, the only significant factor associated with moderate or severe left atrioventricular valve regurgitation was the absence of Down syndrome (P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left atrioventricular valve regurgitation after surgical repair of complete atrioventricular septal defect at our practice. PMID:26313720

  15. Postoperative mortality and need for transitional care following liver resection for metastatic disease in elderly patients: a population-level analysis of 4026 patients

    PubMed Central

    Orcutt, Sonia T; Artinyan, Avo; Li, Linda T; Silberfein, Eric J; Berger, David H; Albo, Daniel; Anaya, Daniel A

    2012-01-01

    Objectives The goal of this study was to characterize the association of age with postoperative mortality and need for transitional care following hepatectomy for liver metastases. Methods A retrospective cohort study using the Nationwide Inpatient Sample (2005–2008) was performed. Patients undergoing hepatectomy for liver metastases were categorized by age as: Young (aged <65 years); Old (aged 65–74 years), and Oldest (aged ≥75 years). Multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality and need for transitional care (non-home discharge). Results A total of 4026 patients were identified; 36.6% (n = 1475) were elderly (aged ≥65 years). Rates of in-hospital mortality and non-home discharge increased with advancing age group [1.3% vs. 2.2% vs. 3.3% (P = 0.005) and 2.1% vs. 6.1% vs. 18.3% (P < 0.001), respectively]. Independent predictors of in-hospital mortality were age within the Oldest category [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.19–4.12] and a Deyo Comorbidity Index score of ≥3 (OR 6.95, 95% CI 3.55–13.60). Independent predictors for need for transitional care were age within the Old group (OR 2.44, 95% CI 1.66–3.58), age within the Oldest group (OR 8.48, 95% CI 5.87–12.24), a Deyo score of 1 (OR 2.00, 95% CI 1.40–2.85), a Deyo score of 2 (OR 4.70, 95% CI 2.93–7.56), a Deyo score of ≥3 (OR 6.41, 95% CI 3.67–11.20), and female gender (OR 1.56, 95% CI 1.15–2.11). Conclusions Although increasing age was associated with higher risk for in-hospital mortality, the absolute risk was low and within accepted ranges, and comorbidity was the primary driver of mortality. Conversely, need for transitional care was significantly more common in elderly patients. Therefore, liver resection for metastases is safe in well-selected elderly patients, although consideration should be made for potential transitional care needs. PMID:23134189

  16. Characteristics of older adults rehospitalized within 7 and 30 days of discharge: implications for nursing practice.

    PubMed

    Hain, Debra J; Tappen, Ruth; Diaz, Sanya; Ouslander, Joseph G

    2012-08-01

    Rehospitalization within 30 days consumes a significant portion of health care costs; therefore, interventions aimed at reducing the risk of rehospitalization are needed. A retrospective study was conducted examining rehospitalization rates and diagnoses according to discharge location and comparing characteristics of older adults within 7 and 30 days of discharge from a community hospital. Data on rehospitalization for Medicare fee-for-service patients (75 and older) over a 12-month period were obtained from the information technology department of a not-for-profit community hospital. A total of 6,809 patients were discharged, with 12% rehospitalized within 30 days. Skilled nursing facilities had the highest rehospitalization rates (15%), followed by home with home health care (13%) and then home with self-care (8%). The highest rehospitalization rates were in areas where nursing has a strong presence, suggesting that nurses can play an important role in the development of interventions aimed at reducing rehospitalizations.

  17. Myelinated fibers of the mouse spinal cord after a 30-day space flight.

    PubMed

    Povysheva, T V; Rezvyakov, P N; Shaimardanova, G F; Nikolskii, E E; Islamov, R R; Chelyshev, Yu A; Grygoryev, A I

    2016-07-01

    Myelinated fibers and myelin-forming cells in the spinal cord at the L3-L5 level were studied in C57BL/6N mice that had spent 30 days in space. Signs of destruction of myelin in different areas of white matter, reduction of the thickness of myelin sheath and axon diameter, decreased number of myelin-forming cells were detected in "flight" mice. The stay of mice in space during 30 days had a negative impact on the structure of myelinated fibers and caused reduced expression of the markers myelin-forming cells. These findings can complement the pathogenetic picture of the development of hypogravity motor syndrome.

  18. 77 FR 67657 - Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-13

    ... health care and preventive health services. To support the IHS mission and to provide the product/service... HUMAN SERVICES Indian Health Service Request for Public Comment: 30-Day Proposed Information Collection: Indian Health Service (IHS) Sharing What Works--Best Practice, Promising Practice, and Local...

  19. 77 FR 13128 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-05

    ...'' campaign is a national Public Service Announcement (PSA) campaign that aims to educate, engage and empower... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  20. 78 FR 49280 - 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile Transmittal...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  1. 78 FR 52008 - 30-Day Notice of Proposed Information Collection: Multifamily Housing Service Coordinator Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Multifamily Housing Service..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  2. 78 FR 39002 - 30-Day Notice of Proposed Information Collection: Request for Withdrawals From Replacements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Request for Withdrawals From..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  3. 78 FR 52009 - 30-Day Notice of Proposed Information Collection: Utility Allowance Adjustments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Utility Allowance Adjustments AGENCY... Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at...

  4. 78 FR 39001 - 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and Physical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Uniform Physical Standards and..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  5. 78 FR 52007 - 30-Day Notice of Proposed Information Collection: Management Certification and Management Entity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Management Certification and... Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street, SW., Washington,...

  6. 78 FR 52007 - 30-Day Notice of Proposed Information Collection: Financial Statement of Corporate Applicant for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Financial Statement of Corporate..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street,...

  7. 78 FR 52006 - 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit Instrument

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-21

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Final Endorsement of Credit..., Department of Housing and Urban Development, 451 7th Street, SW., Washington, DC 20410; email Colette...

  8. 77 FR 39318 - 30-Day Notice of Proposed Information Collection: DS-5513, Supplemental Questionnaire To...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-02

    ..., Office of Project Management and Operational Support, Program Coordination (CA/PPT/PMO/PC) Form Number... information collection request to the Office of Management and Budget (OMB) for approval in accordance with... to the Office of Management and Budget (OMB) for up to 30 days from July 2, 2012. ADDRESSES:...

  9. 78 FR 36565 - 30-Day Notice of Proposed Information Collection: Standardized Form for Collecting Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Standardized Form for Collecting... Information Collection: Standardized Form for Collecting Information Regarding Race and Ethnic Data. OMB... quality, utility, and clarity of the information to be collected; and (4) Ways to minimize the burden...

  10. 77 FR 37407 - Agency Information Collection Request-30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-21

    ... HUMAN SERVICES Agency Information Collection Request--30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is.... Proposed Project: New Comprehensive Communication Campaign on Right To Non-Discrimination in Certain...

  11. Enhanced recovery of Phytophthora ramorum from soil following 30 days storage at 4C

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chlamydospores of Phytophthora ramorum produced by mixing 20 percent V8 juice broth cultures with sand and incubating over a 30 day period were used to infest field soil at densities ranging from 0.2 to 42 chlamydospores per cubic centimeter of soil. Chlamydospore recovery was determined by baiting...

  12. 77 FR 18820 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services,...

  13. 78 FR 38070 - 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing... Marketing (AFHM) Plan. OMB Approval Number: 2529-0013. Type of Request: Extension of a currently approved collection. Form Number: HUD-935.2A Affirmative Fair Housing Marketing (AFHM) Plan (Multifamily),...

  14. 78 FR 1916 - 30-Day Notice of Proposed Information Collection: Smart Traveler Enrollment Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-09

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Smart Traveler Enrollment Program ACTION: Notice of request... Information Collection: Smart Traveler Enrollment Program (STEP). OMB Control Number: 1405-0152. Type...

  15. 78 FR 64142 - 30-Day Notice of Proposed Information Collection: Condominium Project Approval Document Collection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Condominium Project Approval... submitted the proposed information collection requirement described below to the Office of Management and... Management and Budget, New Executive Office Building, Washington, DC 20503; fax: 202-395-5806. Email:...

  16. 78 FR 36560 - 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal, Periodic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: FHA Lender Approval, Annual Renewal...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th... Title of Information Collection: FHA Lender Approval, Annual Renewal, Periodic Updates and...

  17. 78 FR 40309 - 30-Day Notice of Proposed Information Collection: Application for Multifamily Project Mortgage...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-03

    ... described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public comment. DATES... sent to: HUD Desk Officer, Office of Management and Budget, New Executive Office Building,...

  18. 77 FR 59354 - Removal of 30-Day Residency Requirement for Per Diem Payments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-27

    ... reasons other than hospital care, such as when a veteran travels to visit family members. This proposed... payments, stating: ``We believe that 30 days is a minimal amount of time for demonstrating that a veteran... State home within a specific period of time, or communicates that he or she will not be returning....

  19. 77 FR 59318 - Removal of 30-Day Residency Requirement for Per Diem Payments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-27

    ... reasons other than hospital care, such as when a veteran travels to visit family members. This rule also... 30 days is a minimal amount of time for demonstrating that a veteran intends to be a resident at the... State home within a specific period of time, or communicates that he or she will not be returning....

  20. 78 FR 75366 - 30-Day Notice of Proposed Information Collection: Public Housing Energy Audits and Utility...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Public Housing Energy Audits and... Audits and Utility Allowances. OMB Approval Number: 2577-062. Type of Request: Reinstatement, with change... information and proposed use: 24 CFR 965.301, Subpart C, Energy Audit and Energy Conservation...

  1. 76 FR 59129 - Agency Information Collection Request; 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-23

    ... HUMAN SERVICES Agency Information Collection Request; 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... to send comments regarding this burden estimate or any other aspect of this collection of...

  2. 26 CFR 31.3406(d)-3 - Special 30-day rules for certain reportable payments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false Special 30-day rules for certain reportable payments. 31.3406(d)-3 Section 31.3406(d)-3 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... account. (b) Sale of an instrument for a customer by electronic transmission or by mail. The special...

  3. 78 FR 39305 - 30-Day Notice of Proposed Information Collection: OSHC Progress Report Template

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ... Doc No: 2013-15689] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5683-N-54] 30-Day... Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard at Colette.Pollard@hud.gov or... proposed use: The Appropriations Act, provided a total of $100,000,000 to HUD for a Sustainable...

  4. 77 FR 32638 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-01

    ... HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is...) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the...

  5. 78 FR 52964 - 30-Day Notice of Proposed Information Collection: Section 8 Management Assessment Program (SEMAP...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-27

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Section 8 Management Assessment..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  6. 78 FR 65695 - 30-Day Notice of Proposed Information Collection: Technical Processing Requirements for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Technical Processing Requirements..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette...

  7. 78 FR 66042 - 30-Day Notice of Proposed Information Collection: Section 3 Business Registry Pilot Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Section 3 Business Registry Pilot..., Reports Management Officer, QDAM, Department of Housing and Urban Development, 451 7th Street...

  8. 75 FR 50791 - 30-Day Notice of Proposed Information Collection: Recording, Reporting, and Data Collection...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-17

    ... following information collection request to the Office of Management and Budget (OMB) for approval in... Office: Bureau of Educational and Cultural Affairs, Office of Designation, ECA/EC/D. Form Number: Forms...: Submit comments to the Office of Management and Budget (OMB) for up to 30 days from August 17,...

  9. 76 FR 79683 - Agency Information Collection Request. 30-Day Public Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-22

    ... HUMAN SERVICES Agency Information Collection Request. 30-Day Public Comment Request AGENCY: Office of... Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is... new AIDS cases. As one strategy to address this disparity, the U.S. Department of Health and...

  10. 78 FR 79474 - 30-Day Notice of Proposed Information Collection: Father's Day

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-30

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  11. 78 FR 79475 - 30-Day Notice of Proposed Information Collection: The Impact of Housing and Services...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-30

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  12. 78 FR 75365 - 30-Day Notice of Proposed Information Collection: Assessment of Native American, Alaska Native...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-11

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Assessment of Native American..., Department of Housing and Urban Development, 451 7th Street SW., Washington, DC 20410; email Colette Pollard... Number: 2528-0288. Type of Request: Revision of a currently approved collection. Form Number:...

  13. 78 FR 79703 - Submission for OMB Review; 30-Day Comment Request: Application Process for Clinical Research...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-31

    ... for OMB Review; 30-Day Comment Request: Application Process for Clinical Research Training and Medical... contact: Robert M. Lembo, MD, Deputy Director, Office of Clinical Research Training and Medical Education... Process for Clinical Research Training and Medical Education at the Clinical Center and its Impact...

  14. 76 FR 6794 - 30-Day Submission Period for Requests for ONC-Approved Accreditor (ONC-AA) Status

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-08

    ... HUMAN SERVICES 30-Day Submission Period for Requests for ONC-Approved Accreditor (ONC-AA) Status AGENCY... ONC-Approved Accreditor (ONC-AA) status. Authority: 42 U.S.C. 300jj-11. DATES: The 30-day submission... a notice in the Federal Register to announce the 30-day period during which requests for...

  15. Shorter Duration of Post-Operative Antibiotics for Cecal Ligation and Puncture Does Not Increase Inflammation or Mortality

    PubMed Central

    Iskander, Kendra N.; Vaickus, Max; Duffy, Elizabeth R.

    2016-01-01

    Antimicrobial therapy for sepsis has beneficial effects, but prolonged use fosters emergence of resistant microorganisms, increases cost, and secondary infections. We tested whether 3 days versus 5 days of antibiotics in the murine model of cecal ligation and puncture (CLP) negatively influences outcomes. Following CLP mice were randomized to receive the antibiotic imipenem-cilastatin (25mg/kg) in dextrose 5% in Lactated Ringer’s solution every 12 hours for either three or five days. Serial monitoring over 28 days included body weight, temperature, pulse oximetry, and facial vein sampling for hematological analysis and glucose. A separate group of mice were euthanized on post-CLP day 5 to measure cytokines and peritoneal bacterial counts. The first study examined no antimicrobial therapy and demonstrated that antibiotics significantly improved survival compared to fluids only (p = 0.004). We next tested imipenem-cilastatin therapy for 3 days versus 5 days. Body weight, temperature, glucose, and pulse oximetry measurements remained generally consistent between both groups as did the hematological profile. Pro-inflammatory plasma cytokines were comparable between both groups for IL-6, IL-1β, MIP-2 and anti-inflammatory cytokines IL-10, and TNF SRI. At 5 days post-CLP, i.e. 2 days after the termination of antibiotics in the 3 day group, there were no differences in the number of peritoneal bacteria. Importantly, shortening the course of antibiotics by 40% (from 5 days to 3 days) did not decrease survival. Our results indicate that reducing the duration of broad-spectrum antibiotics in murine sepsis did not increase inflammation or mortality. PMID:27669150

  16. Work capacity during 30 days of bed rest with isotonic and isokinetic exercise training

    NASA Technical Reports Server (NTRS)

    Greenleaf, J. E.; Bernauer, E. M.; Ertl, A. C.; Trowbridge, T. S.; Wade, C. E.

    1989-01-01

    Results are presented from a study to determine whether or not short-term variable intensity isotonic and intermittent high-intensity isokinetic short-duration leg exercise is effective for the maintenance of peak O2 (VO2) uptake and muscular strength and endurance, respectively, during 30 days of -6 deg head-down bed rest deconditioning. The results show no significant changes in leg peak torque, leg mean total work, arm total peak torque, or arm mean total work for members of the isotonic, isokinetic, and controls groups. Changes are observed, however, in peak VO2 levels. The results suggest that near-peak variabile intensity, isotonic leg excercise maintains peak VO2 during 30 days of bed rest, while peak intermittent, isokinetic leg excercise protocol does not.

  17. Incidence, Causes and Predictors of 30-Day Readmission After Shoulder Arthroplasty

    PubMed Central

    Westermann, Robert W; Anthony, Chris A.; Duchman, Kyle R.; Pugely, Andrew J.; Gao, Yubo; Hettrich, Carolyn M.

    2016-01-01

    Background The Center for Medicare and Medicaid Service has identified several quality metrics, including unplanned readmission within 30 days of surgery, to assess and compare surgeons and hospitals. The purpose of this study was to identify the incidence, causes and risk factors for unplanned 30-day readmission after total shoulder arthroplasty. Methods We identified patients undergoing primary elective shoulder arthroplasty performed at American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participating hospitals in 2013. Cases were stratified by readmission status. Univariate and multivariate analyses were employed to assess patient demographics, comorbidities and operative variables predicting unplanned readmission. Results 2779 patients undergoing shoulder arthroplasty were identified, with 74 (2.66%) requiring unplanned readmissions within 30 days of surgery. The most common surgical causes for unplanned readmission were surgical site infections (18.6%), dislocations (16.3%) and venous thromboembolism (14.0%). Medical causes for readmission were responsible for 51% of unplanned readmissions. Multivariate analysis identified patient age >75 (OR 2.62, 95% CI: 1.27 - 5.41), and ASA class of 3 (OR 1.79, 95% CI: 1.01 - 3.18) or 4 (OR 3.63, 95% CI: 1.31 - 10.08) as independent risk factors for unplanned readmission. Predictive modeling estimated that patients with ASA class of 4 and age >75 are 17.4 times more likely (95% CI 1.77-171.09) to be readmitted within 30 days of shoulder arthroplasty. Conclusion Unplanned readmission after shoulder arthroplasty is infrequent and medical complications account for more than 50% of occurrences. The risk of readmission exponentially increases when age and preoperative comorbidity burden are increased. PMID:27528839

  18. Skeletal muscle adaptations following blood flow-restricted training during 30 days of muscular unloading.

    PubMed

    Cook, Summer B; Brown, Kimberly A; Deruisseau, Keith; Kanaley, Jill A; Ploutz-Snyder, Lori L

    2010-08-01

    This study evaluated the effectiveness of low-load resistance training with a blood flow restriction (LL(BFR)) to attenuate muscle loss and weakness after 30 days of unilateral lower limb suspension (ULLS). Sixteen subjects (ages 18-50 yr) underwent 30 days of ULLS. Measurements of muscle strength, cross-sectional area, and endurance on the knee extensors and plantar flexors were collected before and after ULLS. Plasma concentrations of IGF-1 and IGFBP-3 were also assessed. During ULLS, eight subjects (5 males, 3 females) participated in LL(BFR) three times per week (ULLS + Exercise) while eight subjects (4 males, 4 females) did not exercise (ULLS). The blood flow-restricted exercise consisted of dynamic knee extension at 20% of the subject's isometric maximum voluntary contraction coupled with a suprasystolic blood flow restriction. After 30 days of limb suspension, the ULLS + Exercise group experienced minimal and insignificant losses in knee extensor cross-sectional area and strength (1.2% and 2.0%, respectively; P 0.05). Muscular endurance in the knee extensors improved 31% in the ULLS + Exercise group, while it decreased 24% in the ULLS group (P = 0.01). No changes were seen in hormone concentrations throughout the study. In conclusion, LL(BFR) of the knee extensors is effective in maintaining muscle strength and size during 30 days of ULLS and results in improved knee extensor muscular endurance.

  19. The 10-30-day intraseasonal variation of the East Asian winter monsoon: The temperature mode

    NASA Astrophysics Data System (ADS)

    Yao, Suxiang; Sun, Qingfei; Huang, Qian; Chu, Peng

    2016-09-01

    East Asia is known for its monsoon characteristics, but little research has been performed on the intraseasonal time scale of the East Asian winter monsoon (EAWM). In this paper, the extended reanalysis (ERA)-Interim sub-daily data are used to study the surface air temperature intraseasonal oscillation (ISO) of the EAWM. The results show that the air temperature (2-m level) of the EAWM has a dominant period of 10-30 days. Lake Baikal and south China are the centers of the air temperature ISO. An anomalous low frequency (10-30-day filtered) anticyclone corresponds to the intraseasonal cold air. The 10-30-day filtered cold air spreads from Novaya Zemlya to Lake Baikal and even to South China. The ISO of the Arctic Oscillation (AO) index influences the temperature of the EAWM by stimulating Rossby waves in middle latitude, causing meridional circulation, and eventually leads to the temperature ISO of the EAWM. RegCM4 has good performance for the simulation of the air temperature ISO. The simulated results indicate that the plateau is responsible for the southward propagation of the intraseasonal anticyclone. The anticyclone could not reach South China when there was no plateau in western China and its upper reaches.

  20. The importance of in-hospital mortality for patients requiring free tissue transfer for head and neck oncology.

    PubMed

    Pohlenz, P; Klatt, J; Schmelzle, R; Li, L

    2013-09-01

    Mortality is a rare but disastrous complication of microvascular head and neck reconstruction. The investigators attempt to identify the procedure-related mortality cases and analyse the causes of death. A retrospective analysis of 804 consecutive free flap procedures during a 19-year period was performed and fatal cases were identified (n=42 deaths). Multivariate logistic regression was employed to determine the association of in-hospital mortality with patient-related characteristics. The 30-day post-operative mortality rate was 1% (8 out of 804 patients), and the in-hospital mortality rate (post-operative deaths in-hospital before or after the 30th post-operative day without discharge) was 5.2% (42 out of 804 patients). Cancer recurrence and metastases related pneumonia were the most common causes of death (n=26, 62%), followed by cardiac, pulmonary, infectious and hepatic/renal aetiologies. Logistic regression analysis revealed that patients with stage IV disease and an operation time of >9h were significantly associated with post-operative mortality. Malignancy-related conditions were the most common causes of death following free flap transfer for head and neck reconstruction. For patients with stage IV head and neck cancer, this aggressive surgical approach should be cautiously justified due to its association with post-operative mortality. To shorten the operation time, experienced microsurgical operation teams are necessary.

  1. The 30-day prognosis of chronic-disease patients after contact with the out-of-hours service in primary healthcare

    PubMed Central

    Carlsen, Anders Helles; Moth, Grete; Christensen, Morten Bondo; Vestergaard, Mogens; Olesen, Frede; Vedsted, Peter

    2014-01-01

    Abstract Objective. Little is known about the prognosis of patients with chronic disease who contact the out-of-hours (OOH) service in primary care. The characteristics of contacts with the Danish out-of-hours service and daytime general practice, hospitalization, and death were studied during a 30-day follow-up period in patients with chronic heart diseases. Design. Cohort study. Setting and subjects. The study was based on data from 11 897 adults aged 18 + years from a Danish survey of OOH contacts, including information on consultation type. Reason for encounter (RFE) was categorized by OOH GPs at triage as either “exacerbation” or “new health problem”. Registry data were used to identify eligible patients, and the cohort was followed for 30 days after OOH contact through nationwide registries on healthcare use and mortality. Main outcome measures. The 30-day prognosis of chronic-disease patients after OOH contact. Results. Included patients with chronic disease had a higher risk of new OOH contact, daytime GP contact, and hospitalization than other patients during the 30-day follow-up period. OOH use was particularly high among patients with severe mental illness. A strong association was seen between chronic disease and risk of dying during follow-up. Conclusion. Patients with chronic disease used both daytime general practice and the out-of-hours service more often than others during the 30-day follow-up period; they were more often hospitalized and had higher risk of dying. The findings call for a proactive approach to future preventive day care and closer follow-up of this group, especially patients with psychiatric disease. PMID:25471829

  2. Risk factors for postoperative complications in total thyroidectomy

    PubMed Central

    Caulley, Lisa; Johnson-Obaseki, Stephanie; Luo, Lindy; Javidnia, Hedyeh

    2017-01-01

    Abstract Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting. The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery. Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes. From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ≥70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P < 0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P  0.05). We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity. PMID:28151852

  3. Complications Associated with Mortality after Head and Neck Surgery.

    PubMed

    Mulvey, Carolyn L; Brant, Jason A; Bur, Andrés M; Chen, Jinbo; Fischer, John P; Cannady, Steven B; Newman, Jason G

    2017-03-01

    Objective To determine which complications, as defined by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, correlate with 30-day mortality in surgery for malignancies of the head and neck. Study Design Retrospective review of prospectively collected national database. Setting NSQIP. Subjects and Methods NSQIP data from 2005 to 2014 were queried for ICD-9 codes head and neck malignancies. Multivariate logistic regression was used to examine the correlation of individual complications with 30-day mortality. Results In total, 15,410 cases met criteria with 3499 complications in 2235 cases. After controlling for patient and surgical variables, postoperative pneumonia ( P = .02; odds ratio [OR], 2.39; 95% confidence interval [CI], 1.15-4.72), progressive renal insufficiency ( P < .001; OR, 21.28; 95% CI, 4.22-87.94), bleeding requiring transfusion ( P = .02; OR, 2.10; 95% CI, 1.12-3.84), sepsis ( P = .02; OR, 2.86; 95% CI, 1.15-6.46), septic shock ( P = .045; OR, 2.87; 95% CI, 0.98-7.81), stroke ( P < .001; OR, 19.81; 95% CI, 6.23-56.03), and cardiac arrest ( P < .001; OR, 135.59; 95% CI, 65.00-286.48) were independently associated with increased odds of 30-day mortality. Conclusion The NSQIP database has been extensively validated and used to examine surgical complications, yet there is little analysis on which complications are associated with death. This study identified complications associated with increased risk of 30-day mortality following head and neck cancer surgery. These associations may be used as a measure of complication severity and should be considered when using the NSQIP database to evaluate outcomes in head and neck surgery.

  4. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  5. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  6. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  7. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  8. 17 CFR 240.3a55-2 - Indexes underlying futures contracts trading for fewer than 30 days.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... contracts trading for fewer than 30 days. 240.3a55-2 Section 240.3a55-2 Commodity and Securities Exchanges... Indexes underlying futures contracts trading for fewer than 30 days. (a) An index on which a contract of... the Act (15 U.S.C. 78c(a)(55)) for the first 30 days of trading, if: (1) Such index would not...

  9. Rat brain pro-oxidant effects of peripherally administered 5 nm ceria 30 days after exposure.

    PubMed

    Hardas, Sarita S; Sultana, Rukhsana; Warrier, Govind; Dan, Mo; Florence, Rebecca L; Wu, Peng; Grulke, Eric A; Tseng, Michael T; Unrine, Jason M; Graham, Uschi M; Yokel, Robert A; Butterfield, D Allan

    2012-10-01

    The objective of this study was to determine the residual pro-or anti-oxidant effects in rat brain 30 days after systemic administration of a 5 nm citrate-stabilized ceria dispersion. A ∼4% aqueous ceria dispersion was iv-infused (0 or 85 mg/kg) into rats which were terminated 30 days later. Ceria concentration, localization, and chemical speciation in the brain was assessed by inductively coupled plasma mass spectrometry (ICP-MS), light and electron microscopy (EM), and electron energy loss spectroscopy (EELS), respectively. Pro- or anti-oxidant effects were evaluated by measuring levels of protein carbonyls (PC), 3-nitrotyrosine (3NT), and protein-bound-4-hydroxy-2-trans-nonenal (HNE) in the hippocampus, cortex, and cerebellum. Glutathione reductase (GR), glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase levels and activity were measured in addition to levels of inducible nitric oxide (iNOS), and heat shock protein-70 (Hsp70). The blood brain barrier (BBB) was visibly intact and no ceria was seen in the brain cells. Ceria elevated PC and Hsp70 levels in hippocampus and cerebellum, while 3NT and iNOS levels were elevated in the cortex. Whereas glutathione peroxidase and catalase activity were decreased in the hippocampus, GR levels were decreased in the cortex, and GPx and catalase levels were decreased in the cerebellum. The GSH:GSSG ratio, an index of cellular redox status, was decreased in the hippocampus and cerebellum. The results are in accordance with the observation that this nanoscale material remains in this mammal model up to 30 days after its administration and the hypothesis that it exerts pro-oxidant effects on the brain without crossing the BBB. These results have important implications on the potential use of ceria ENM as therapeutic agents.

  10. Derivation and validation of a 30-day heart failure readmission model.

    PubMed

    Fleming, Lisa M; Gavin, Michael; Piatkowski, Gail; Chang, James D; Mukamal, Kenneth J

    2014-11-01

    In 2006, there were >1 million hospital admissions for heart failure (HF), and the estimated cost to the United States in 2009 was >$37.2 billion. Better models to target aggressive therapy to patients at the highest risk for readmission are clearly needed. We studied 3,413 consecutive admissions for HF based on discharge diagnosis codes from October 2007 to August 2011 from a single academic center. We randomly generated derivation and validation sets in a 3:1 ratio. We used generalized estimating equations to develop our models, accounting for repeated hospitalizations and the Hosmer-Lemeshow test to examine model calibration. The 30-day readmission rate was 24.2% in the derivation set. Of 25 candidate variables, the best fitting model included creatinine, troponin, hematocrit, and hyponatremia at discharge; race; zip code of residence; discharge hour; and number of hospitalizations in the previous year. Insignificant variables included intravenous diuretic use on day of discharge, discharge service, diabetes, atrial fibrillation, age, and gender. The risk of 30-day readmission increased with increasing decile of predicted risk in both the validation and derivation cohorts. The area under the receiver operating characteristic curve for the model was 0.69 in the derivation set and 0.66 in the validation set. In conclusion, we derived and validated a simple model relating discharge-specific characteristics at risk of 30-day readmission. Application of this approach may facilitate targeted intervention to reduce the burden of rehospitalization in patients with HF, but our results suggest that the best readmission models may require incorporation of both clinical and local system factors for optimal prediction.

  11. Changes in size and compliance of the calf after 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Convertino, Victor A.; Doerr, Donald F.; Stein, Stewart L.

    1989-01-01

    The hypothesis that reducing muscle compartment by a long-term exposure to microgravity would cause increased leg venous compliance was tested in eight men who were assessed for vascular compliance and for serial circumferences of the calf before and after 30 days of continuous 6-deg head-down bed rest. It was found that head-down bed rest caused decreases in the calculated calf volume and the calf-muscle compartment, as well as increases in calf compliance. The percent increases in calf compliance correlated significantly with decreases in calf muscle compartment.

  12. Race, Rehabilitation, and 30-Day Readmission After Elective Total Knee Arthroplasty

    PubMed Central

    Jorgenson, Erik S.; Richardson, Diane M.; Thomasson, Arwin M.; Nelson, Charles L.

    2015-01-01

    Introduction: To examine racial variations in access to postacute care (PAC) and rehabilitation (Rehab) services following elective total knee arthroplasty and whether where patients go after surgery for PAC/Rehab is associated with 30-day readmission to acute care facility. Materials and Methods: Sample consisted of 129 522 patients discharged from 169 hospitals in the State of Pennsylvania between fiscal years 2008 and 2012. We used multinomial regression models to assess the relationship between patient race and discharge destination after surgery, for patients aged 18 to 64 years and for those aged 65 and older. We used multivariable (MV) regression and propensity score (PS) approaches to examine the relationship between patient discharge destination after surgery for PAC/Rehab and 30-day readmission, controlling for key individual- and facility-level factors. Results: Lower proportions of younger patients compared to those older than 65 were discharged to inpatient rehabilitation facilities (IRFs; 5.8% vs 12.6%, respectively) and skilled nursing facilities (SNFs; 15.2% vs 32.7%, respectively) compared to home-based Rehab (self-care; 23.3% vs 14.2%, respectively). Compared to whites, African American patients had significantly higher odds of discharge to IRF (age < 65, odds ratio = 2.04; age ≥ 65, odds ratio = 1.64) and to SNF (age < 65, odds ratio = 2.86; age ≥ 65, odds ratio = 2.19) and discharge to home care in patients younger than 65 years (odds ratio = 1.31). The odds of 30-day readmission among patients discharged to an IRF (MV odds ratio = 7.76; PS odds ratio = 8.34) and SNF (MV odds ratio = 2.01; PS odds ratio = 1.83) were significantly higher in comparison to patients discharged home with self-care. Conclusion: African American patients with knee replacement are more likely to be discharged to inpatient Rehab settings following surgery. Inpatient Rehab is significantly associated with 30-day readmission to acute care facility. PMID:26623166

  13. Development and implementation of a real-time 30-day readmission predictive model.

    PubMed

    Cronin, Patrick R; Greenwald, Jeffrey L; Crevensten, Gwen C; Chueh, Henry C; Zai, Adrian H

    2014-01-01

    Hospitals are under great pressure to reduce readmissions of patients. Being able to reliably predict patients at increased risk for rehospitalization would allow for tailored interventions to be offered to them. This requires the creation of a functional predictive model specifically designed to support real-time clinical operations. A predictive model for readmissions within 30 days of discharge was developed using retrospective data from 45,924 MGH admissions between 2/1/2012 and 1/31/2013 only including factors that would be available by the day after admission. It was then validated prospectively in a real-time implementation for 3,074 MGH admissions between 10/1/2013 and 10/31/2013. The model developed retrospectively had an AUC of 0.705 with good calibration. The real-time implementation had an AUC of 0.671 although the model was overestimating readmission risk. A moderately discriminative real-time 30-day readmission predictive model can be developed and implemented in a large academic hospital.

  14. The Relationship Between Nurse Staffing and 30-Day Readmission for Adults With Heart Failure

    PubMed Central

    Giuliano, Karen K.; Danesh, Valerie; Funk, Marjorie

    2016-01-01

    OBJECTIVE The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. BACKGROUND Heart failure is the most common cause of hospitalization for patients older than 65 years and is the most frequent diagnosis associated with 30-day hospital readmission in the United States. METHODS A secondary data analysis was conducted using nurse staffing data from 661 cardiology and heart surgery hospitals from the 2013 US News & World Report “Best Hospitals” survey. These data were combined with excess readmission ratios from the Centers for Medicare & Medicaid Services Hospital Compare database from 2013. An independent-samples t test was used to compare staffing (low/high) and excess hospital readmissions rates. RESULTS A significant difference (P = .021) was found between the low nurse staffing group (n = 358) and the high nurse staffing group (n = 303). Hospitals with a lower nurse staffing index had a significantly higher excess readmission rate. CONCLUSION These data provide further support to the body of research showing a positive relationship between nurse staffing and positive outcomes. PMID:26579974

  15. Beyond volume: hospital-based healthcare technology as a predictor of mortality for cardiovascular patients in Korea.

    PubMed

    Kim, Jae-Hyun; Lee, Yunhwan; Park, Eun-Cheol

    2016-06-01

    To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.This study used the National Health Insurance Service-Cohort Sample Database from 2002 to 2013, which was released by the Korean National Health Insurance Service. A total of 11,109 cardiovascular surgical procedure patients were analyzed. The primary analysis was based on logistic regression models to examine our hypothesis.After adjusting for hospital volume of cardiovascular surgical procedures as well as for all other confounders, the odds ratio (OR) of 30-day mortality in low healthcare technology hospitals was 1.567-times higher (95% confidence interval [CI] = 1.069-2.297) than in those with high healthcare technology. We also found that, overall, cardiovascular surgical patients treated in low healthcare technology hospitals, regardless of the extent of cardiovascular surgical procedures, had the highest 30-day mortality rate.Although the results of our study provide scientific evidence for a hospital volume-mortality relationship in cardiovascular surgical patients, the independent effect of hospital-based healthcare technology is strong, resulting in a lower mortality rate. As hospital characteristics such as clinical pathways and protocols are likely to also play an important role in mortality, further research is required to explore their respective contributions.

  16. 78 FR 58318 - Submission for OMB Review; 30-day Comment Request: The Framingham Heart Study (FHS)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ... studying the determinants of cardiovascular disease. Morbidity and mortality follow-up will continue to... data collection plans and instruments, contact Dr. Gina Wei, Division of Cardiovascular Sciences,...

  17. Hospital Blood Transfusion Patterns During Major Noncardiac Surgery and Surgical Mortality.

    PubMed

    Chen, Alicia; Trivedi, Amal N; Jiang, Lan; Vezeridis, Michael; Henderson, William G; Wu, Wen-Chih

    2015-08-01

    We retrospectively examined intraoperative blood transfusion patterns at US veteran's hospitals through description of national patterns of intraoperative blood transfusion by indication for transfusion in the elderly; assessment of temporal trends in the use of intraoperative blood transfusion; and relationship of institutional use of intraoperative blood transfusion to hospital 30-day risk-adjusted postoperative mortality rates.Limited data exist on the pattern of intraoperative blood transfusion by indication for transfusion at the hospital level, and the relationship between intraoperative transfusion rates and institutional surgical outcomes.Using the Department of Veterans Affairs Surgical Quality Improvement Program database, we assigned 424,015 major noncardiac operations among elderly patients (≥65 years) in 117 veteran's hospitals, from 1997 to 2009, into groups based on indication for intraoperative blood transfusion according to literature and clinical guidelines. We then examined institutional variations and temporal trends in surgical blood use based on these indications, and the relationship between these institutional patterns of transfusion and 30-day postoperative mortality.Intraoperative transfusion occurred in 38,056/424,015 operations (9.0%). Among the 64,390 operations with an indication for transfusion, there was wide variation (median: 49.9%, range: 8.7%-76.2%) in hospital transfusion rates, a yearly decline in transfusion rates (average 1.0%/y), and an inverse relationship between hospital intraoperative transfusion rates and hospital 30-day risk-adjusted mortality (adjusted mortality of 9.8 ± 2.8% vs 8.3 ± 2.1% for lowest and highest tertiles of hospital transfusion rates, respectively, P = 0.02). In contrast, for the 225,782 operations with no indication for transfusion, there was little variation in hospital transfusion rates (median 0.7%, range: 0%-3.4%), no meaningful temporal change in transfusion (average 0.0%/y), and

  18. 78 FR 70958 - 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Recordkeeping for HUD's Continuum of Care Program AGENCY: Office of the Chief Information Officer, HUD. ACTION: Notice. SUMMARY: HUD has... allow for an additional 30 days of public comment. DATES: Comments Due Date: December 27,...

  19. Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization.

    PubMed

    Horne, Benjamin D; Budge, Deborah; Masica, Andrew L; Savitz, Lucy A; Benuzillo, José; Cantu, Gabriela; Bradshaw, Alejandra; McCubrey, Raymond O; Bair, Tami L; Roberts, Colleen A; Rasmusson, Kismet D; Alharethi, Rami; Kfoury, Abdallah G; James, Brent C; Lappé, Donald L

    2017-03-01

    Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk.

  20. Correspondence between hair cortisol concentrations and 30-day integrated daily salivary and weekly urinary cortisol measures.

    PubMed

    Short, Sarah J; Stalder, Tobias; Marceau, Kristine; Entringer, Sonja; Moog, Nora K; Shirtcliff, Elizabeth A; Wadhwa, Pathik D; Buss, Claudia

    2016-09-01

    Characterization of cortisol production, regulation and function is of considerable interest and relevance given its ubiquitous role in virtually all aspects of physiology, health and disease risk. The quantification of cortisol concentration in hair has been proposed as a promising approach for the retrospective assessment of integrated, long-term cortisol production. However, human research is still needed to directly test and validate current assumptions about which aspects of cortisol production and regulation are reflected in hair cortisol concentrations (HCC). Here, we report findings from a validation study in a sample of 17 healthy adults (mean±SD age: 34±8.6 yrs). To determine the extent to which HCC captures cumulative cortisol production, we examined the correspondence of HCC, obtained from the first 1cm scalp-near hair segment, assumed to retrospectively reflect 1-month integrated cortisol secretion, with 30-day average salivary cortisol area-under-the curve (AUC) based on 3 samples collected per day (on awakening, +30min, at bedtime) and the average of 4 weekly 24-h urinary free cortisol (UFC) assessments. To further address which aspects of cortisol production and regulation are best reflected in the HCC measure, we also examined components of the salivary measures that represent: (1) production in response to the challenge of awakening (using the cortisol awakening response [CAR]), and (2) chronobiological regulation of cortisol production (using diurnal slope). Finally, we evaluated the test-retest stability of each cortisol measure. Results indicate that HCC was most strongly associated with the prior 30-day integrated cortisol production measure (average salivary cortisol AUC) (r=0.61, p=0.01). There were no significant associations between HCC and the 30-day summary measures using CAR or diurnal slope. The relationship between 1-month integrated 24-h UFC and HCC did not reach statistical significance (r=0.30, p=0.28). Lastly, of all cortisol

  1. Etiologies, Trends, and Predictors of 30-Day Readmission in Patients With Heart Failure.

    PubMed

    Arora, Shilpkumar; Patel, Prashant; Lahewala, Sopan; Patel, Nilay; Patel, Nileshkumar J; Thakore, Kosha; Amin, Aditi; Tripathi, Byomesh; Kumar, Varun; Shah, Harshil; Shah, Mahek; Panaich, Sidakpal; Deshmukh, Abhishek; Badheka, Apurva; Gidwani, Umesh; Gopalan, Radha

    2017-03-01

    Heart failure (HF) is the most common discharge diagnosis across the United States, and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the problem. The study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data 2013, sponsored by the Agency for Healthcare Research and Quality. HF was identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. Readmission was defined as a subsequent hospital admission within 30 days after discharge day of index admission. Readmission causes were identified using International Classification of Diseases, Ninth Revision, codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical 2-level logistic models were used to evaluate study outcomes. From a total 301,892 principal admissions (73.4% age ≥65 years and 50.6% men), 55,857 (18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by coronary artery disease and arrhythmias), whereas pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (odds ratio, 95% confidence interval, p value: 1.06, 1.03 to 1.08, p <0.001), chronic lung disease (1.13, 1.11 to 1.16, p <0.001), renal failure/electrolyte imbalance (1.12, 1.10 to 1.15, p <0.001), discharge to facilities (1.07, 1.04 to 1.09, p <0.001), lengthier hospital stay, and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to

  2. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  3. Assessing Risk and Preventing 30-Day Readmissions in Decompensated Heart Failure: Opportunity to Intervene?

    PubMed

    Dunbar-Yaffe, Richard; Stitt, Audra; Lee, Joseph J; Mohamed, Shanas; Lee, Douglas S

    2015-10-01

    Heart failure (HF) patients are at high risk of hospital readmission, which contributes to substantial health care costs. There is great interest in strategies to reduce rehospitalization for HF. However, many readmissions occur within 30 days of initial hospital discharge, presenting a challenge for interventions to be instituted in a short time frame. Potential strategies to reduce readmissions for HF can be classified into three different forms. First, patients who are at high risk of readmission can be identified even before their initial index hospital discharge. Second, ambulatory remote monitoring strategies may be instituted to identify early warning signs before acute decompensation of HF occurs. Finally, strategies may be employed in the emergency department to identify low-risk patients who may not need hospital readmission. If symptoms improve with initial therapy, low-risk patients could be referred to specialized, rapid outpatient follow-up care where investigations and therapy can occur in an outpatient setting.

  4. The Gravity of LBNP Exercise: Lessons Learned from Identical Twins in Bed for 30 Days

    NASA Technical Reports Server (NTRS)

    Hargens, Alan R.; Groppo, Eli R.; Lee, Stuart M. C.; Watenpaugh, Donald; Schneider, Suzanne; O'Leary, Deborah; Smith, Scott M.; Steinbach, Gregory C.; Tanaka, Kunihiko; Kimura, Shinji; Meyer, R. Scott

    2002-01-01

    Microgravity leads to cardiovascular deconditioning in humans, which is manifested by post-flight reduction of orthostatic tolerance and upright exercise capacity. During upright posture on Earth, blood pressures are greater in the feet than at heart or head levels due to gravity's effects on columns of blood in the body. During exposure to Microgravity, all gravitational blood pressures disappear. Presently, there is no exercise hardware available for space flight to provide gravitational blood pressures to tissues of the lower body. We hypothesized that 40 minutes of supine treadmill running per day in a LBNP chamber at 1.0 to 1.2 body weight (approximately 50 - 60 mm Hg LBNP) with a 5 min resting, nonexercise LBNP exposure at 50 mm Hg after the exercise session will maintain aerobic fitness orthostatic tolerance, and selected parameters of musculoskeletal function during 30 days of bed rest (simulated microgravity). This paper is an interim report of some of our findings on 16 subjects.

  5. Development of Lightweight Material Composites to Insulate Cryogenic Tanks for 30-Day Storage in Outer Space

    NASA Technical Reports Server (NTRS)

    Krause, D. R.

    1972-01-01

    A conceptual design was developed for an MLI system which will meet the design constraints of an ILRV used for 7- to 30-day missions. The ten tasks are briefly described: (1) material survey and procurement, material property tests, and selection of composites to be considered; (2) definition of environmental parameters and tooling requirements, and thermal and structural design verification test definition; (3) definition of tanks and associated hardware to be used, and definition of MLI concepts to be considered; (4) thermal analyses, including purge, evacuation, and reentry repressurization analyses; (5) structural analyses (6) thermal degradation tests of composite and structural tests of fastener; (7) selection of MLI materials and system; (8) definition of a conceptual MLI system design; (9) evaluation of nondestructive inspection techniques and definition of procedures for repair of damaged areas; and (10) preparation of preliminary specifications.

  6. Structural and metabolic characteristics of human skeletal muscle following 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Hikida, Robert S.; Gollnick, Philip D.; Dudley, Gary A.; Convertino, Victor A.; Buchanan, Paul

    1989-01-01

    The effects of simulated microgravity (30 days of continuous 6-deg headdown bedrest, BR) on the structural and metabolic characteristics of human skeletal muscle were determined. Percutaneous needle biopsy samples obtained from the vastus lateralis and soleus muscles before and after the headdown BR were analyzed for histochemical, biochemical and ultrastructual changes. It was found that headdown BR led to decreases in both fast-twitch and slow-twitch fiber areas in both muscles, and there was evidence of remodeling of the ultrastructure in both muscles. The activities of beta-hydroxyacyl-CoA dehydrogenase and citrate synthase were reduced during BR, but phosphofructokinase and lactate dehydrogenase activities did not change. The results indicate that 30-d exposure to simulated microgravity decreased the capacity for aerobic energy supply of human skeletal muscle and led to a disorganization of the contractile machinery.

  7. Continuous 30-day measurements utilizing the monkey metabolism pod. [study of weightlessness effects

    NASA Technical Reports Server (NTRS)

    Pace, N.; Kodama, A. M.; Mains, R. C.; Rahlmann, D. F.; Grunbaum, B. W.

    1977-01-01

    A fiberglass system was previously described, using which quantitative physiological measurements could be made to study the effects of weightlessness on 10 to 14 kg adult monkeys maintained in comfortable restraint under space flight conditions. Recent improvements in the system have made it possible to obtain continuous measurements of respiratory gas exchange, cardiovascular function, and mineral balance for periods of up to 30 days on pig-tailed monkeys. It has also been possible to operate two pods which share one set of instrumentation, thereby permitting simultaneous measurements to be made on two animals by commutating signal outputs from the pods. In principle, more than two pods could be operated in this fashion. The system is compatible with Spacelab design. Representative physiological data from ground tests of the system are presented.

  8. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest.

    PubMed

    Morgan, Jennifer L L; Zwart, Sara R; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen; Smith, Scott M

    2012-11-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25-49 yr) who participated in a 30-day -6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ~20% (P < 0.001), and serum parathyroid hormone decreased ~25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ~20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = -0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration.

  9. Bone metabolism and nutritional status during 30-day head-down-tilt bed rest

    PubMed Central

    Morgan, Jennifer L. L.; Zwart, Sara R.; Heer, Martina; Ploutz-Snyder, Robert; Ericson, Karen

    2012-01-01

    Bed rest studies provide an important tool for modeling physiological changes that occur during spaceflight. Markers of bone metabolism and nutritional status were evaluated in 12 subjects (8 men, 4 women; ages 25–49 yr) who participated in a 30-day −6° head-down-tilt diet-controlled bed rest study. Blood and urine samples were collected twice before, once a week during, and twice after bed rest. Data were analyzed using a mixed-effects linear regression with a priori contrasts comparing all days to the second week of the pre-bed rest acclimation period. During bed rest, all urinary markers of bone resorption increased ∼20% (P < 0.001), and serum parathyroid hormone decreased ∼25% (P < 0.001). Unlike longer (>60 days) bed rest studies, neither markers of oxidative damage nor iron status indexes changed over the 30 days of bed rest. Urinary oxalate excretion decreased ∼20% during bed rest (P < 0.001) and correlated inversely with urinary calcium (R = −0.18, P < 0.02). These data provide a broad overview of the biochemistry associated with short-duration bed rest studies and provide an impetus for using shorter studies to save time and costs wherever possible. For some effects related to bone biochemistry, short-duration bed rest will fulfill the scientific requirements to simulate spaceflight, but other effects (antioxidants/oxidative damage, iron status) do not manifest until subjects are in bed longer, in which case longer studies or other analogs may be needed. Regardless, maximizing research funding and opportunities will be critical to enable the next steps in space exploration. PMID:22995395

  10. Report from the Society of Thoracic Surgeons National Database Workforce: clarifying the definition of operative mortality.

    PubMed

    Overman, David M; Jacobs, Jeffrey P; Prager, Richard L; Wright, Cameron D; Clarke, David R; Pasquali, Sara K; O'Brien, Sean M; Dokholyan, Rachel S; Meehan, Paul; McDonald, Donna E; Jacobs, Marshall L; Mavroudis, Constantine; Shahian, David M

    2013-01-01

    Several distinct definitions of postoperative death have been used in various quality reporting programs. Some have defined postoperative mortality as the occurrence of death after a surgical procedure when the patient dies while still in the hospital, while others have considered all deaths occurring within a predetermined, standardized time interval after surgery to be postoperative mortality. While mortality data are still collected and reported using both these individual definitions, the Society of Thoracic Surgeons (STS) believes that either approach alone may be inadequate. Accordingly, the STS prefers a more encompassing metric, Operative Mortality. Operative Mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30th postoperative day. This article provides clarification for some uncommon but important scenarios in which the correct application of this definition may be challenging.

  11. 78 FR 65697 - 30-Day Notice of Proposed Information Collection: Public Housing, Contracting With Resident-Owned...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Public Housing, Contracting With...: Colette Pollard, Reports Management Officer, QDAM, Department of Housing and Urban Development, 451...

  12. 77 FR 73731 - 30-Day Notice of Proposed Information Collection: Application Under the Hague Convention on the...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-11

    ... Notice is to allow 30 days for public comment. DATES: Submit comments directly to the Office of Management and Budget (OMB) up to January 10, 2013. ADDRESSES: Direct comments to the Department of...

  13. Analysis of rat testicular proteome following 30-day exposure to 900 MHz electromagnetic field radiation.

    PubMed

    Sepehrimanesh, Masood; Kazemipour, Nasrin; Saeb, Mehdi; Nazifi, Saeed

    2014-12-01

    The use of electromagnetic field (EMF) generating apparatuses such as cell phones is increasing, and has caused an interest in the investigations of its effects on human health. We analyzed proteome in preparations from the whole testis in adult male Sprague-Dawley rats that were exposed to 900 MHz EMF radiation for 1, 2, or 4 h/day for 30 consecutive days, simulating a range of possible human cell phone use. Subjects were sacrificed immediately after the end of the experiment and testes fractions were solubilized and separated via high-resolution 2D electrophoresis, and gel patterns were scanned, digitized, and processed. Thirteen proteins, which were found only in sham or in exposure groups, were identified by MALDI-TOF/TOF-MS. Among them, heat shock proteins, superoxide dismutase, peroxiredoxin-1, and other proteins related to misfolding of proteins and/or stress were identified. These results demonstrate significant effects of radio frequency modulated EMFs exposure on proteome, particularly in protein species in the rodent testis, and suggest that a 30-day exposure to EMF radiation induces nonthermal stress in testicular tissue. The functional implication of the identified proteins was discussed.

  14. [Activity of various oxidases and transaminases in the rat liver in the readaptation period after hypokinesia up to 30 days].

    PubMed

    Potapov, P P

    1990-01-01

    The activity of alpha-ketoglutarate dehydrogenase and succinic dehydrogenase in readaptation after 15-day hypokinesia was within normal limits, whereas following 30-day hypokinesia it was enhanced on days 11-15. Pyruvate dehydrogenase exhibited hyperactivity in the end of readaptation week 2 both in 15- and 30-day hypokinesia which resulted in rat liver hyperactivity of glutamate dehydrogenase and transaminases. Normal levels of the latter were recorded on readaptation day 12-19.

  15. Estimating the Magnitude and Field-Size Dependence of Radiotherapy-Induced Mortality and Tumor Control After Postoperative Radiotherapy For Non-Small-Cell Lung Cancer: Calculations From Clinical Trials

    SciTech Connect

    Miles, Edward F. . E-mail: edward.miles@duke.edu; Kelsey, Chris R.; Kirkpatrick, John P.; Marks, Lawrence B.

    2007-07-15

    Purpose: To create, on the basis of available data, a mathematical model to describe the tumor stage- and field size-dependent risks/benefits of postoperative radiotherapy (PORT) for non-small-cell lung cancer (NSCLC), and to assess whether this simple model can accurately describe the reported changes in overall survival. Methods and Materials: The increase in overall survival afforded by PORT is assumed equal to the increase in cancer-specific survival minus the rate of RT-induced mortality. The increase in cancer-specific survival is the product of the probabilities of (residual local disease) x (sterilization of residual disease with PORT) x (absence of metastatic disease). Data were extracted from the literature to estimate these probabilities. Different models were considered to relate the RT-induced mortality to field size. Results: The rate of RT-induced mortality seems to be proportional to the cube of the field size. When these mortality rates are included in the model, the predicted changes in overall survival approximate the literature values. Conclusion: Clinical data can be explained by a simple model that suggests that RT-induced mortality is strongly dependent on field size and at least partly offsets the benefit afforded by PORT. Smaller RT fields, tailored to treat the areas most at risk for recurrence, provide the highest therapeutic ratio. The data used do not reflect the impact of chemotherapy, which will reduce the rate of distant metastases and enhance the efficacy of RT.

  16. Unplanned 30-Day Readmissions in a General Internal Medicine Hospitalist Service at a Comprehensive Cancer Center

    PubMed Central

    Manzano, Joanna-Grace M.; Gadiraju, Sahitya; Hiremath, Adarsh; Lin, Heather Yan; Farroni, Jeff; Halm, Josiah

    2015-01-01

    Purpose: Hospital readmissions are considered by the Centers for Medicare and Medicaid as a metric for quality of health care delivery. Robust data on the readmission profile of patients with cancer are currently insufficient to determine whether this measure is applicable to cancer hospitals as well. To address this knowledge gap, we estimated the unplanned readmission rate and identified factors influencing unplanned readmissions in a hospitalist service at a comprehensive cancer center. Methods: We retrospectively analyzed unplanned 30-day readmission of patients discharged from the General Internal Medicine Hospitalist Service at a comprehensive cancer center between April 1, 2012, and September 30, 2012. Multiple independent variables were studied using univariable and multivariable logistic regression models, with generalized estimating equations to identify risk factors associated with readmissions. Results: We observed a readmission rate of 22.6% in our cohort. The median time to unplanned readmission was 10 days. Unplanned readmission was more likely in patients with metastatic cancer and those with three or more comorbidities. Patients discharged to hospice were less likely to be readmitted (all P values < .01). Conclusion: We observed a high unplanned readmission rate among our population of patients with cancer. The risk factors identified appear to be related to severity of illness and open up opportunities for improving coordination with primary care physicians, oncologists, and other specialists to manage comorbidities, or perhaps transition appropriate patients to palliative care. Our findings will be instrumental for developing targeted interventions to help reduce readmissions at our hospital. Our data also provide direction for appropriate application of readmission quality measures in cancer hospitals. PMID:26152375

  17. Monitoring and Modeling the Fluctuations in Apparent Groundwater Age During a 30-Day Pumping Test.

    NASA Astrophysics Data System (ADS)

    Perle, M. E.; Zhang, Y.; Fogg, G. E.

    2004-12-01

    Recent research shows that dispersion due to geologic heterogeneity can cause large (10's to 100's of yrs) variations in actual groundwater age within individual samples drawn from a well, even if well bore mixing is not significant. We hypothesize that the presence of such large ranges in groundwater age may cause the mean apparent age as estimated from environmental tracers such as CFC's, SF&_{6}, and ^{3}H-^{3}He to drift measurably during long-term, continuous pumping. This hypothesis was confirmed by 3-D numerical experiments wherein variation in groundwater ages under high-rate (\\sim0.06 m^{3}/s; 1,000 gpm) long-term pumping was modeled using backward-time random walk particle tracking techniques combined with geostatistical simulations of hydrofacies heterogeneity. Results indicate that the age distribution within a water sample and the mean apparent age implied by environmental tracers is strongly influenced by historical atmospheric concentrations of environmental tracers and subsurface heterogeneity. As a partial implementation of this same experiment in the field, an abandoned well was pumped at a low rate (\\sim0.005 m^{3}/s; 75 gpm) during 53 days. Water samples were collected from the top and bottom of a 25 foot well screen at 12 hour intervals for the first 30 days and were analyzed for CFC's, SF&6, and 3H-3He. The measured tracer ages indicate that 1) CFC-11 apparent ages increased with time within the first five days of pumping and then remained constant for the remainder of the pump test; 2) trends in CFC-12, CFC-113 and SF&_{6}$ indicate a discrepancy in apparent ages with CFC-11, 3) water reaching the top interval is younger than water reaching the bottom interval. Gas samples were collected from the unsaturated zone to investigate possible CFC contamination and tracer concentration spatial variations in the pumping well recharge zone. Potential effects of heterogeneity and local CFC contamination on the monitoring results will be discussed.

  18. Bion M1. Peculiarities of life activities of microbes in 30-day spaceflight

    NASA Astrophysics Data System (ADS)

    Viacheslav, Ilyin; Korshunov, Denis; Morozova, Julia; Voeikova, Tatiana; Tyaglov, Boris; Novikova, Liudmila; Krestyanova, Irina; Emelyanova, Lydia

    The aim of this work was to analyze the influence of space flight factors ( SFF) to microorganism strains , exposed inside unmanned spacecraft Bion M-1 during the 30- day space flight. Objectives of the work - the study of the influence of the SFF exchange chromosomal DNA in crosses microorganisms of the genus Streptomyces; the level of spontaneous phage induction of lysogenic strains fS31 from Streptomyces lividans 66 and Streptomyces coelicolor A3 ( 2 ) on the biosynthesis of the antibiotic tylosin strain of Streptomyces fradiae; survival electrogenic bacteria Shewanella oneidensis MR- 1 is used in the microbial fuel cell As a result of this work it was found that the SFF affect the exchange of chromosomal DNA by crossing strains of Streptomyces. Was detected polarity crossing , expressed in an advantageous contribution chromosome fragment of one of the parent strains in recombinant offspring. This fact may indicate a more prolonged exposure of cells in microgravity and , as a consequence, the transfer of longer fragments of chromosomal DNA This feature is the transfer of genetic material in microgravity could lead to wider dissemination and horizontal transfer of chromosomal and plasmid DNA of symbiotic microflora astronauts and other strains present in the spacecraft. It was shown no effect on the frequency of recombination PCF and the level of mutation model reversion of auxotrophic markers to prototrophy It was demonstrated that PCF increase the level of induction of cell actinophage fS31 lysogenic strain of S. lividans 66, but did not affect the level of induction of this phage cells S. coelicolor A3 ( 2). It is shown that the lower the level of synthesis PCF antibiotic aktinorodina (actinorhodin) in lysogenic strain S. coelicolor A3 ( 2). 66 Strains of S. lividans and S. coelicolor A3 ( 2 ) can be used as a biosensor for studying the effect on microorganisms PCF It is shown that the effect of the PCF reduces synthesis of tylosin and desmicosyn S. fradiae at

  19. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    PubMed

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  20. [Postoperative hypothyroidism].

    PubMed

    Olifirova, O S; Trynov, N N

    2015-01-01

    There is a number of factors such as the thyroidectomy and limiting subtotal thyroid resection against the background of euthyroidism and initial hypothyroidism (in any extent of operation) which leads to the prediction of early postoperative hypothyroidism origin during 10 days of the postoperative peri- od. The early postoperative hypothyroidism is accompanied by activation processes of lipid peroxide oxidation and at the same time by reduction of antioxidant protection.

  1. Early cardiology assessment and intervention reduces mortality following myocardial injury after non-cardiac surgery (MINS)

    PubMed Central

    Hua, Alina; Pattenden, Holly; Leung, Maria; Davies, Simon; George, David A.; Raubenheimer, Hilgardt; Niwaz, Zakiyah

    2016-01-01

    Background Myocardial injury after non-cardiac surgery (MINS) is defined as troponin elevation of ≥0.03 ng/mL associated with 3.87-fold increase in early mortality. We sought to determine the impact of cardiology intervention on mortality in patients who developed MINS after general thoracic surgery. Methods A retrospective review was performed in patients over 5 years. Troponin was routinely measured and levels ≥0.04 ng/mL classified as positive. Data acquisition and mortality status was obtained via medical records and NHS tracing systems. Thirty-day mortality was compared on MINS cohort using Fisher’s exact square testing and logistic regression analysis. Results Troponin levels were measured in 491 (96%) of 511 patients. Eighty (16%) patients fulfilled the MINS criteria. Sixty-one (76%) received early cardiology consult and “myocardial infarction” stated in four (5%) patients. Risk assessment (for AMI) was undertaken; 20 (25%) patients were commenced on aspirin, four (5%) on β-blockers and one (1%) underwent percutaneous coronary intervention. Forty-nine (61%) patients received primary risk factor modifications and 26 (33%) had outpatient follow-up. There were no significant differences in the proportion of patients who died within 30 days post-operatively in the MINS group of 2.6% compared to the non-MINS group of 1.6% (P=0.625). The odds ratio for 30-day mortality in the MINS group was 1.69 (95% CI: 0.34 to 8.57, P=0.522). Conclusions MINS is common after general thoracic surgery. Early cardiology intervention reduced the expected hazard ratio of early death from 3.87 to an odds ratio of 1.69 with no significant difference in 30-day mortality for patients who developed MINS. PMID:27162667

  2. Superfund reform: US Environmental Protection Agency`s 30-day study and its implication for the US Department of Energy

    SciTech Connect

    Siegel, M.R.; Friedman, J.R.; Neff, R.W.

    1993-03-01

    As part of an ongoing effort to reform and restructure the US Environmental Protection Agency`s (EPAS) Superfund program, the EPA Administrator on October 21, 1991, announced several key programmatic reforms. These reforms are a result of the Superfund 30-Day Task Force Report (30-Day Study, EPA 1991a), an effort carried out by EPAs office of Solid Waste and Emergency Response (OSWER). The EPA OSWER oversees environmental cleanup activities under a number of statutory authorities, including the Comprehensive Environmental response, Compensation, and Liability Act (CERCLA, also known as Superfund). CERCLA and its implementing regulation, the National Contingency Plan (NCP), establish a regulatory framework to govern the cleanup of existing, and often abandoned, hazardous waste sites. The purposes of this report are to (1) review the background and recommendations of EPNs 30-Day Study, (2) identify and discuss the initiatives from the 30-Day Study that may impact DOE`s environmental restoration mission, (3) report on EPAs progress in implementing the selected priority initiatives, and (4) describe potentially related DOE activities.

  3. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  4. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  5. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  6. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  7. 31 CFR 538.506 - 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-November 4, 1997 trade contracts involving Sudan. 538.506 Section 538.506 Money and Finance: Treasury....506 30-day delayed effective date for pre-November 4, 1997 trade contracts involving Sudan. (a) Pre... of Sudanese origin or owned or controlled by the Government of Sudan, importations under the...

  8. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  9. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  10. 31 CFR 560.515 - 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-May 7, 1995 trade contracts involving Iran. 560.515 Section 560.515 Money and Finance: Treasury....515 30-day delayed effective date for pre-May 7, 1995 trade contracts involving Iran. (a) All... involving Iran (a pre-existing trade contract), including the exportation of goods, services...

  11. Predicting 30-Day Readmissions: Performance of the LACE Index Compared with a Regression Model among General Medicine Patients in Singapore

    PubMed Central

    Low, Lian Leng; Lee, Kheng Hock; Hock Ong, Marcus Eng; Wang, Sijia; Tan, Shu Yun; Thumboo, Julian; Liu, Nan

    2015-01-01

    The LACE index (length of stay, acuity of admission, Charlson comorbidity index, CCI, and number of emergency department visits in preceding 6 months) derived in Canada is simple and may have clinical utility in Singapore to predict readmission risk. We compared the performance of the LACE index with a derived model in identifying 30-day readmissions from a population of general medicine patients in Singapore. Additional variables include patient demographics, comorbidities, clinical and laboratory variables during the index admission, and prior healthcare utilization in the preceding year. 5,862 patients were analysed and 572 patients (9.8%) were readmitted in the 30 days following discharge. Age, CCI, count of surgical procedures during index admission, white cell count, serum albumin, and number of emergency department visits in previous 6 months were significantly associated with 30-day readmission risk. The final logistic regression model had fair discriminative ability c-statistic of 0.650 while the LACE index achieved c-statistic of 0.628 in predicting 30-day readmissions. Our derived model has the advantage of being available early in the admission to identify patients at high risk of readmission for interventions. Additional factors predicting readmission risk and machine learning techniques should be considered to improve model performance. PMID:26682212

  12. 76 FR 17734 - 30-Day Notice of Proposed Information Collection: Form DS-1998E, Foreign Service Officer Test...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-30

    .... Originating Office: Human Resources, HR/REE/BEX. Form Number: DS-1998E. Respondents: Registrants for the... information collection request to the Office of Management and Budget (OMB) for ] approval in accordance with... Office of Management and Budget (OMB) for up to 30 days from March 30, 2011. ADDRESSES: Direct...

  13. 78 FR 31999 - 30-Day Notice of Proposed Information Collection: Young Turkey/Young America Evaluation (YTYA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-28

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Young Turkey/ Young America Evaluation (YTYA) Survey ACTION... Collection: Young Turkey/Young America Evaluation (YTYA) Survey. OMB Control Number: None. Type of...

  14. 78 FR 36562 - 30-Day Notice of Proposed Information Collection: Application and Re-certification Packages for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ...HUD has submitted the proposed information collection requirement described below to the Office of Management and Budget (OMB) for review, in accordance with the Paperwork Reduction Act. The purpose of this notice is to allow for an additional 30 days of public...

  15. 78 FR 66040 - 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate-Sales Contract and Addendums

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-04

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: HUD-Owned Real Estate--Sales... collection entitled HUD-Owned Real Estate-Sales Contract and Addendums (2502-0306). HUD will republish...

  16. 78 FR 59047 - 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... Title of Information Collection: Semi-annual Labor Standards Enforcement Report--Local Contracting... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Semi-Annual Labor Standards Enforcement Report--Local Contracting Agencies (HUD Programs) AGENCY: Office of the Chief Information...

  17. 76 FR 58074 - 30-Day Notice of Proposed Information Collection: DS-7001 and DS-7005, DOS-Sponsored Academic...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-19

    ... information collection request to the Office of Management and Budget (OMB) for approval in accordance with... Collection. Originating Office: Bureau of Educational and Cultural Affairs, ECA/A/E/EUR. Form Number: DS-7001... to the Office of Management and Budget (OMB) for up to 30 days from September 19, 2011....

  18. 77 FR 47690 - 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-09

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Civilian Response Corps Database In-Processing Electronic Form... Database In-Processing Electronic Form. OMB Control Number: 1405-0168. Type of Request: Extension of...

  19. 75 FR 32961 - 30-Day Federal Register Notice of Intention To Request Clearance of Collection of Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-10

    ... collection Office of Management and Budget (OMB) Control 1024-0231. The OMB has up to 60 days to approve or... consideration, OMB should receive public comments within 30 days of the date on which this notice is published... were received on this notice. DATES: Public comments on the proposed Information Collection...

  20. 78 FR 15799 - 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE 30-Day Notice of Proposed Information Collection: Statement Regarding a Lost or Stolen U.S. Passport Book and/or... INFORMATION: Title of Information Collection: Statement Regarding a Lost or Stolen U.S. Passport Book...

  1. 78 FR 64145 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-25

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing..., 2013. A. Overview of Information Collection Title of Information Collection: Housing Finance Agency... Secretary to implement risk sharing with State and local housing finance agencies (HFAs). Under this...

  2. 78 FR 65696 - 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... URBAN DEVELOPMENT 30-Day Notice of Proposed Information Collection: Housing Finance Agency Risk-Sharing... Collection Title of Information Collection: Housing Finance Agency Risk- Sharing Program. OMB Approval Number... with State and local housing finance agencies (HFAs). Under this program, HUD provides full...

  3. 78 FR 35040 - Submission for OMB Review; 30-day Comment Request; Web-Based Media Literacy Parent Training for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ... HUMAN SERVICES National Institutes of Health Submission for OMB Review; 30-day Comment Request; Web-Based Media Literacy Parent Training for Substance Use Prevention in Rural Locations SUMMARY: Under the... Branch, Division of Epidemiology, Services, and Prevention Research, NIDA, NIH, 6001 Executive...

  4. Relationship between Early Physician Follow-Up and 30-Day Readmission after Acute Myocardial Infarction and Heart Failure

    PubMed Central

    Tung, Yu-Chi; Chang, Guann-Ming; Chang, Hsien-Yen

    2017-01-01

    Background Thirty-day readmission rates after acute myocardial infarction (AMI) and heart failure are important patient outcome metrics. Early post-discharge physician follow-up has been promoted as a method of reducing 30-day readmission rates. However, the relationships between early post-discharge follow-up and 30-day readmission for AMI and heart failure are inconclusive. We used nationwide population-based data to examine associations between 7-day physician follow-up and 30-day readmission, and further associations of 7-day same physician (during the index hospitalization and at follow-up) and cardiologist follow-up with 30-day readmission for non-ST-segment-elevation myocardial infarction (NSTEMI) or heart failure. Methods We analyzed all patients 18 years or older with NSTEMI and heart failure and discharged from hospitals in 2010 in Taiwan through Taiwan’s National Health Insurance Research Database. Cox proportional hazard models with robust sandwich variance estimates and propensity score weighting were performed after adjustment for patient and hospital characteristics to test associations between 7-day physician follow-up and 30-day readmission. Results The study population for NSTEMI and heart failure included 5,008 and 13,577 patients, respectively. Early physician follow-up was associated with a lower hazard ratio of readmission compared with no early physician follow-up for patients with NSTEMI (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.39–0.57), and for patients with heart failure (HR, 0.54; 95% CI, 0.48–0.60). Same physician follow-up was associated with a reduced hazard ratio of readmission compared with different physician follow-up for patients with NSTEMI (HR, 0.56; 95% CI, 0.48–0.65), and for patients with heart failure (HR, 0.69; 95% CI, 0.62–0.76). Conclusions For each condition, patients who have an outpatient visit with a physician within 7 days of discharge have a lower risk of 30-day readmission. Moreover

  5. Temporal Changes in Survival after Cardiac Surgery Are Associated with the Thirty-Day Mortality Benchmark

    PubMed Central

    Maxwell, Bryan G; Wong, Jim K; Miller, D Craig; Lobato, Robert L

    2014-01-01

    Objective To assess the hypothesis that postoperative survival exhibits heterogeneity associated with the timing of quality metrics. Data Sources Retrospective observational study using the Nationwide Inpatient Sample from 2005 through 2009. Study Design Survival analysis was performed on all admission records with a procedure code for major cardiac surgery (n = 595,089). The day-by-day hazard function for all-cause in-hospital mortality at 1-day intervals was analyzed using joinpoint regression (a data-driven method of testing for changes in hazard). Data Extraction Methods A comprehensive analysis of a publicly available national administrative database was performed. Principal Findings Statistically significant shifts in the pattern of postoperative mortality occurred at day 6 (95 percent CI = day 5–8) and day 30 (95 percent CI = day 20–35). Conclusions While the shift at day 6 plausibly can be attributed to the separation between routine recovery and a complicated postoperative course, the abrupt increase in mortality at day 30 has no clear organic etiology. This analysis raises the possibility that this observed shift may be related to clinician behavior because of the use of 30-day mortality as a quality metric, but further studies will be required to establish causality. PMID:24713085

  6. 30 Days Wild: Development and Evaluation of a Large-Scale Nature Engagement Campaign to Improve Well-Being.

    PubMed

    Richardson, Miles; Cormack, Adam; McRobert, Lucy; Underhill, Ralph

    2016-01-01

    There is a need to increase people's engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature.

  7. African Easterly Waves in 30-day High-Resolution Global Simulations: A Case Study During the 2006 NAMMA Period

    NASA Technical Reports Server (NTRS)

    Shen, Bo-Wen; Tao, Wei-Kuo; Wu, Man-Li C.

    2010-01-01

    In this study, extended -range (30 -day) high-resolution simulations with the NASA global mesoscale model are conducted to simulate the initiation and propagation of six consecutive African easterly waves (AEWs) from late August to September 2006 and their association with hurricane formation. It is shown that the statistical characteristics of individual AEWs are realistically simulated with larger errors in the 5th and 6th AEWs. Remarkable simulations of a mean African easterly jet (AEJ) are also obtained. Nine additional 30 -day experiments suggest that although land surface processes might contribute to the predictability of the AEJ and AEWs, the initiation and detailed evolution of AEWs still depend on the accurate representation of dynamic and land surface initial conditions and their time -varying nonlinear interactions. Of interest is the potential to extend the lead time for predicting hurricane formation (e.g., a lead time of up to 22 days) as the 4th AEW is realistically simulated.

  8. No evidence for race and socioeconomic status as independent predictors of 30-day readmission rates following orthopedic surgery.

    PubMed

    Hunter, Tracey; Yoon, Richard S; Hutzler, Lorraine; Band, Philip; Liublinksa, Victoria; Slover, James; Bosco, Joseph A

    2015-01-01

    The Centers for Medicare & Medicaid Services considers readmissions within 30 days of discharge to be a quality indicator. Hospitals' and eventually physicians' readmission rates will be used to determine payment for services. It is imperative that health care providers understand which patients are at risk for readmission so that they can apply the appropriate preventive interventions. The research team analyzed all orthopedic admissions and readmissions at their institution from September 2008 to April 2011 in this study. Preparing for the next stage in health care reform, identifying any preoperative factors that may place certain patients into a "high-risk" category for readmission following an orthopedic procedure is of paramount importance. This data analysis of more than 13 000 patients noted that race-based and income-based risk factors did not translate into significant risk factors or predictors of 30-day readmission following orthopedic admission.

  9. 30 Days Wild: Development and Evaluation of a Large-Scale Nature Engagement Campaign to Improve Well-Being

    PubMed Central

    Richardson, Miles; Cormack, Adam; McRobert, Lucy; Underhill, Ralph

    2016-01-01

    There is a need to increase people’s engagement with and connection to nature, both for human well-being and the conservation of nature itself. In order to suggest ways for people to engage with nature and create a wider social context to normalise nature engagement, The Wildlife Trusts developed a mass engagement campaign, 30 Days Wild. The campaign asked people to engage with nature every day for a month. 12,400 people signed up for 30 Days Wild via an online sign-up with an estimated 18,500 taking part overall, resulting in an estimated 300,000 engagements with nature by participants. Samples of those taking part were found to have sustained increases in happiness, health, connection to nature and pro-nature behaviours. With the improvement in health being predicted by the improvement in happiness, this relationship was mediated by the change in connection to nature. PMID:26890891

  10. Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity

    PubMed Central

    Low, Lian Leng; Liu, Nan; Wang, Sijia; Thumboo, Julian; Ong, Marcus Eng Hock; Lee, Kheng Hock

    2016-01-01

    Background To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months), an established risk stratification tool. Method This was a retrospective cohort study of all patients ≥ 21 years of age, who were admitted to a tertiary hospital in Singapore from January 1, 2013 through May 31, 2015. Data were extracted from the hospital’s electronic health records. The outcome was defined as unplanned readmissions within 30 days of discharge from the index hospitalization. Candidate predictive variables were broadly grouped into five categories: Patient demographics, social determinants of health, past healthcare utilization, medical comorbidities, and markers of hospitalization severity. Multivariable logistic regression was used to predict the outcome, and receiver operating characteristic analysis was performed to compare our model with the LACE index. Results 74,102 cases were enrolled for analysis. Of these, 11,492 patient cases (15.5%) were readmitted within 30 days of discharge. A total of fifteen predictive variables were strongly associated with the risk of 30-day readmissions, including number of emergency department visits in the past 6 months, Charlson Comorbidity Index, markers of hospitalization severity such as ‘requiring inpatient dialysis during index admission, and ‘treatment with intravenous furosemide 40 milligrams or more’ during index admission. Our predictive model outperformed the LACE index by achieving larger area under the curve values: 0.78 (95% confidence interval [CI]: 0.77–0.79) versus 0.70 (95% CI: 0.69–0.71). Conclusion Several factors are important for

  11. International Validity of the “HOSPITAL” Score to Predict 30-day Potentially Avoidable Readmissions in Medical Patients

    PubMed Central

    Donzé, Jacques D.; Williams, Mark V.; Robinson, Edmondo J.; Zimlichman, Eyal; Aujesky, Drahomir; Vasilevskis, Eduard E.; Kripalani, Sunil; Metlay, Joshua P.; Wallington, Tamara; Fletcher, Grant S.; Auerbach, Andrew D.; Schnipper, Jeffrey L.

    2016-01-01

    IMPORTANCE Identification of patients at high risk of potentially avoidable readmission allows hospitals to efficiently direct additional care transitions services to the patients most likely to benefit. OBJECTIVE To externally validate the “HOSPITAL” score in an international multicenter study to assess its generalizability. DESIGN International multicenter retrospective cohort study. SETTING 9 large hospitals across 4 different countries. PARTICIPANTS All adult patients consecutively discharged alive from a medical department between January and December, 2011 (117,065 participants). Patients transferred to another acute care facility were excluded. EXPOSURES The “HOSPITAL” score includes the following predictors at discharge: Hemoglobin, discharge from an Oncology service, Sodium level, Procedure during the index admission, Index Type of admission (urgent), number of Admissions during the last 12 months, and Length of stay. MAIN OUTCOMES AND MEASURES 30-day potentially avoidable readmission to the index hospital using the SQLape algorithm. RESULTS Of all medical discharges, 14.5% (n=16,992) were followed by a 30-day readmission, and 9.7% (n=11,307) were followed by a 30-day potentially avoidable readmission. The discriminatory power of the “HOSPITAL” score to predict potentially avoidable readmission was good with a C-statistic of 0.72 (95% CI 0.72-0.72). As in the derivation study, patients were classified into 3 risk categories: low (62%), intermediate (24%), and high risk (14%). The estimated proportions of potentially avoidable readmission for each risk category matched the observed proportion, resulting in an excellent calibration (Pearson goodness of fit test P=0.89). CONCLUSIONS AND RELEVANCE The “HOSPITAL” score identified patients at high risk of 30-day potentially avoidable readmission with moderately high discrimination and excellent calibration when applied to a large international multicenter cohort of medical patients. This score

  12. Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

    PubMed Central

    Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

    2014-01-01

    Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

  13. Emergency department evaluation and 30-day readmission after craniotomy for primary brain tumor resection in New York State.

    PubMed

    Missios, Symeon; Bekelis, Kimon

    2017-01-06

    OBJECTIVE Fragmentation of care has been recognized as a major contributor to 30-day readmissions after surgical procedures. The authors investigated the association of evaluation in the hospital where the original procedure was performed with the rate of 30-day readmissions for patients presenting to the emergency department (ED) after craniotomy for primary brain tumor resection. METHODS A cohort study was conducted, involving patients who were evaluated in the ED within 30 days after discharge following a craniotomy for primary brain tumor resection between 2009 and 2013, and who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. A propensity score-adjusted model was used to control for confounding, whereas a mixed-effects model accounted for clustering at the hospital level. RESULTS Of the 610 patients presenting to the ED, 422 (69.2%) were evaluated in a hospital different from the one where the original procedure was performed (28.9% were readmitted), and 188 (30.8%) were evaluated at the original hospital (20.3% were readmitted). In a multivariable analysis, the authors demonstrated that being evaluated in the ED of the original hospital was associated with a decreased rate of 30-day readmission (OR 0.64, 95% CI 0.41-0.98). Similar associations were found in a mixed-effects logistic regression model (OR 0.63, 95% CI 0.40-0.96) and a propensity score-adjusted model (OR 0.64, 95% CI 0.41-0.98). This corresponds to one less readmission per 12 patients evaluated in the hospital where the original procedure was performed. CONCLUSIONS Using a comprehensive all-payer cohort of patients in New York State who were evaluated in the ED after craniotomy for primary brain tumor resection, the authors identified an association of assessment in the hospital where the original procedure was performed with a lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in

  14. Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child-Pugh score.

    PubMed

    Jacob, Kirolos A; Hjortnaes, Jesper; Kranenburg, Guido; de Heer, Frederiek; Kluin, Jolanda

    2015-04-01

    Liver cirrhosis is a known risk factor for postoperative mortality in patients undergoing cardiac surgery. Clinical assessment of liver cirrhosis using the widely accepted Child-Pugh (CP) score is thus vital for evaluation of surgical options and perioperative care. However, detailed mortality rates as a consequence of liver cirrhosis are unclear. This review aimed to stratify the risk of short-term (<30 days) and overall (up to 10 years) mortality after cardiac surgery in patients with liver cirrhosis, classified by the CP score. Thus, PubMed, Embase, CINAHL and the Cochrane Library were systematically reviewed by two independent investigators for studies published up to February 2014, in which mortality in cirrhotic patients, classified by the CP classification, undergoing cardiac surgery was evaluated postoperatively. A total of 993 articles were identified. After critical appraisal of 21 articles, 19 were selected for final analysis. Weighted short-term mortality of cirrhotic patients undergoing cardiac surgery was 19.3% [95% confidence interval (CI): 16.4-22.5%]. Across the different CP groups, short-term mortality appeared to be 9.0% (95% CI: 6.6-12.2%), 37.7% (95% CI: 30.8-44.3%) and 52.0% (95% CI: 33.5-70.0%) in Groups A, B and C, respectively. Weighted overall mortality within 1 year was 42.0% (95% CI: 36.0-48.3%) in all cirrhotic patients. Subdivided in groups, overall mortality within that 1 year was 27.2% (95% CI: 20.9-34.7%), 66.2% (95% CI: 54.3-76.3%) and 78.9% (95% CI: 56.1-92.1%) in Groups A, B and C, respectively. In conclusion, short-term mortality is considerably increased in patients with liver cirrhosis CP class B and C. Overall mortality is significantly high in all classes of liver cirrhosis.

  15. Incidence, Predictors, and Impact of Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting in Military Veterans

    PubMed Central

    Cornwell, Lorraine D.; Bakshi, Ankur; Rachlin, Eric; Preventza, Ourania; Rosengart, Todd K.; Coselli, Joseph S.; LeMaire, Scott A.; Petersen, Nancy J.; Pattakos, Greg; Bakaeen, Faisal G.

    2016-01-01

    Little is known about the frequency and clinical implications of postoperative atrial fibrillation in military veterans who undergo coronary artery bypass grafting (CABG). We examined long-term survival data, clinical outcomes, and associated risk factors in this population. We retrospectively reviewed baseline, intraoperative, and postoperative data from 1,248 consecutive patients with similar baseline risk profiles who underwent primary isolated CABG at a Veterans Affairs hospital from October 2006 through March 2013. Multivariable logistic regression identified predictors of postoperative atrial fibrillation. Kaplan-Meier analysis was used to evaluate long-term survival (the primary outcome measure), morbidity, and length of hospital stay. Postoperative atrial fibrillation occurred in 215 patients (17.2%). Independent predictors of this sequela were age ≥65 years (odds ratios [95% confidence intervals], 1.7 [1.3–2.4] for patients of age 65–75 yr and 2.6 [1.4–4.8] for patients >75 yr) and body mass index ≥30 kg/m2 (2.0 [1.2–3.2]). Length of stay was longer for patients with postoperative atrial fibrillation than for those without (12.7 ± 6.6 vs 10.3 ± 8.9 d; P ≤0.0001), and the respective 30-day mortality rate was higher (1.9% vs 0.4%; P=0.014). Seven-year survival rates did not differ significantly. Older and obese patients are particularly at risk of postoperative atrial fibrillation after CABG. Patients who develop the sequela have longer hospital stays than, but similar long-term survival rates to, patients who do not. PMID:27777519

  16. Effects of leg strength and bicycle ergometry exercise on cardiovascular deconditioning after 30-day head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wu, Bin; Liu, Yusheng; Sun, Hongyi; Zhao, Dongming; Wang, Yue; Wu, Ping; Ni, Chengzhi

    2010-10-01

    The purpose of this study is to determine if the intermittent leg muscular strength exercise and bicycle ergometry exercise could attenuate cardiovascular deconditioning induced by prolonged -6° head-down bed rest (HDBR). Fifteen male subjects were randomly allocated into group A ( n=5, 30 days HDBR without exercise), group B ( n=5, 30 days HDBR with leg muscular strength exercise) and group C ( n=5, 30 days HDBR with bicycle ergometry exercise). The orthostatic tolerance (OT) was determined by +75°/20 min head-up tilt (HUT) test and the submaximal exercise capacity was determined by bicycle ergometry before and after HDBR. The results were as follows: (1) Compared with that before HDBR, OT time decreased dramatically by 57.6% ( p<0.001) after HDBR in group A, while it decreased by 36.4% ( p=0.084) in group B and by 34.7% ( p=0.062) in group C. (2) Compared with that before HDBR, the submaximal exercise time decreased significantly by 17.7% ( p<0.05) and 21.1% ( p<0.05) in groups A and B, respectively, after HDBR. However, it had no change (+1.3%, p>0.77) in group C. (3) compared with that before HDBR, the changes of heart rate (HR) and blood pressure were slightly improved in group B and C, while deteriorated in group A during orthostatic test and exercise test after HDBR. The results indicate that leg muscular strength exercise and bicycle ergometry exercise could partially attenuate the cardiovascular deconditioning induced by 30 d HDBR, and the latter exercise training could fully provide the protection for the loss of exercise capacity.

  17. Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

    PubMed Central

    McHugh, Matthew D.; Ma, Chenjuan

    2013-01-01

    Background Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions. PMID:23151591

  18. Effects of Cardiopulmonary Support With a Novel Pediatric Pump-Lung in a 30-Day Ovine Animal Model.

    PubMed

    Liu, Yang; Sanchez, Pablo G; Wei, Xufeng; Watkins, Amelia C; Niu, Shuqiong; Wu, Zhongjun J; Griffith, Bartley P

    2015-12-01

    The scarcity of donor organs has led to the development of devices that provide optimal long-term respiratory or cardiopulmonary support to bridge recipients as they wait for lung and/or heart transplantation. This study was designed to evaluate the 30-day in vivo performance of the newly developed pediatric pump-lung (PediPL) for cardiopulmonary support using a juvenile sheep model. The PediPL device was placed surgically between the right atrium and descending aorta in eight sheep (25.4-31.2 kg) and evaluated for 30 days. Anticoagulation was maintained with continuous heparin infusion (activated clotting time 150-200 s). The flow rate was measured continually, and gas transfer was measured daily. Plasma free hemoglobin, platelet activation, hematologic data, and blood biochemistry were assessed twice a week. Sheep were euthanized after 30 days. The explanted devices were examined for gross thrombosis. Six sheep survived for 30-32 days. During the study, the oxygen transfer rate of the devices was 54.9 ± 13.2 mL/min at a mean flow rate of 1.14 ± 0.46 L/min with blood oxygen saturation of 95.4% ± 1.7%. Plasma free hemoglobin was 8.2 ± 3.7 mg/dL. Platelet activation was 5.35 ± 2.65%. The animals had normal organ chemistries except for surgery-related transient alterations in kidney and liver function. Although we found some scattered thrombi on the membrane surfaces of some explanted devices during the necropsy, the device function and performance did not degrade. The PediPL device was capable of providing cardiopulmonary support with long-term reliability and good biocompatibility over the 30-day duration and offers the potential option for bridging pediatric patients with end-stage heart or lung disease to heart and/or lung transplantation.

  19. A space maintainability experiment aboard the Ben Franklin submersible during the 30-day Gulf Stream drift mission.

    NASA Technical Reports Server (NTRS)

    Kappler, J. R.; May, C. B.

    1972-01-01

    In the summer of 1969, a deep submersible drifted for 30 days below the surface of the Gulf Stream, while operated by a six man crew. The main purpose of the mission was oceanographic research. The crew's activities and completely self-contained environment resembled those of a space station such as Skylab. Because of these similarities aspects of onboard vehicle maintenance during the actual conduct of a scientific mission were investigated. The maintainability study was accomplished in six distinct phases. Two useful plots of manpower distribution were developed. A maintenance action summary is presented in a table.

  20. Long-acting bronchodilators with or without inhaled corticosteroids and 30-day readmission in patients hospitalized for COPD

    PubMed Central

    Bishwakarma, Raju; Zhang, Wei; Kuo, Yong-Fang; Sharma, Gulshan

    2017-01-01

    Background The ability of a long-acting muscarinic antagonist (LAMA) and long-acting beta 2 agonists (LABAs; long-acting bronchodilators, LABDs) with or without inhaled corticosteroids (ICSs) to reduce early readmission in hospitalized patients with COPD is unknown. Methods We studied a 5% sample of Medicare beneficiaries enrolled in Medicare parts A, B and D and hospitalized for COPD in 2011. We examined prescriptions filled for LABDs with or without ICSs (LABDs±ICSs) within 90 days prior to and 30 days after hospitalization. Primary outcome was the 30-day readmission rate between “users” and “nonusers” of LABDs±ICSs. Propensity score matching and sensitivity analysis were performed by limiting analysis to patients hospitalized for acute exacerbation of COPD (AECOPD). Among 6,066 patients hospitalized for COPD, 3,747 (61.8%) used LABDs±ICSs during the specified period. The “user” and “nonuser” groups had similar rates of all-cause emergency room (ER) visits and readmissions within 30 days of discharge date (22.4% vs 20.7%, P-value 0.11; 18.0% vs 17.8%, P-value 0.85, respectively). However, the “users” had higher rates of COPD-related ER visits (5.3% vs 3.4%, P-value 0.0006), higher adjusted odds ratio (aOR) 1.47 (95% CI, 1.11–1.93) and readmission (7.8% vs 5.0%, P-value <0.0001 and aOR 1.48 [95% CI, 1.18–1.86]) than “nonusers”. After propensity score matching, the aOR of COPD-related ER visits was 1.45 (95% CI, 1.07–1.96) and that of readmission was 1.34 (95% CI, 1.04–1.73). The results were similar when restricted to patients hospitalized for AECOPD. Conclusion Use of LABDs±ICSs did not reduce 30-day readmissions in patients hospitalized for COPD. PMID:28203071

  1. Predictors of Mortality Up to One Year After Emergent Major Abdominal Surgery in Older Adults

    PubMed Central

    Cooper, Zara; Mitchell, Susan L.; Gorges, Rebecca J.; Rosenthal, Ronnie A.; Lipsitz, Stuart R.; Kelley, Amy S.

    2015-01-01

    Background The number of older patients who undergo emergent major abdominal procedures is expected to increase yet little is known about mortality beyond 30 days after surgery. Objective Identify factors associated with mortality among older patients at 30, 180 and 365 days after emergency major abdominal surgery. Design A retrospective study of the Health and Retirement Study (HRS) linked to Medicare Claims from 2000-2010. Setting N/A Participants Medicare beneficiaries > 65.5 years enrolled in the Health and Retirement Study (HRS) from 2000-2010, with at least one urgent/emergent major abdominal surgery and a core interview from the HRS within 3 years prior to surgery. Main Outcomes and Measures Survival analysis was used to describe all-cause mortality at 30, 180 and 365 days after surgery. Complementary log-log regression was used to identify patient characteristics and postoperative events associated with worse survival. Results 400 patients had one of the urgent/emergent surgeries of interest. Of these 24% were > 85 years; 50% had coronary artery disease, 48% had cancer, and 33% had congestive heart failure; and 37% experienced a postoperative complication. Postoperative mortality was 20%, 31% and 34% at 30, 180 days and 365 days. Among those > 85 years, 50% were dead one year after surgery. After multivariate adjustment including postoperative complications, dementia (Hazard ratio (HR) 2.02, 95%CI 1.24-3.31), hospitalization within 6 months before surgery (HR 1.63, 95% CI 1.12-2.28) and complications (HR 3.45, 95%CI (2.32-5.13) were independently associated with worse one-year survival. Conclusion Overall mortality is high up to one year after surgery in many older patients undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival. PMID:26661929

  2. Pharmacokinetic and Genomic Effects of Arsenite in Drinking Water on Mouse Lung in a 30-Day Exposure.

    PubMed

    Chilakapati, Jaya; Wallace, Kathleen; Hernandez-Zavala, Araceli; Moore, Tanya; Ren, Hongzu; Kitchin, Kirk T

    2015-01-01

    The 2 objectives of this subchronic study were to determine the arsenite drinking water exposure dependent increases in female C3H mouse liver and lung tissue arsenicals and to characterize the dose response (to 0, 0.05, 0.25, 1, 10, and 85 ppm arsenite in drinking water for 30 days and a purified AIN-93M diet) for genomic mouse lung expression patterns. Mouse lungs were analyzed for inorganic arsenic, monomethylated, and dimethylated arsenicals by hydride generation atomic absorption spectroscopy. The total lung mean arsenical levels were 1.4, 22.5, 30.1, 50.9, 105.3, and 316.4 ng/g lung tissue after 0, 0.05, 0.25, 1, 10, and 85 ppm, respectively. At 85 ppm, the total mean lung arsenical levels increased 14-fold and 131-fold when compared to either the lowest noncontrol dose (0.05 ppm) or the control dose, respectively. We found that arsenic exposure elicited minimal numbers of differentially expressed genes (DEGs; 77, 38, 90, 87, and 87 DEGs) after 0.05, 0.25, 1, 10, and 85 ppm, respectively, which were associated with cardiovascular disease, development, differentiation, apoptosis, proliferation, and stress response. After 30 days of arsenite exposure, this study showed monotonic increases in mouse lung arsenical (total arsenic and dimethylarsinic acid) concentrations but no clear dose-related increases in DEG numbers.

  3. Kansas City Cardiomyopathy Questionnaire Utility in Prediction of 30-Day Readmission Rate in Patients with Chronic Heart Failure

    PubMed Central

    Gui, Junhong; Zhu, Xiang; Malhotra, Divyanshu; Li, Shenjing; Virkram, Fnu; Chada, Aditya; Jiang, Haibing

    2016-01-01

    Background. Heart failure (HF) is one of the most common diagnoses associated with hospital readmission. We designed this prospective study to evaluate whether Kansas City Cardiomyopathy Questionnaire (KCCQ) score is associated with 30-day readmission in patients hospitalized with decompensated HF. Methods and Results. We enrolled 240 patients who met the study criteria. Forty-eight (20%) patients were readmitted for decompensated HF within thirty days of hospital discharge, and 192 (80%) patients were not readmitted. Compared to readmitted patients, nonreadmitted patients had a higher average KCCQ score (40.8 versus 32.6, P = 0.019) before discharge. Multivariate analyses showed that a high KCCQ score was associated with low HF readmission rate (adjusted OR = 0.566, P = 0.022). The c-statistic for the base model (age + gender) was 0.617. The combination of home medication and lab tests on the base model resulted in an integrated discrimination improvement (IDI) increase of 3.9%. On that basis, the KCQQ further increased IDI of 2.7%. Conclusions. The KCCQ score determined before hospital discharge was significantly associated with 30-day readmission rate in patients with HF, which may provide a clinically useful measure and could significantly improve readmission prediction reliability when combined with other clinical components. PMID:27872790

  4. Psychometric Properties of 7- and 30-Day Versions of the PROMIS Emotional Distress Item Banks in an Australian Adult Sample.

    PubMed

    Batterham, Philip J; Sunderland, Matthew; Carragher, Natacha; Calear, Alison L

    2017-01-01

    This study aimed to examine the psychometric properties of the PROMIS depression, anxiety, and anger item banks in a large Australian population-based sample. The study tested for unidimensionality; evaluated invariance across age, gender, and education; assessed local independence; and tested item bank scores as an indicator for clinical criteria. In addition, equivalence of the 7-day time frame against an alternative 30-day time frame was assessed. A sample of 3,175 Australian adults were recruited into the study through online advertising. All three item banks showed strong evidence of unidimensionality and parsimony, with no items showing local dependence. All items were invariant across age, gender, and education. The item banks were accurate in detecting clinical criteria for major depressive disorder, generalized anxiety disorder, and panic disorder, although legacy measures designed for this purpose sometimes performed marginally better. Responses to the 30-day time frame were highly consistent with the original 7-day time frame. The study provided support for the validity of the PROMIS emotional distress item banks as measures of depression, anxiety, and anger in the Australian population, supporting the generalizability of the measures. The time frame chosen for assessing mental health outcomes using these item banks should be based on pragmatic considerations.

  5. Postoperative astigmatism.

    PubMed

    Swinger, C A

    1987-01-01

    With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.

  6. [Effect of 30-day space flight and subsequent readaptation on the signaling processes in m. longissimus dorsi of mice].

    PubMed

    Mirzoev, T M; Vil'chinskaia, N A; Lomonosova, Iu N; Nemirovskaia, T L; Shenkman, B S

    2014-01-01

    Some steps of anabolic and catabolic signaling pathways were investigated in postural/tonic m. longissimus dorsi of mice following the 30-day orbital flight of biosatellite "Bion-M1" and 8-day recovery. Western blotting was used for determining insulin receptor substrate 1 (IRS-1) and AMR-activated protein kinase (AMPK) involved in reciprocal regulation of anabolic and catabolic pathways, as well as E3-ligase MURF-1, and elongation factor eEF2. Functioning of the IGF-1-dependent IRS-1 signaling pathway was activated in the recovery period only. Though the content of ubiquitinligase MURF-1 showed an increase after flight, on completion of the recovery period it did not exceed the pre-flight level unambiguously.

  7. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    PubMed

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families.

  8. Effect of a 30-day isolation stress on calcium, phosphorus and other excretory products in an unrestrained chimpanzee.

    NASA Technical Reports Server (NTRS)

    Sabbot, I. M.; Mcnew, J. J.; Hoshizaki, T.; Sedgwick, C. J.; Adey, W. R.

    1972-01-01

    An unrestrained chimpanzee was studied in an isolation chamber and in his home cage environment. The study consisted of 49 urine collection days (14 days pre-, 5 days post- and 30 days of isolation), and then of 10 days in the home cage. Dietary intake, urine and fecal data were obtained. The effect of isolation on various excretory parameters was studied. Urine samples were analyzed for volume, osmolarity, creatinine, creatine, urea-N, 17-hydroxy corticosteroids, VMA, calcium and inorganic phosphorus. One way analyses of variance performed on the urinary excretion parameters showed all except creatinine excretion to vary significantly during periods of the study. The changes observed in calcium and phosphorus were highly significant. The data suggests that the calcium to phosphorus excretion ratio might serve as a physiological stress indicator of Selye's adaptation syndrome (period of resistance).

  9. Community Level Association between Home Health and Nursing Home Performance on Quality and Hospital 30-day Readmissions for Medicare Patients.

    PubMed

    Wang, Yun; Pandolfi, Michelle M; Fine, Jonathan; Metersky, Mark L; Wang, Changqin; Ho, Shih-Yieh; Galusha, Deron; Nuti, Sudhakar V; Murugiah, Karthik; Spenard, Ann; Elwell, Timothy; Krumholz, Harlan M

    2016-11-01

    We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients used data from the Centers for Medicare & Medicaid Service from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zipcodes. Based on a mixed effect model, we found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases of 0.25% (95% CI 0.17-0.34) and 0.60% (95% CI 0.33-0.83), respectively, in community-level risk-standardized readmission rates.

  10. Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

    PubMed Central

    Blunt, Ian; Bardsley, Martin; Grove, Amy; Clarke, Aileen

    2015-01-01

    Background Many health systems across the globe have introduced arrangements to deny payment for patients readmitted to hospital as an emergency. The purpose of this study was to develop an exploratory categorisation based on likely causes of readmission, and then to assess the prevalence of these different types. Methods Retrospective analysis of 82 million routinely collected National Health Service hospital records in England (2004–2010) was undertaken using anonymised linkage of records at person-level. Numbers of 30-day readmissions were calculated. Exploratory categorisation of readmissions was applied using simple rules relating to International Classification of Diseases (ICD) diagnostic codes for both admission and readmission. Results There were 5 804 472 emergency 30-day readmissions over a 6-year period, equivalent to 7.0% of hospital discharges. Readmissions were grouped into hierarchically exclusive categories: potentially preventable readmission (1 739 519 (30.0% of readmissions)); anticipated but unpredictable readmission (patients with chronic disease or likely to need long-term care; 1 141 987 (19.7%)); preference-related readmission (53 718 (0.9%)); artefact of data collection (16 062 (0.3%)); readmission as a result of accident, coincidence or related to a different body system (1 101 818 (19.0%)); broadly related readmission (readmission related to the same body system (1 751 368 (30.2%)). Conclusions In this exploratory categorisation, a large minority of emergency readmissions (eg, those that are potentially preventable or due to data artefacts) fell into groups potentially amenable to immediate reduction. For other categories, a hospital's ability to reduce emergency readmission is less clear. Reduction strategies and payment incentives must be carefully tailored to achieve stated aims. PMID:24668396

  11. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    NASA Astrophysics Data System (ADS)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  12. Body Mass Index: Surgical Site Infections and Mortality After Lower Extremity Bypass from the National Surgical Quality Improvement Program 2005-2007

    PubMed Central

    Giles, Kristina A.; Hamdan, Allen D.; Pomposelli, Frank B.; Wyers, Mark C.; Siracuse, Jeffrey J.; Schermerhorn, Marc L.

    2009-01-01

    Objectives Patients undergoing lower extremity bypass are at high risk for surgical site infections (SSI). We examine lower extremity bypasses by graft origin and body mass index (BMI) classification to analyze differences in postoperative mortality and SSI occurrence. Methods The 2005-2007 National Surgical Quality Improvement Program (NSQIP), a multi-institutional risk-adjusted database, was queried to compare perioperative mortality (30-day), overall morbidity, and SSIs after lower extremity arterial bypass for peripheral arterial disease. Bypass was stratified by graft origin as aorto-iliac, femoral, or popliteal. Patient demographics, comorbidities, operative, and post-operative occurrences were analyzed. Results There were 7,595 bypasses performed (1,596 aorto-iliac, 5,483 femoral, and 516 popliteal origin). Mortality was similar regardless of bypass origin (2.8%, 2.4%, & 2.7%, P=.57). Surgical site infections occurred in 11% of overall cases (10%, 11%, & 11%, P=.47). Graft failure was significantly associated with postoperative SSI occurrence (OR 2.4, 95%CI 1.9-3.1, P<.001) as was postoperative sepsis (OR 6.5, 95%CI 5.1-8.3, P<.001). Independent predictors of mortality were age, aorto-iliac bypass origin, underweight, normal weight, or morbid obesity (compared to overweight and obese), end stage renal disease, poor preoperative functional status, preoperative sepsis, chronic obstructive pulmonary disease, hypoalbuminemia, and cardiac disease. Independent predictors of SSI were obesity, diabetes, poor preoperative functional status, a history of smoking, and female gender. Conclusions Surgical site infections occur frequently after lower extremity bypass regardless of bypass origin and are associated with early graft failure and sepsis. Obesity predicts postoperative SSI. Mortality risk was greatest in the underweight followed by morbidly obese and normal weight patients, while overweight and mild-moderate obesity were associated with the lowest mortality

  13. Effect of 30-day orbital flight BION M1 on excretion of expired endogenous CO in mice

    NASA Astrophysics Data System (ADS)

    Shulagin, Yury; Tatarkin, Sergey; Dyachenko, Alexander

    It is known that increased destruction of hem structures is accompanied by increase of the endogenous carbon monoxide excretion rate with respiration (VCO). Changes VCO preceded the observed changes in the blood composition [D’yachenko A. et al., 2010]. Changes in blood composition, i.e. rise of red blood cells content and reduction of reticulocytes content was detected after a 12-day orbital flight (OF) in mice C57BL/6 [Gridley D.et al., 2003]. The purpose of this study was to investigate the effect of 30-day OF on excretion of endogenous CO. The method and apparatus for simultaneous measurement of VCO, and O2 and CO2 exchange were developed. The research consisted of three parts: 1). Measurement of VCO in five C57BL/6 mice after 30-day OF on the Russian satellite BION M1. 2). Measurement of VCO in six C57BL/6 mice after 30-day ground-based experiment (GBE) with simulated flight telemetry environment of BION M1. 3). Measurement of VCO in seven C57BL/6 mice in vivarium The results: Mice weight after OF was 24.3+-3.3 (mean +-SD) with minimal weight 18.1 g, and maximal weight 29.9 g. Vivarium mice weight was 27.0+-1.8 g. KGE mice weight was 25.0+-1.3 g. Mice age in all three groups was the same. We measured and estimated VCO and total CO excretion (MCO) for two gas mixtures ventilated mouse camera: atmospheric CO-contained air and then CO-free air(30 min). The results showed that the average MCO allocated GBE and vivarium mice did not significantly differ. Average MCO in mice after OF was significantly higher then in vivarium group (T=-2,74; p=0.02). MCO after GBE was between the vivarium and OF groups. MCO in OF and KGE groups did not differ ( T=-1,93; p=0,085). Blood tests in mice after OF was not carried out, because the recovery after the OF was studied in this group. The largest excretion of CO was observed in a mouse N39 after the OF. The weight of this mouse was only 18.1 g, i.e. much less than mean weight. Increase of VCO in food-restricted animal is known

  14. Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review

    PubMed Central

    Zhou, Huaqiong; Della, Phillip R; Roberts, Pamela; Goh, Louise; Dhaliwal, Satvinder S

    2016-01-01

    Objective To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. Design Systematic review. Setting/data source CINAHL, Embase, MEDLINE from 2011 to 2015. Participants All studies of 28-day and 30-day readmission predictive model. Outcome measures Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. Results Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21–0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables ‘comorbidities’, ‘length of stay’ and ‘previous admissions’ were frequently cited across 73 models. The variables ‘laboratory tests’ and ‘medication’ had more weight in the models for cardiovascular disease and medical condition-related readmissions. Conclusions The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative

  15. Immunohistochemical study of motoneurons in lumbar spinal cord of c57black/6 mice after 30-days space flight

    NASA Astrophysics Data System (ADS)

    Tyapkina, Oksana; Islamov, Rustem; Nurullin, Leniz; Petrov, Konstantin.; Rezvyakov, Pavel; Nikolsky, Evgeny

    To investigate mechanisms of hypogravity motor syndrome development the immunoexpression of heat shock proteins (Hsp27 and Hsp70), proteins of synaptic transmission (Synaptophysin and PSD95) and neuroprotective proteins (VEGF and Flt-1) in motoneurons of lumbar spinal cord in c57black/6 control mice (n=2) and after 30-days space flight (n=2) was studied. For a quantitative assessment of target proteins level in motoneurons frozen cross sections of lumbar spinal cord were underwent to immunohistochemical staining. Primary antibodies against VEGF, Flt-1, Hsp27 and Hsp70 (SantaCruz Biotechnology, inc. USA), against Synaptophysin and PSD95 (Abcam plc, UK) were visualized by streptavidin-biotin method. Images of spinal cords were received using OlympusBX51WI microscope with AxioCamMRm camera (CarlZeiss, Germany) and the AxioVisionRel. 4.6.3 software (CarlZeiss, Germany). The digitized data were analyzed using ImageJ 1.43 software (NIH, the USA). Quantitively, protein level in motoneurons was estimated by the density of immunoprecipitation. Results of research have not revealed any reliable changes in the immunnoexpression of vascular endothelial growth factor (VEGF) and its Flt-1 receptor in motoneurons of lumbar spinal cord in control and in mice after 30-day space flight. Studying of heat shock proteins, such as Hsp27 and Hsp70, revealed the decrease in level of these proteins immunoexpression in motoneurons of mice from flight group by 15% and 10%, respectively. Some decrease in level of immunnoexpression of presynaptic membrane proteins (synaptophysin, by 21%) and proteins of postsynaptic area (PSD95, by 55%) was observed after space flight. The data obtained testify to possible changes in a functional state (synaptic activity and stress resistance) of motoneurons of lumbar spinal cord in mice after space flight. Thus, we obtained new data on involvement of motoneurons innervating skeletal muscles in development of hypogravity motor syndrome. Research was supported

  16. Effects of 30 day simulated microgravity and recovery on fluid homeostasis and renal function in the rat

    NASA Technical Reports Server (NTRS)

    Tucker, Bryan J.; Mendonca, Margarida M.

    1995-01-01

    Transition from a normal gravitational environment to that of microgravity eventually results in decreased plasma and blood volumes, increasing with duration of exposure to microgravity. This loss of vascular fluid is presumably due to negative fluid and electrolyte balance and most likely contributes to the orthostatic intolerance associated with the return to gravity. The decrease in plasma volume is presumed to be a reflection of a concurrent decrease in extracellular fluid volume with maintenance of normal plasma-interstitial fluid balance. In addition, the specific alterations in renal function contributing to these changes in fluid and electrolyte homeostasis are potentially responding to neuro-humoral signals that are not consistent with systemic fluid volume status. We have previously demonstrated an early increase in both glomerular filtration rate and extracellular fluid volume and that this decreases towards control values by 7 days of simulated microgravity. However, longer duration studies relating these changes to plasma volume alterations and the response to return to orthostasis have not been fully addressed. Male Wistar rats were chronically cannulated, submitted to 30 days heat-down tilt (HDT) and followed for 7 days after return to orthostasis from HDT. Measurements of renal function and extracellular and blood volumes were performed in the awake rat.

  17. Increased in vivo glucose utilization in 30-day-old obese Zucker rat: Role of white adipose tissue

    SciTech Connect

    Krief, S.; Bazin, R.; Dupuy, F.; Lavau, M. )

    1988-03-01

    In vivo whole-body glucose utilization and uptake in multiple individual tissues were investigated in conscious 30-day-old Zucker rats, which when obese are hyperphagic, hyperinsulinemic, and normoglycemic. Whole-body glucose metabolism (assessed by (3-{sup 3}H)glucose) was 40% higher in obese (fa/fa) than in lean (Fa/fa) rats, suggesting that obese rats were quite responsive to their hyperinsulinemia. In obese compared with lean rats, tissue glucose uptake was increased by 15, 12, and 6 times in dorsal, inguinal, perigonadal white depots, respectively; multiplied by 2.5 in brown adipose tissue; increased by 50% in skin from inguinal region but not in that from cranial, thoracic, or dorsal area; and increased twofold in diaphragm but similar in heart in proximal intestine, and in total muscular mass of limbs. The data establish that in young obese rats the hypertrophied white adipose tissue was a major glucose-utilizing tissue whose capacity for glucose disposal compared with that of half the muscular mass. Adipose tissue could therefore play an important role in the homeostasis of glucose in obese rats in the face of their increased carbohydrate intake.

  18. Human performance profiles for planetary analog extra-vehicular activities: 120 day and 30 day analog missions

    NASA Astrophysics Data System (ADS)

    Swarmer, Tiffany M.

    Understanding performance factors for future planetary missions is critical for ensuring safe and successful planetary extra-vehicular activities (EVAs). The goal of this study was to gain operational knowledge of analog EVAs and develop biometric profiles for specific EVA types. Data was collected for a 120 and 30 day analog planetary exploration simulation focusing on EVA type, pre and post EVA conditions, and performance ratings. From this five main types of EVAs were performed: maintenance, science, survey/exploratory, public relations, and emergency. Each EVA type has unique characteristics and performance ratings showing specific factors in chronological components, environmental conditions, and EVA systems that have an impact on performance. Pre and post biometrics were collected to heart rate, blood pressure, and SpO2. Additional data about issues and specific EVA difficulties provide some EVA trends illustrating how tasks and suit comfort can negatively affect performance ratings. Performance decreases were noted for 1st quarter and 3rd quarter EVAs, survey/exploratory type EVAs, and EVAs requiring increased fine and gross motor function. Stress during the simulation is typically higher before the EVA and decreases once the crew has returned to the habitat. Stress also decreases as the simulation nears the end with the 3rd and 4th quarters showing a decrease in stress levels. Operational components and studies have numerous variable and components that effect overall performance, by increasing the knowledge available we may be able to better prepare future crews for the extreme environments and exploration of another planet.

  19. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks.

    PubMed

    Schulte, Laura H; May, Arne

    2016-07-01

    Functional imaging using positron emission tomography and later functional magnetic resonance imaging revealed a particular brainstem area that is believed to be specifically activated in migraine during, but not outside of the attack, and consequently has been coined the 'migraine generator'. However, the pathophysiological concept behind this term is not undisputed and typical migraine premonitory symptoms such as fatigue and yawning, but also a typical association of attacks to circadian and menstrual cycles, all make the hypothalamus a possible regulating region of migraine attacks. Neuroimaging studies investigating native human migraine attacks however are scarce and for methodological but also clinical reasons there are currently no studies investigating the last 24 h before headache onset. Here we report a migraine patient who had magnetic resonance imaging every day for 30 days, always in the morning, to cover, using functional imaging, a whole month and three complete, untreated migraine attacks. We found that hypothalamic activity as a response to trigeminal nociceptive stimulation is altered during the 24 h prior to pain onset, i.e. increases towards the next migraine attack. More importantly, the hypothalamus shows altered functional coupling with the spinal trigeminal nuclei and the region of the migraine generator, i.e. the dorsal rostral pons during the preictal day and the pain phase of native human migraine attacks. These data suggest that although the brainstem is highly linked to the migraine biology, the real driver of attacks might be the functional changes in hypothalamo-brainstem connectivity.

  20. Postoperative red blood cell transfusion strategy in frail anemic elderly with hip fracture. A randomized controlled trial.

    PubMed

    Gregersen, Merete

    2016-04-01

    Hip fracture in the elderly is associated with poor recovery from physical disability and mortality. Perioperative blood loss is common, and anemia might be fatal in the frail elderly. Red blood cell transfusions might increase the risk of infection. In an observational study, a liberal transfusion strategy with hemoglobin (Hb) target of 7 mmol/l (11.3 g/dl) seemed to improve survival in nursing home residents with hip fracture compared to the recommended restrictive strategy with a Hb target of 6 mmol/l (9.7 g/dl) according to the Danish Health Authority. Our aim was to compare these two strategies in the frail elderly in a randomized controlled trial on the outcomes: recovery from physical disabilities, mortality, infection, infection biomarkers, and overall Quality of Life (OQoL). We included 284 elderly admitted to hospital for surgical hip fracture repair from nursing homes or sheltered housing facilities. The anemic patients were assigned postoperatively to the liberal or the restrictive transfusion strategy. Randomization divided each transfusion group into two equal blocks with regard to type of the residence. Hb was measured daily during the first three postoperative days, at least once during the following 4-6 days, then at least once a week during the subsequent three weeks. The transfusions were administered according to group assignments, but no later than 24 hours after the Hb determination, one unit at a time, and no more than two units per day. The intervention lasted for 30 days after surgery. Outcome measurements were performed on days 10, 30, 90, and 365. Blinded assessors evaluated physical performance and OQoL. The liberal transfusion strategy did not improve recovery from physical disabilities, mortality, infection rate, or OQoL compared to the restrictive strategy. However, in nursing home residents, 90-day mortality rate (20%) following the liberal strategy was statistically significantly lower than that (36%) after the restrictive strategy

  1. Gene Expression Profiling in Slow-Type Calf Soleus Muscle of 30 Days Space-Flown Mice.

    PubMed

    Gambara, Guido; Salanova, Michele; Ciciliot, Stefano; Furlan, Sandra; Gutsmann, Martina; Schiffl, Gudrun; Ungethuem, Ute; Volpe, Pompeo; Gunga, Hanns-Christian; Blottner, Dieter

    2017-01-01

    Microgravity exposure as well as chronic disuse are two main causes of skeletal muscle atrophy in animals and humans. The antigravity calf soleus is a reference postural muscle to investigate the mechanism of disuse-induced maladaptation and plasticity of human and rodent (rats or mice) skeletal musculature. Here, we report microgravity-induced global gene expression changes in space-flown mouse skeletal muscle and the identification of yet unknown disuse susceptible transcripts found in soleus (a mainly slow phenotype) but not in extensor digitorum longus (a mainly fast phenotype dorsiflexor as functional counterpart to soleus). Adult C57Bl/N6 male mice (n = 5) flew aboard a biosatellite for 30 days on orbit (BION-M1 mission, 2013), a sex and age-matched cohort were housed in standard vivarium cages (n = 5), or in a replicate flight habitat as ground control (n = 5). Next to disuse atrophy signs (reduced size and myofiber phenotype I to II type shift) as much as 680 differentially expressed genes were found in the space-flown soleus, and only 72 in extensor digitorum longus (only 24 genes in common) compared to ground controls. Altered expression of gene transcripts matched key biological processes (contractile machinery, calcium homeostasis, muscle development, cell metabolism, inflammatory and oxidative stress response). Some transcripts (Fzd9, Casq2, Kcnma1, Ppara, Myf6) were further validated by quantitative real-time PCR (qRT-PCR). Besides previous reports on other leg muscle types we put forth for the first time a complete set of microgravity susceptible gene transcripts in soleus of mice as promising new biomarkers or targets for optimization of physical countermeasures and rehabilitation protocols to overcome disuse atrophy conditions in different clinical settings, rehabilitation and spaceflight.

  2. Gene Expression Profiling in Slow-Type Calf Soleus Muscle of 30 Days Space-Flown Mice

    PubMed Central

    Gambara, Guido; Salanova, Michele; Ciciliot, Stefano; Furlan, Sandra; Gutsmann, Martina; Schiffl, Gudrun; Ungethuem, Ute; Volpe, Pompeo; Gunga, Hanns-Christian; Blottner, Dieter

    2017-01-01

    Microgravity exposure as well as chronic disuse are two main causes of skeletal muscle atrophy in animals and humans. The antigravity calf soleus is a reference postural muscle to investigate the mechanism of disuse-induced maladaptation and plasticity of human and rodent (rats or mice) skeletal musculature. Here, we report microgravity-induced global gene expression changes in space-flown mouse skeletal muscle and the identification of yet unknown disuse susceptible transcripts found in soleus (a mainly slow phenotype) but not in extensor digitorum longus (a mainly fast phenotype dorsiflexor as functional counterpart to soleus). Adult C57Bl/N6 male mice (n = 5) flew aboard a biosatellite for 30 days on orbit (BION-M1 mission, 2013), a sex and age-matched cohort were housed in standard vivarium cages (n = 5), or in a replicate flight habitat as ground control (n = 5). Next to disuse atrophy signs (reduced size and myofiber phenotype I to II type shift) as much as 680 differentially expressed genes were found in the space-flown soleus, and only 72 in extensor digitorum longus (only 24 genes in common) compared to ground controls. Altered expression of gene transcripts matched key biological processes (contractile machinery, calcium homeostasis, muscle development, cell metabolism, inflammatory and oxidative stress response). Some transcripts (Fzd9, Casq2, Kcnma1, Ppara, Myf6) were further validated by quantitative real-time PCR (qRT-PCR). Besides previous reports on other leg muscle types we put forth for the first time a complete set of microgravity susceptible gene transcripts in soleus of mice as promising new biomarkers or targets for optimization of physical countermeasures and rehabilitation protocols to overcome disuse atrophy conditions in different clinical settings, rehabilitation and spaceflight. PMID:28076365

  3. The statistical extended-range (10-30-day) forecast of summer rainfall anomalies over the entire China

    NASA Astrophysics Data System (ADS)

    Zhu, Zhiwei; Li, Tim

    2017-01-01

    The extended-range (10-30-day) rainfall forecast over the entire China was carried out using spatial-temporal projection models (STPMs). Using a rotated empirical orthogonal function analysis of intraseasonal (10-80-day) rainfall anomalies, China is divided into ten sub-regions. Different predictability sources were selected for each of the ten regions. The forecast skills are ranked for each region. Based on temporal correlation coefficient (TCC) and Gerrity skill score, useful skills are found for most parts of China at a 20-25-day lead. The southern China and the mid-lower reaches of Yangtze River Valley show the highest predictive skills, whereas southwestern China and Huang-Huai region have the lowest predictive skills. By combining forecast results from ten regional STPMs, the TCC distribution of 8-year (2003-2010) independent forecast for the entire China is investigated. The combined forecast results from ten STPMs show significantly higher skills than the forecast with just one single STPM for the entire China. Independent forecast examples of summer rainfall anomalies around the period of Beijing Olympic Games in 2008 and Shanghai World Expo in 2010 are presented. The result shows that the current model is able to reproduce the gross pattern of the summer intraseasonal rainfall over China at a 20-day lead. The present study provides, for the first time, a guide on the statistical extended-range forecast of summer rainfall anomalies for the entire China. It is anticipated that the ideas and methods proposed here will facilitate the extended-range forecast in China.

  4. Postoperative hyperkalemia.

    PubMed

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

  5. Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange

    PubMed Central

    Hao, Shiying; Wang, Yue; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Zheng, Le; Luo, Jin; Hu, Zhongkai; Fu, Changlin; Dai, Dorothy; Wang, Yicheng; Culver, Devore S.; Alfreds, Shaun T.; Rogow, Todd; Stearns, Frank; Sylvester, Karl G.; Widen, Eric; Ling, Xuefeng B.

    2015-01-01

    Objectives Identifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups. Methods Our objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients. Results A risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0–30), intermediate (score of 30–70) and high (score of 70–100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates. Conclusions The risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient’s risk of readmission score may be useful to providers

  6. Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG).

    PubMed

    Toh Yoon, Ezekiel Wong; Yoneda, Kaori; Nishihara, Kazuki

    2016-12-01

    Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 - 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.

  7. Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

    PubMed Central

    Toh Yoon, Ezekiel Wong; Yoneda, Kaori; Nishihara, Kazuki

    2016-01-01

    Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 – 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful. PMID:27995184

  8. Fish Oil and Post-Operative Atrial Fibrillation – Results of the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) Trial

    PubMed Central

    Mozaffarian, Dariush; Marchioli, Roberto; Macchia, Alejandro; Silletta, Maria G.; Ferrazzi, Paolo; Gardner, Timothy J.; Latini, Roberto; Libby, Peter; Lombardi, Federico; O’Gara, Patrick T.; Page, Richard L.; Tavazzi, Luigi; Tognoni, Gianni

    2013-01-01

    Context Post-operative atrial fibrillation/flutter (AF) is one of the most common complications of cardiac surgery and significantly increases morbidity and healthcare utilization. A few small trials have evaluated whether long-chain n-3-polyunsaturated fatty acids (PUFA) reduce post-op AF, with mixed results. Objective To determine whether peri-operative n-3-PUFA supplementation reduces post-op AF. Design Randomized, double-blind, placebo-controlled, multinational, clinical trial. Patients A total of 1,516 patients scheduled for cardiac surgery across 28 centers in the US, Italy, and Argentina, enrolled between Aug 2010 and Jun 2012. Inclusion criteria were broad; the main exclusions were regular use of fish oil or absence of sinus rhythm at enrollment. Forty-eight percent of screened patients and 94% of eligible patients were enrolled. Intervention Patients were randomized to receive fish oil (1 g capsules containing ≥840 mg n-3-PUFA as ethyl esters) or placebo, with pre-operative loading of 10g over 3-5 days (or 8g over 2 days) followed post-operatively by 2g/d until hospital discharge or post-op day10, whichever first. Main Outcome Measures The primary endpoint was occurrence of post-op AF >30 sec. We also evaluated post-op AF lasting >1hr, resulting in symptoms, or treated with cardioversion; other secondary post-op AF endpoints; other tachyarrhythmias; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events. All endpoints and analyses plans were prespecified. Results At enrollment, mean±SD age was 64±13 years, 72.2% were male, and 51.8% had planned valvular surgery. The primary endpoint occurred in 233 (30.7%) and 227 (30.0%) patients assigned to placebo and n-3-PUFA, respectively (OR=0.96, 95%CI=0.77-1.20; P=0.74). None of the secondary endpoints were significantly different, including post-op AF that was sustained, symptomatic, or treated (n=231 [30.5%] vs. n=224 [29.6%], P=0.70) or number of

  9. Postoperative Delirium in the Geriatric Patient

    PubMed Central

    Schenning, Katie J.; Deiner, Stacie G.

    2015-01-01

    SYNOPSIS Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients over the age of 65 years receive greater than 1/3 of the over 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. PMID:26315635

  10. Does neoadjuvant chemotherapy affect morbidity, mortality, reoperations, or readmissions in patients undergoing lumpectomy or mastectomy for breast cancer?

    PubMed Central

    Bennie, Barbara; Bray, Mallory S.; Vang, Choua A.; Linebarger, Jared H.

    2017-01-01

    Background The influence of neoadjuvant chemotherapy (NAC) prior to breast cancer surgery on postoperative complications is unclear. Our objective was to determine whether NAC was associated with postoperative outcomes in patients undergoing lumpectomy or mastectomy without reconstruction. Methods Patients meeting inclusion criteria were identified from the National Surgical Quality Improvement Program (NSQIP) database participant user files from 2005 through 2012, after which NSQIP discontinued the NAC variable. Primary outcome measures included a composite measure of morbidity and mortality (M&M) and reoperations and readmissions within 30 days of the index procedure. Rates of postoperative complications stratified by receipt of NAC were compared by χ2. A logistic regression model was then built that included confounding factors for M&M. Results There were 30,309 patients meeting inclusion criteria. NAC was not associated with any postoperative outcomes from 2005 through 2012, but it was associated with higher M&M in lumpectomy patients during 2011 to 2012 [P=0.011, odds ratio (OR) 2.579; 95% confidence interval (CI), 1.239–5.368]. Conclusions The finding that NAC was associated with higher M&M in lumpectomy patients during 2011 to 2012 warrants further investigation. Therefore, we recommend that the NSQIP database reinstitute the NAC variable to allow monitoring during anticipated changes in chemotherapy agents and protocols. PMID:28210548

  11. Kidney Function Alters the Relationship between Postoperative Troponin T Level and Death

    PubMed Central

    Wang, Chew-Yin; Ong, Gracie S.Y.; Tan, Alvin S.B.; Mansor, Marzida; Shariffuddin, Ina I.; Hashim, Noorjahan H.M.; Lai, Hou Yee; Undok, A. Wahab; Kolandaivel, Ushananthini N.; Vajiravelu, Vasanthan; Garg, Amit X.; Cuerden, Meaghan; Guyatt, Gordon; Thabane, Lehana; Mooney, John; Lee, Vincent; Chow, Clara; Devereaux, Phillip J.

    2015-01-01

    Cardiac troponin T (cTnT), even at low concentrations, is a risk factor for 30-day mortality in patients undergoing noncardiac surgery, but it is uncertain whether that risk is generalizable to patients with poor kidney function. We, therefore, evaluated the relationship between cTnT concentration and kidney function on the outcome of 30-day mortality in a post hoc analysis of a prospective cohort study of patients undergoing noncardiac surgery. cTnT was measured for 3 days after surgery and considered abnormal if the peak was ≥0.02 ng/ml. Of the included 14,037 patients, 267 (1.9%) patients died within 30 days of surgery. The adjusted hazard ratios for death with an abnormal cTnT concentration were 4.37 (95% confidence intervals [95% CI], 3.21 to 6.22), 6.15 (95% CI, 2.95 to 140.9), 6.30 (95% CI, 3.12 to 21.23), 1.33 (95% CI, 0.56 to 4.85), and 1.46 (95% CI, 0.46 to 9.21) for eGFR≥60, 45 to <60, 30 to <45, 15 to <30, and <15 ml/min per 1.73 m2 or on dialysis, respectively. Compared with patients with eGFR≥60 ml/min per 1.73 m2, the adjusted hazard ratio was significantly lower for patients with eGFR=15 to <30 ml/min per 1.73 m2 (interaction P value=0.02). Redefining abnormal cTnT concentration as ≥0.03 ng/ml or a change of ≥0.02 ng/ml did not alter results. Because the risk associated with postoperative cTnT levels may be different for patients with eGFR<30 ml/min per 1.73 m2, additional research is required to determine how to interpret perioperative cTnT values for patients with low kidney function. PMID:25711126

  12. Factors affecting morbidity, mortality and survival in patients undergoing surgery for rectal cancer in a district general hospital.

    PubMed Central

    Macadam, Robert; Yeomans, Neil; Wilson, Jonathan; Case, William; White, Clive; Lovegrove, John; Lyndon, Philip

    2005-01-01

    INTRODUCTION: This is a review of elective rectal cancer surgery during 1993-1999 at a single district general hospital to investigate the variables that affected the care of these patients. PATIENTS AND METHODS: A retrospective study of patients presenting with rectal adenocarcinoma to a district general hospital where total mesorectal excision was practiced over a 7-year period was performed to identify factors associated with complications, death and disease recurrence. RESULTS: Sixty-one patients developed a total of 89 complications and 30-day mortality was 8.3%. Overall, 81% of all resections and 86% of potentially curative resections were free of tumour at the circumferential resection margin. A positive circumferential resection margin and 30-day mortality were both associated with increased postoperative blood transfusion volume. Twenty-nine recurrences were detected during the follow-up period (mean, 21.7 months) and circumferential margin involvement by tumour, Dukes' stage, pre-operative functional status (ASA grade) and length of hospital stay correlated with disease-free survival. CONCLUSIONS: Surgical outcomes in lower volume hospitals are comparable with those reported by larger centres. PMID:16176691

  13. 75 FR 77901 - 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-14

    ... National Park Service 30-Day Notice of Opportunity for Public Comment on U.S. Nominations to the World Heritage List and Potential Additions to the U.S. World Heritage Tentative List AGENCY: National Park... to comment on the next potential U.S. nominations from the U.S. World Heritage Tentative List to...

  14. The association of culling and death rate within 30 days after calving with productivity or reproductive performance in dairy herds in Fukuoka, Southern Japan

    PubMed Central

    GOTO, Akira; NAKADA, Ken; KATAMOTO, Hiromu

    2015-01-01

    The incidence of peripartum disorders in dairy herds negatively influences productivity and reproductive performance. Concrete data from local areas are helpful for explaining the importance of peripartum management to dairy farmers. This study was conducted to clarify the association of culling and death rate within 30 days after calving with productivity or reproductive performance in 179 dairy herds in Fukuoka, Southern Japan. A database was compiled from the records of the Livestock Improvement Association of Japan, the Dairy Cooperative Association and the Federation of Agricultural Mutual Relief Association. In this study, we created a comprehensive database of dairy farm production data for epidemiological analysis and used a general linear mixed model to analyze the association of culling and death rate within 30 days after calving with milk production or reproductive performance. The database can be used to describe, analyze and predict the risk of production. A cross-sectional analysis with contrasts was applied to investigate the association of cows served by AI/all cows, pregnant cows/cows served by AI, days open, milk yield and somatic cell counts with culling and death rate within 30 days after calving. The days open value significantly increased with increasing rate of culling and death within 30 days after calving (P for trend <0.001). No significant differences were found for the other comparisons. Our data suggest that proper feeding and management in the dry period may lead to improved postpartum reproductive performance in this dairy cow cohort. PMID:26666177

  15. 75 FR 55625 - 30-Day Notice of Proposed Information Collection: Form DS-1622, DS-1843, DS-1622P, and DS-1843P...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-13

    .... SUMMARY: The Department of State is seeking Office of Management and Budget (OMB) approval for the... Management and Budget (OMB) for up to 30 days from August 30, 2010. ADDRESSES: You may submit comments by any... maintain the health and fitness of the individual and family members within the Department of State...

  16. The AFFORD Clinical Decision Aid To Identify Emergency Department Patients With Atrial Fibrillation At Low Risk For 30-Day Adverse Events

    PubMed Central

    Barrett, Tyler W.; Storrow, Alan B.; Jenkins, Cathy A.; Abraham, Robert L.; Liu, Dandan; Miller, Karen F.; Moser, Kelly M.; Russ, Stephan; Roden, Dan M.; Harrell, Frank E.; Darbar, Dawood

    2015-01-01

    There is wide variation in the management of emergency department (ED) patients with atrial fibrillation (AF). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated, tertiary-care, ED. Patients were enrolled from June 9, 2010 to February 28, 2013 and followed for 30 days. We enrolled a convenience sample of ED patients presenting with symptomatic AF. Candidate predictors were based on ED data available in the first two hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We utilized an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients, respectively. The decision aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement); medical history (heart failure, home sotalol use, prior percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms); ED data (2 hour heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid’s c-statistic in predicting any 30-day adverse event was 0.7 (95% CI, 0.65, 0.76). In conclusion, among ED patients with AF, AFFORD provides the first evidence based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. PMID:25633190

  17. Tropical 40-50- and 25-30-day oscillations appearing in realistic and idealized GFDL climate models and the ECMWF dataset

    SciTech Connect

    Hayashi, Y.; Golder, D.G. )

    1993-02-01

    To clarify differences between the tropical 40-50- and 25-30-day oscillations and to evaluate simulations and various theories, space-time spectrum and filter analyses were performed on a nine-year dataset taken from the nine-level R30 spectral general circulation model and the nine-year (1979-1987) ECMWF four-dimensional analysis dataset. The 40-level SKYHI model was analyzed to examine the effect of increased vertical resolution, while an ocean-surface perpetual January R30 model was analyzed to examine the effects of the absence of geographical and seasonal variations. The R30 model results indicate that the relative amplitude of the wavenumber-one component of the 40-50- and 25-30-day oscillations varies greatly from year to year. The SKYHI model indicates that 25-30-day oscillations still appear too strong, although this model reveals a longer vertical wavelength, a higher penetration of the 25-30-day amplitude above the level of convective heating, and a slightly greater height of the convective-heating amplitude, which cannot be detected in the R30 model. The ocean-surface perpetual January R30 model indicates that not only the 25-30-day mode but also the 40-50-day mode can be simulated in the absence of geographical and seasonal modulations, while the wave-CISK and evaporation-wind feedback theories cannot explain the 40-50-day mode. Both R30 models indicate that daily precipitation is usuallys associated with upward motion. A comparison between the two R30 models suggests that the sea surface temperature geographically modules the intrinsically eastward-moving wavenumber-one precipitation oscillations, resulting in their major Pacific and minor Atlantic local amplitudes. This causes planetary-scale eastward-moving zonal-velocity oscillations and standing geopotential oscillations. 121 refs., 26 figs.

  18. Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

    PubMed Central

    Analitis, Antonis; Michaelides, Stylianos A.; Charalabopoulos, Konstantinos A.; Tzonou, Anastasia

    2016-01-01

    Background Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients. Methods Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. Results The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68–5.95] (first meta-analysis) and 5.26% (95% CI: 3.47–7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59–44.75) (first meta-analysis) and 45.59% (95% CI: 35.62–55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93–86.86) and 52.03% (95% CI: 34.71–69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability. Conclusions Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative

  19. Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older.

    PubMed

    Robinson, Robert

    2015-01-01

    Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan-Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30-4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03-1.38]) to be significant independent

  20. Low serum albumin and total lymphocyte count as predictors of 30 day hospital readmission in patients 65 years of age or older

    PubMed Central

    2015-01-01

    Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission. Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge. Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9%) and had a DRG weight of 1.22 (0.68). 219 patients (13%) were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58%) patients and a low TLC was found in 1,152 (68%) patients. Low albumin and low TLC was found in 709 (42%) of patients. Kaplan–Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001) predictor of hospital readmission. Low serum albumin (p < 0.001) and TLC (p = 0.018) show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30–4.63]) and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03–1.38]) to be significant independent

  1. Predictors of morbidity and mortality after hepatectomy in elderly patients: analysis of 7621 NSQIP patients

    PubMed Central

    Tzeng, Ching-Wei D; Cooper, Amanda B; Vauthey, Jean-Nicolas; Curley, Steven A; Aloia, Thomas A

    2014-01-01

    Objectives Increasingly, surgeons are performing hepatectomies in older patients. This study was designed to analyse the incidences of and risk factors for post-hepatectomy morbidity and mortality in elderly patients. Methods All elective hepatectomies for the period 2005–2010 recorded in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were evaluated. Factors associated with 30-day rates of morbidity and mortality were compared between patients aged ≥75 years and those aged <75 years. Results Elderly patients accounted for 894 of 7621 (11.7%) hepatectomies. These patients more frequently had comorbidities (diabetes, cardiovascular or lung disease, lower albumin, elevated creatinine, anaesthesia risk; all P < 0.05) and were more likely to undergo partial or left rather than right or extended hepatectomies (P = 0.013). Despite the lesser surgical magnitude of these procedures, elderly patients experienced higher rates of severe complications (23.9% versus 18.4%; P < 0.001) and overall postoperative mortality (4.8% versus 2.0%; P < 0.001). The occurrence of any severe complication was associated with a mortality rate of 20.1% in elderly patients and 10.8% in non-elderly patients (P < 0.001). This disparity in mortality was more pronounced in patients with two or more (31.7% versus 20.2%; P < 0.001) and three or more (46.3% versus 31.1%; P < 0.001) severe complications. Independent risk factors for severe complications and/or mortality included an albumin level of < 4 g/dl, lung disease, intraoperative transfusion, a concurrent intra-abdominal operation, and an operative time of >240 min (all P < 0.05). Conclusions Given their lower physiologic reserve, elderly patients are at much greater risk for mortality after severe complications. To improve outcomes, surgeons should balance age and preoperative comorbidities with magnitude of hepatectomy. PMID:24033514

  2. Thrombomodulin Gene Variants are Associated with Increased Mortality Following Coronary Artery Bypass Surgery in Replicated Analyses

    PubMed Central

    Lobato, Robert L.; White, William D.; Mathew, Joseph P.; Newman, Mark F.; Smith, Peter K.; McCants, Charles B.; Alexander, John H.; Podgoreanu, Mihai V.

    2011-01-01

    Background We tested the hypothesis that genetic variation in thrombotic and inflammatory pathways is independently associated with long-term mortality following coronary artery bypass grafting (CABG). Methods and Results Two separate cohorts of patients undergoing CABG at a single institution were examined, and all-cause mortality between 30 days and 5 years after the index CABG was ascertained from the National Death Index. In a discovery cohort of 1018 patients, a panel of 90 single nucleotide polymorphisms (SNPs) in 49 candidate genes was tested in Cox proportional hazard models to identify clinical and genomic multivariate predictors of incident death. After adjustment for multiple comparisons and clinical predictors of mortality, the homozygote minor allele of a common variant in the thrombomodulin (THBD) gene (rs1042579) was independently associated with significantly increased risk of all-cause mortality (HR 2.26; 95%CI, 1.31–3.92; p=0.003). Six tag SNPs in the THBD gene, one of which (rs3176123) in complete linkage disequilibrium with rs1042579, were then assessed in an independent validation cohort of 930 patients. Following multivariate adjustment for the clinical predictors identified in the discovery cohort and multiple testing, the homozygote minor allele of rs3176123 independently predicted all-cause mortality (HR 3.6; 95%CI, 1.67–7.78; p=0.001). Conclusion In two independent cardiac surgery cohorts, linked common allelic variants in the THBD gene are independently associated with increased long-term mortality risk following CABG, and significantly improve the classification ability of traditional postoperative mortality prediction models. PMID:21911804

  3. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

    PubMed Central

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna

    2017-01-01

    Objectives The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. PMID:28182162

  4. Influence of second- and third-degree heart block on 30-day outcome following acute myocardial infarction in the drug-eluting stent era.

    PubMed

    Kim, Hack-Lyoung; Kim, Sang-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Zo, Joo-Hee; Kim, Myung-A; Park, Kyung-Woo; Koo, Bon-Kwon; Kim, Hyo-Soo; Chae, In-Ho; Choi, Dong-Ju; Cho, Myeong-Chan; Kim, Young-Jo; Kim, Ju Han; Ahn, Youngkeun; Jeong, Myung Ho

    2014-12-01

    This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block.

  5. In vitro study of 24-hour and 30-day shear bond strengths of three resin-glass ionomer cements used to bond orthodontic brackets.

    PubMed

    Lippitz, S J; Staley, R N; Jakobsen, J R

    1998-06-01

    Interest in using composite resin-glass ionomer hybrid cements as orthodontic bracket adhesives has grown because of their potential for fluoride release. The purpose of this pilot study was to compare shear bond strengths of three resin-glass ionomer cements (Advance, Fuji Duet, Fuji Ortho LC) used as bracket adhesives with a composite resin 24 hours and 30 days after bonding. The amount of adhesive remaining on the debonded enamel surface was scored for each adhesive. Mesh-backed stainless-steel brackets were bonded to 100 extracted human premolars, which were stored in artificial saliva at 37 degrees C until being tested to failure in a testing machine. The hybrid cements, with one exception, had bond strengths similar to those of the composite resin at 24 hours and 30 days. Fuji Ortho LC had significantly lower bond strengths (ANOVA p < or = 0.05) than the other adhesives at 24 hours and 30 days when it was bonded to unetched, water-moistened enamel. Adhesive-remnant scores were similar for all cements, except for cement Fuji Ortho LC when it was bonded to unetched enamel. The resin-glass ionomer cements we tested appear to have bond strengths suitable for routine use as orthodontic bracket-bonding adhesives.

  6. The age estimation of blood stains up to 30 days old using visible wavelength hyperspectral image analysis and linear discriminant analysis.

    PubMed

    Li, Bo; Beveridge, Peter; O'Hare, William T; Islam, Meez

    2013-09-01

    A novel application of visible wavelength hyperspectral image analysis has been applied to determine the age of blood stains up to 30 days old. Reflectance spectra from selected locations within the hyperspectral image, obtained from a portable instrument, were subjected to spectral pre-processing. This was followed by the application of a linear discriminant classification model, making estimations possible with an average error of ±0.27days for the first 7 days and an overall average error of ±1.17days up to 30 days. This is also the first reported study of the determination of the age of fresh blood stains (less than one day old) with an error of ±0.09h. The studies have been made under controlled conditions and represent, at this stage, proof of concept results but also are the most accurate age estimation results for measurements between 0 and 30 days reported to date. The results are consistent with well-established kinetic processes suggesting that the pre-processing stages described are revealing spectroscopic changes which are reliably following the time dependent oxidation of HbO2. The potential for parameterisation of environmental factors to make the method generally applicable at crime scenes is discussed, along with the developments required to further improve classification and to make the instrument genuinely portable.

  7. The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

    PubMed Central

    Hudali, Tamer

    2017-01-01

    Introduction Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Validated risk assessment tools such as the HOSPITAL score and LACE index have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. This study aims to evaluate the utility of HOSPITAL score and LACE index for predicting hospital readmission within 30 days in a moderate-sized university affiliated hospital in the midwestern United States. Materials and Methods All adult medical patients who underwent one or more ICD-10 defined procedures discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC) from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score and LACE index were a significant predictors of hospital readmission within 30 days. Results During the study period, 463 discharges were recorded for the hospitalist service. The analysis includes data for the 432 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 35 (8%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.75 (95% CI [0.67–0.83]), indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.069, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 3.71 with a p value of 0.59. A receiver operating characteristic evaluation of the LACE index for this patient population shows a C statistic of 0.58 (95% CI [0.48–0.68]), indicating poor discrimination for hospital readmission. The Brier score for the LACE index in this setting was 0.082, indicating good overall performance

  8. [Causal analysis and management strategies of 30-day unplanned revision surgery following single-stage posterior vertebral column resection for severe spinal deformity].

    PubMed

    Tao, Y P; Wu, J G; Ma, H S; Shao, S L; Zhang, L L; Gao, B; Li, H X

    2017-03-01

    Objective: To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management. Methods: A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306(th) Hospital of People's Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded. Results: The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients' neurological status improved from Frankel D to Frankel E, one patient's neurological status improved from Frankel C to Frankel E. Conclusions: One

  9. Effects of Mini-Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low-Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support.

    PubMed

    Kim, Sang Yoon; Cho, Sungkyu; Choi, Eunseok; Kim, Woong-Han

    2016-01-01

    Mixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low-bodyweight neonates. In an effort to reduce these effects, mini-volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low-bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low-bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS-1, priming volume, CPB time, and aortic cross-clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30-day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P < 0.001). Hematocrit at the end of the CPB and maximal decrease of hematocrit during CPB were not significantly different between the two groups. The 30-day mortality rate was 12.8% in the MP group versus 20.0% in the CP group. Postoperative ECMO support was performed in 5.1% of patients in the MP group versus 17.4% of patients in the CP group. Open sternum status was required in 20.8% of patients in the MP group versus 10.3% of patients in the CP group, and prolonged ventilator care was required in 54.2% of patients in the MP group versus 38.5% of patients in the CP group. However, no statistical

  10. Effectiveness of using thyrocalcitonin for the prevention of a calcium metabolic disorder in the mineralized tissues of rabbits with 30 days hypokinesia

    NASA Technical Reports Server (NTRS)

    Volozhin, A. I.; Shashkov, V. S.; Dmitriyev, B. S.; Yegorov, B. B.; Lobachik, V. I.; Brishin, A. I.

    1980-01-01

    A 30 day hypokinesia in rabbits led to a considerable lag in weight gain for the skeletal bones, reduction in Ca45 uptake, and an increase in isotope resorption rate in the rapidly metabolized fraction of extremity bones. On the other hand, Ca45 content in the teeth and maxillae increased, which may be explained by redistribution of isotope among the various mineralized tissues. Injection of thyrocalcitonin (50 IU/day) produced a distinct normalizing effect on Ca45 uptake and resorption in the mineralized tissues of rabbits kept hypokinetic.

  11. Life sciences payload definition and integration study. Volume 4: Appendix, costs, and data management requirements of the dedicated 30-day laboratory. [carry-on laboratory for Spacelab

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The results of the updated 30-day life sciences dedicated laboratory scheduling and costing activities are documented, and the 'low cost' methodology used to establish individual equipment item costs is explained in terms of its allowances for equipment that is commerical off-the-shelf, modified commercial, and laboratory prototype; a method which significantly lowers program costs. The costs generated include estimates for non-recurring development, recurring production, and recurring operations costs. A cost for a biomedical emphasis laboratory and a Delta cost to provide a bioscience and technology laboratory were also generated. All cost reported are commensurate with the design and schedule definitions available.

  12. [The participation of opioids in the antinociceptive effect induced by the stimulation of hypothalamic "pleasure zones" in 20- to 30-day-old rabbits].

    PubMed

    Butkevich, I P; Kassil', V G

    1995-01-01

    The involvement of opioid peptides in the mediation of inhibitory influences of the positive reinforcement system ("reward areas") on the evoked potential (EPs) recorded in the thalamic parafascicular complex (CM-Pf) in response to the nociceptive electrodermal stimulation of the hind paw in 20-30 day rabbits has been studied. Electrical stimulation of "reward areas" identified in the preliminary behavioural experiments inhibited the EPs. The systemic injection of naloxone potentiated the antinociceptive effect of "reward areas" stimulation in 75% of cases under the incomplete inhibition of EPs (the decrease of EPs amplitude) but decreased its inhibitory effect in 87% of cases under the complete inhibition of EPs. Naloxone did not change the inhibitory effect of "reward areas" stimulation suggesting to the relationship of analgesic "reward areas" function with nonopioid mechanisms too. On the basis of the comparison of the present data and the ones obtained before it can be inferred that opioid mechanism in realization of antinociceptive influence of "reward areas" stimulation on EPs in CM-Pf is more important for 20-30 day rabbits compared with 41-60 day ones. The correlation of the phenomenon under investigation with the formation of neurotransmitter systems has been discussed.

  13. Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes

    PubMed Central

    Cooper, Zara; Scott, John W.; Rosenthal, Ronnie A.; Mitchell, Susan L.

    2016-01-01

    OBJECTIVES To systematically review the current literature on mortality and functional outcomes after emergency major abdominal surgery in older adults. DESIGN Systematic literature search and standardized data collection of primary research publications from January 1994 through December 2013 on mortality or functional outcome in adults aged 65 and older after emergency major abdominal surgery using PubMed, EMBASE, Web of Science, Cochrane, and CINAHL. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies. SETTING Systematic review of retrospective and cohort studies using Preferred Reporting Items for Systematic reviews and Meta-Analyses, Meta-analysis Of Observational Studies in Epidemiology, Strengthening the Reporting of Observational Studies in Epidemiology, and A Measurement Tool to Assess Systematic Reviews guidelines. PARTICIPANTS Older adults. MEASUREMENTS Articles were assessed using a standardized quality scoring system based on study design, measurement of exposures, measurement of outcomes, and control for confounding. RESULTS Of 1,459 articles screened, 93 underwent full-text review, and 20 were systematically reviewed. In-hospital and 30-day mortality of all older adults exceeded 15% in 14 of 16 studies, where reported. Older adults undergoing emergency major abdominal surgery consistently had higher mortality across study settings and procedure types than younger individuals undergoing emergency procedures and older adults undergoing elective procedures. In studies that stratified older adults, odds of death increased with age. None of these studies examined postoperative functional status, which precluded including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using metaanalysis. CONCLUSION Age independently predicts mortality after emergency major abdominal surgery. Data on changes in

  14. [Postoperative pain in craniotomy].

    PubMed

    Peón, Andréa Ungaro; Diccini, Solange

    2005-01-01

    In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain.

  15. Characteristics and preliminary observations of the influence of electromyostimulation on the size and function of human skeletal muscle during 30 days of simulated microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A.; Buchanan, Paul; Gollnick, Philip A.; Dudley, Gary A.

    1989-01-01

    The effect of transcutaneous electromyostimulation (EMS) on the development of atrophy and the loss of strength in lower limb musculature in humans exposed to microgravity was determined in three subjects who received EMS twice daily in a 3-d on/1-d off cycle on their dominant leg during 30 days of bedrest. The output waveform from the stimulator was sequenced to the knee extensors, knee flexors, ankle extensors, and ankle flexors, and caused three isometric contractions of each muscle group per minute. It was found that, in the dominant leg, EMS acted to attenuate the changes caused by bedrest, such as reductions in the leg volume, muscle compartment size, cross-sectional area of slow- and fast-twitch fibers, strength, and aerobic enzyme activities, and an increase in leg compliance.

  16. Results of 30-day petroleum Co-Fire test at the Houston Lighting & Power W.A. Parish Station. Final report

    SciTech Connect

    Jones, A.F.; Booth, R.C.; Machtemes, A.P.

    1995-10-01

    As more heavy crude oil is refined, petroleum coke may become cheaper and more available. A 30-day test co-firing of petroleum coke with Western coal was performed on Unit 8 of Houston Lighting & Power`s W.A. Parish Station to address several concerns about the effects of co-firing coke. The test program studied fuel handling and consistency issues, coal mill performance, furnace operation, emissions, baghouse operation, and flue gas desulfurization (FGD) system performance. Results indicated that petroleum coke can be co-fired with Western coal without any significant problems. The limiting factor on how much coke can be in the bend is the ability of the FGD system to meet emission limits for SO{sub 2}.

  17. Myeloid Precursors in the Bone Marrow of Mice after a 30-Day Space Mission on a Bion-M1 Biosatellite.

    PubMed

    Sotnezova, E V; Markina, E A; Andreeva, E R; Buravkova, L B

    2017-02-01

    The content of myeloid stem CFU in bone marrow karyocytes from the tibial bone of C57Bl/6 mice was evaluated after a 30-day Bion-M1 pace flight/ground control experiment and subsequent 7-day recovery period. After the space flight, we observed a significant decrease in the number of erythroid progenitors in the bone marrow, including common myeloid precursor - granulocyte, erythrocyte, monocyte/macrophage, megakaryocyte CFU. After 7-day readaptation, CFU level in flight animals did not recover completely. In the ground control, the count of erythroid burst-forming units was higher than in vivarium animals. Comparison of the changes observed in fight and ground experiments demonstrated effects associated space flight factors and manifesting in suppression of the bone marrow erythropoiesis.

  18. Immunotoxicological Evaluation of Corn Genetically Modified with Bacillus thuringiensis Cry1Ah Gene by a 30-Day Feeding Study in BALB/c Mice

    PubMed Central

    Song, Yan; Liang, Chunlai; Wang, Wei; Fang, Jin; Sun, Nana; Jia, Xudong; Li, Ning

    2014-01-01

    This study was to investigate the immunotoxicological potential of corn genetically modified (GM) with Bacillus thuringiensis (Bt) Cry1Ah gene in BALB/c mice. Female BALB/c mice were randomly assigned to one of the four groups: the negative control group, the parental corn group, the GM corn group and the positive control group with 10 mice per group. Mice in the GM corn group and the parental corn group were fed with diets containing 70% corresponding corn for 30 days. Mice in the negative control group and the positive control group were fed with AIN93G diet, administered with saline or 200 mg/kg of cyclophosphamide (CY) via intraperitoneal injection 24 h before the termination of the study, respectively. At the end of the study, the immunotoxicological effects of the GM corn were evaluated through immunopathology parameters including body and organ weights, hematology and clinical chemistry parameters, histological examination, peripheral blood lymphocytes phenotype; humoral immunity including antibody plaque-forming cell, serum immunoglobulin, cytokine and half hemolysis value; cellular immunity such as mitogen-induced splenocyte proliferation, cytotoxic T-lymphocyte reaction, delayed-type hypersensitivity reaction; non-specific immunity including phagocytic activities of phagocytes, natural killer cell activity. A single dose of cyclophosphamide (200 mg/kg bw) was found to have significant adverse effects on immunopathology, cellular immunity, and humoral immunity in mice. The corn genetically modified with Bt Cry1Ah gene is considered consistent with the parental corn in terms of immunopathology, humoral immunity, cellular immunity and non-specific immunity. No adverse immunotoxicological effects of GM corn with Bt Cry1Ah gene were found when feeding mice for 30 days. PMID:24520311

  19. Immunotoxicological evaluation of corn genetically modified with Bacillus thuringiensis Cry1Ah gene by a 30-day feeding study in BALB/c mice.

    PubMed

    Song, Yan; Liang, Chunlai; Wang, Wei; Fang, Jin; Sun, Nana; Jia, Xudong; Li, Ning

    2014-01-01

    This study was to investigate the immunotoxicological potential of corn genetically modified (GM) with Bacillus thuringiensis (Bt) Cry1Ah gene in BALB/c mice. Female BALB/c mice were randomly assigned to one of the four groups: the negative control group, the parental corn group, the GM corn group and the positive control group with 10 mice per group. Mice in the GM corn group and the parental corn group were fed with diets containing 70% corresponding corn for 30 days. Mice in the negative control group and the positive control group were fed with AIN93G diet, administered with saline or 200 mg/kg of cyclophosphamide (CY) via intraperitoneal injection 24 h before the termination of the study, respectively. At the end of the study, the immunotoxicological effects of the GM corn were evaluated through immunopathology parameters including body and organ weights, hematology and clinical chemistry parameters, histological examination, peripheral blood lymphocytes phenotype; humoral immunity including antibody plaque-forming cell, serum immunoglobulin, cytokine and half hemolysis value; cellular immunity such as mitogen-induced splenocyte proliferation, cytotoxic T-lymphocyte reaction, delayed-type hypersensitivity reaction; non-specific immunity including phagocytic activities of phagocytes, natural killer cell activity. A single dose of cyclophosphamide (200 mg/kg bw) was found to have significant adverse effects on immunopathology, cellular immunity, and humoral immunity in mice. The corn genetically modified with Bt Cry1Ah gene is considered consistent with the parental corn in terms of immunopathology, humoral immunity, cellular immunity and non-specific immunity. No adverse immunotoxicological effects of GM corn with Bt Cry1Ah gene were found when feeding mice for 30 days.

  20. Exposure to microgravity for 30 days onboard Bion M1 caused muscle atrophy and decreased regeneration in the mouse femoral Quadriceps

    NASA Astrophysics Data System (ADS)

    Grigoryan, Eleonora; Radugina, Elena A.; Almeida, Eduardo; Blaber, Elizabeth; Poplinskaya, Valentina; Markitantova, Yulia

    Mechanical unloading of muscle during spaceflight in microgravity is known to cause muscular atrophy, changes in muscle fiber type composition, gene expression, and reductions in regenerative muscle growth. Although limited data exists for long-term effects of microgravity in human muscle, these processes have mostly been studied in rodents for short periods of time, up to two weeks of spaceflight. Here we report on how 30-day, long-term, mechanical unloading in microgravity affects mouse muscle of the femoral Quadriceps group. To conduct these studies we used muscle tissue from 6 mice from the NASA Biospecimen Sharing Program conducted in collaboration with the Institute for Biomedical Problems of the Russian Academy of Sciences, during the Russian Bion M1 biosatellite mission in 2013. Muscle morphology observed in histological sections shows signs of extensive atrophy and regenerative hypoplasia. Specifically, we observed a two-fold decrease in the number of myonuclei and low density of myofibrils, their separation and fragmentation. Despite obvious atrophy, muscle regeneration nevertheless appears to have continued after 30 days in microgravity as evidenced by thin and short newly formed muscle fibers. Many of them however showed evidence of apoptosis and degradation of synthesized fibrils, suggesting long-term unloading in microgravity affects late stages of myofiber differentiation. Ground asynchronous and vivarium control animals showed normal, well-developed tissue structure with sufficient blood and nerve supply and evidence of regenerative formation of new muscle fibers free of apoptotic nuclei. Myofiber nuclei stress responses in spaceflight animals was detected by positive nuclear immunolocalization of c-jun and c-myc proteins. Regenerative activity of satellite cells in muscle was localized with pax-7, MyoD and MCad immunostaining, and did not appear altered in microgravity. In summary, long-term spaceflight in microgravity causes significant atrophy

  1. Air leakage on the postoperative day: powerful factor of postoperative recurrence after thoracoscopic bullectomy

    PubMed Central

    Jeon, Hyun Woo; Kye, Yeo Kon; Kim, Kyung Soo

    2016-01-01

    Background Primary spontaneous pneumothorax (PSP) is a relatively common disorder in young patients. Although various surgical techniques have been introduced, recurrence after video-assisted thoracoscopic surgery (VATS) remains high. The aim of study was to identify the risk factors for postoperative recurrence after thoracoscopic bullectomy in the spontaneous pneumothorax. Methods From January 2011 through March 2013, two hundreds and thirty two patients underwent surgery because of pneumothorax. Patients with a secondary pneumothorax, as well as cases of single port surgery, an open procedure, additional pleural procedure (pleurectomy, pleural abrasion) or lack of medical records were excluded. The records of 147 patients with PSP undergoing 3-port video-assisted thoracoscopic bullectomy with staple line coverage using an absorbable polyglycolic acid (PGA) sheet were retrospectively reviewed. Results The median age was 19 years (range, 11−34 years) with male predominance (87.8%). Median postoperative hospital stay was 3 days (range, 1−10 days) without mortality. Complications were developed in five patients. A total of 24 patients showed postoperative recurrence (16.3%). Younger age less than 17 years old and immediate postoperative air leakage were risk factors for postoperative recurrence after thoracoscopic bullectomy by multivariate analysis. Conclusions Immediate postoperative air leakage was the risk factor for postoperative recurrence. However, further study will be required for the correlation of air leakage with recurrence. PMID:26904217

  2. Understanding postoperative fatigue.

    PubMed

    Rose, E A; King, T C

    1978-07-01

    Performance characteristics of the central nervous, cardiovascular, respiratory and muscular systems in man postoperatively have received little investigative attention, despite the well known syndrome of postoperative fatigue. The impairmen in perception and psychomotor skills that has been shown to result from caloric restriction, bedrest, sedation and sleep deprivation suggests that a similar deficit may occur after surgical procedures. After a simple elective surgical procedure, maximal oxygen uptake decreases and the adaptability of heart rate to submaximal workloads is impaired. Similar deleterious effects on cardiorespiratory performance have been documented with starvation and bedrest; an understanding of cardiorespiratory performance postoperatively awaits further investigation. Maximal muscular force of contraction is also impaired by caloric restriction and bedrest, suggesting that similar effects may be seen in the postoperative state, although this has not been studied. A better understanding of the syndrome of postoperative fatigue could be achieved by a descriptive analysis of physiologic performance postoperatively. Such descriptive data could form the basis for objective evaluation of therapeutic measures intended to improve performance, such as nutritional supplementation and pharmacologic intervention. The observation that exercise with the patient in the supine position may decrease the impairment in maximal aerobic power otherwise expected in immobilized patients suggests that controlled exercise therapy may be of value in reducing physiologic impairment postoperatively.

  3. Infant Mortality

    MedlinePlus

    ... Control and Prevention. (2013). CDC health disparities and inequalities report—United States, 2013. Morbidity and Mortality Weekly ... M. (2008). The fall and rise of U.S. inequalities in premature mortality: 1960–2002. PLOS Medicine, 5 ( ...

  4. [Chronic postoperative pain].

    PubMed

    Cachemaille, Matthieu; Blanc, Catherine

    2016-06-22

    Chronic postoperative pain remains a frequent pathology whose global impact approximates 20 and 30% and accounts for 20% of the consultations in a pain center. Risk factors consider firstly each patient's feature and comorbidity and also different surgical procedures with their technical approach. Neuropathic pain compared to nociceptive pain is a great component in the postoperative period and needs to be recognized by specific tests (DN4). Pain prevention involves risk factors' detection, appropriate anesthetic support and effective postoperative pain management. Treatment is based on the type of pain and includes a multimodal analgesia with interventional pain therapy.

  5. [Characteristics of postoperative peritonitis].

    PubMed

    Lock, J F; Eckmann, C; Germer, C-T

    2016-01-01

    Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

  6. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    PubMed Central

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover

  7. Postoperative permanent pressure alopecia.

    PubMed

    Chang, Zi Yun; Ngian, Jan; Chong, Claudia; Chong, Chin Ted; Liew, Qui Yin

    2016-04-01

    A 49-year-old Chinese female underwent elective laparoscopic assisted Whipple's surgery lasting 12 h. This was complicated by postoperative pressure alopecia at the occipital area of the scalp. Pressure-induced hair loss after general anaesthesia is uncommon and typically temporary, but may be disconcerting to the patient. We report this case of postoperative permanent pressure alopecia due to its rarity in the anaesthesia/local literature, and review the risk factors for its development.

  8. Effect of Hospital Use of Oral Nutritional Supplementation on Length of Stay, Hospital Cost, and 30-Day Readmissions Among Medicare Patients With COPD

    PubMed Central

    Snider, Julia Thornton; Linthicum, Mark T.; Hegazi, Refaat A.; Partridge, Jamie S.; LaVallee, Chris; Lakdawalla, Darius N.; Wischmeyer, Paul E.

    2015-01-01

    BACKGROUND: COPD is a leading cause of death and disability in the United States. Patients with COPD are at a high risk of nutritional deficiency, which is associated with declines in respiratory function, lean body mass and strength, and immune function. Although oral nutritional supplementation (ONS) has been associated with improvements in some of these domains, the impact of hospital ONS on readmission risk, length of stay (LOS), and cost among hospitalized patients is unknown. METHODS: Using the Premier Research Database, we first identified Medicare patients aged ≥ 65 years hospitalized with a primary diagnosis of COPD. We then identified hospitalizations in which ONS was provided, and used propensity-score matching to compare LOS, hospitalization cost, and 30-day readmission rates in a one-to-one matched sample of ONS and non-ONS hospitalizations. To further address selection bias among patients prescribed ONS, we also used instrumental variables analysis to study the association of ONS with study outcomes. Model covariates included patient and provider characteristics and a time trend. RESULTS: Out of 10,322 ONS hospitalizations and 368,097 non-ONS hospitalizations, a one-to-one matched sample was created (N = 14,326). In unadjusted comparisons in the matched sample, ONS use was associated with longer LOS (8.7 days vs 6.9 days, P < .0001), higher hospitalization cost ($14,223 vs $9,340, P < .0001), and lower readmission rates (24.8% vs 26.6%, P = .0116). However, in instrumental variables analysis, ONS use was associated with a 1.9-day (21.5%) decrease in LOS, from 8.8 to 6.9 days (P < .01); a hospitalization cost reduction of $1,570 (12.5%), from $12,523 to $10,953 (P < .01); and a 13.1% decrease in probability of 30-day readmission, from 0.34 to 0.29 (P < .01). CONCLUSIONS: ONS may be associated with reduced LOS, hospitalization cost, and readmission risk in hospitalized Medicare patients with COPD. PMID:25357165

  9. [Desmin content and transversal stiffness of the left ventricle mouse cardiomyocytes and skeletal muscle fibers after a 30-day space flight on board "BION-M1" biosatellite].

    PubMed

    Ogneva, I V; Maximova, M V; Larina, I M

    2014-01-01

    The aim of this study was to determine the transversal stiffness of the cortical cytoskeleton and the cytoskeletal protein desmin content in the left ventricle cardiomyocytes, fibers of the mouse soleus and tibialis anterior muscle after a 30-day space flight on board the "BION-M1" biosatellite (Russia, 2013). The dissection was made after 13-16.5 h after landing. The transversal stiffness was measured in relaxed and calcium activated state by, atomic force microscopy. The desmin content was estimated by western blotting, and the expression level of desmin-coding gene was detected using real-time PCR. The results indicate that, the transversal stiffness of the left ventricle cardiomyocytes and fibers of the soleus muscle in relaxed and activated states did not differ from the control. The transversal stiffness of the tibialis muscle fibers in relaxed and activated state was increased in the mice group after space flight. At the same time, in all types of studied tissues the desmin content and the expression level of desmin-coding gene did not differ from the control level.

  10. Isoform composition and gene expression of thick and thin filament proteins in striated muscles of mice after 30-day space flight.

    PubMed

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft "BION-M" number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from "Flight" group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the "Flight" group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from "Flight" and "Control" groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness.

  11. The 2013 German-Russian BION-M1 Joint Flight Project: Skeletal Muscle and Neuromuscular Changes in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Blottner, Dieter; Shenkman, Boris; Salanova, Michele

    Exposure to microgravity results in various structural, biochemical and molecular changes of the skeletal neuromuscular system. The BION Joint Flight Proposal between the Charité Berlin Center of Space Medicine (www.zwmb.de) in Berlin, and the Institute of Biomedical Problem (IMBP) in Moscow, provided an exciting opportunity for a more detailed analysis of neuromuscular changes in mice (C57/bl6) exposed to real microgravity housed for 30 days in a BION M1 biosatellite on orbit. The mice from the BION flight group (n=5) were compared to three different on-ground control groups (Flight control, BION-ground and Vivarium, each n=5 mice). We started to analyse various skeletal muscles from the hind limbs or trunk. Apart from routine structural and biochemical analysis (fiber size and type distribution, slow/fastMyHC) we test the hypothesis for the presence of a microgravity-induced sarcolemma-cytosolic protein shift of nitric oxide synthase (NOS) and partial loss in neuromuscular synapse scaffold protein (Homer) immunoexpression known to be prone to disuse in mice or humans (hind limb unloading, bed rest) as previously shown (Sandonà D et al., PLoS One, 2012, Salanova M et al., FASEB J, 2011). National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121); Contract RAS-IMBP/Charité Berlin # Bion-M1/2013

  12. Isoform Composition and Gene Expression of Thick and Thin Filament Proteins in Striated Muscles of Mice after 30-Day Space Flight

    PubMed Central

    Ulanova, Anna; Gritsyna, Yulia; Vikhlyantsev, Ivan; Salmov, Nikolay; Bobylev, Alexander; Abdusalamova, Zarema; Rogachevsky, Vadim; Shenkman, Boris; Podlubnaya, Zoya

    2015-01-01

    Changes in isoform composition, gene expression of titin and nebulin, and isoform composition of myosin heavy chains as well as changes in titin phosphorylation level in skeletal (m. gastrocnemius, m. tibialis anterior, and m. psoas) and cardiac muscles of mice were studied after a 30-day-long space flight onboard the Russian spacecraft “BION-M” number 1. A muscle fibre-type shift from slow-to-fast and a decrease in the content of titin and nebulin in the skeletal muscles of animals from “Flight” group was found. Using Pro-Q Diamond staining, an ~3-fold increase in the phosphorylation level of titin in m. gastrocnemius of mice from the “Flight” group was detected. The content of titin and its phosphorylation level in the cardiac muscle of mice from “Flight” and “Control” groups did not differ; nevertheless an increase (2.2 times) in titin gene expression in the myocardium of flight animals was found. The observed changes are discussed in the context of their role in the contractile activity of striated muscles of mice under conditions of weightlessness. PMID:25664316

  13. Increased Rates of Prolonged Length of Stay, Readmissions, and Discharge to Care Facilities among Postoperative Patients with Disseminated Malignancy: Implications for Clinical Practice

    PubMed Central

    Bateni, Sarah B.; Meyers, Frederick J.; Bold, Richard J.; Canter, Robert J.

    2016-01-01

    Background The impact of surgery on end of life care for patients with disseminated malignancy (DMa) is incompletely characterized. The purpose of this study was to evaluate postoperative outcomes impacting quality of care among DMa patients, specifically prolonged length of hospital stay, readmission, and disposition. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for years 2011–2012. DMa patients were matched to non-DMa patients with comparable clinical characteristics and operation types. Primary hepatic operations were excluded, leaving a final cohort of 17,972 DMa patients. The primary outcomes were analyzed using multivariate Cox regression models. Results DMa patients represented 2.1% of all ACS-NSQIP procedures during the study period. The most frequent operations were bowel resections (25.3%). Compared to non-DMa matched controls, DMa patients had higher rates of postoperative overall morbidity (24.4% vs. 18.7%, p<0.001), serious morbidity (14.9% vs. 12.0%, p<0.001), mortality (7.6% vs. 2.5%, p<0.001), prolonged length of stay (32.2% vs. 19.8%, p<0.001), readmission (15.7% vs. 9.6%, p<0.001), and discharges to facilities (16.2% vs. 12.9%, p<0.001). Subgroup analyses of patients by procedure type showed similar results. Importantly, DMa patients who did not experience any postoperative complication experienced significantly higher rates of prolonged length of stay (23.0% vs. 11.8%, p<0.001), readmissions (10.0% vs. 5.2%, p<0.001), discharges to a facility (13.2% vs. 9.5%, p<0.001), and 30-day mortality (4.7% vs. 0.8%, p<0.001) compared to matched non-DMa patients. Conclusion Surgical interventions among DMa patients are associated with poorer postoperative outcomes including greater postoperative complications, prolonged length of hospital stay, readmissions, disposition to facilities, and death compared to non-DMa patients. These data reinforce the importance of clarifying goals of

  14. Nutritional Status and Physical and Mental Performance of Special Operations Soldiers Consuming the Ration, Lightweight, or the Meal, Ready-to-Eat Military Field Ration during a 30-Day Field Training Exercise

    DTIC Science & Technology

    1987-03-23

    reverse if necessary and identify by block number) A 2000 kcal lightweight ration (RLW-30) was tested as the sole source of food for 30 continuous days...after the 30-day FTX. Food and water intakes were recorded daily and nutritional and hydration status were evaluated. Medical examinations were...sole source of food for 30 days, can be expected to cause some uncomfortable physical symptoms and a small to moderate decrement in physical

  15. Aspiration prevention protocol: decreasing postoperative pneumonia in heart surgery patients.

    PubMed

    Starks, Bobbie; Harbert, Christy

    2011-10-01

    BACKGROUND Postoperative pneumonia contributes to morbidity and mortality in patients who have open heart surgery. OBJECTIVES To determine if measures to reduce aspiration in patients after cardiothoracic surgery would decrease the occurrence of postoperative pneumonia. METHODS All patients undergoing cardiothoracic surgery from April 2008 through October 2008 were prospectively enrolled in the study. An aspiration prevention protocol was developed and implemented in a 24-bed intensive care unit. The protocol incorporated a bedside swallowing evaluation by a speech therapist and progressive oral intake. RESULTS In the 6 months before development and implementation of the protocol, postoperative pneumonia developed in 11% of patients. After implementation of the protocol, no patients had postoperative pneumonia (P < .01). CONCLUSIONS Implementing an aspiration prevention protocol was effective in reducing the occurrence of postoperative pneumonia in patients who had cardiothoracic surgery.

  16. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study

    PubMed Central

    Walsh, Michael; Devereaux, P J; MacNeil, S Danielle; Lam, Ngan N; Hildebrand, Ainslie M; Acedillo, Rey R; Mrkobrada, Marko; Chow, Clara K; Lee, Vincent W; Thabane, Lehana; Garg, Amit X

    2017-01-01

    Introduction The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. Methods and analysis The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. Ethics and dissemination The research ethics board at each site approved the VISION protocol prior to recruitment. We will

  17. Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study

    PubMed Central

    Morita, Plinio P; Picton, Peter; Seto, Emily; Zbib, Ahmad; Cafazzo, Joseph A

    2016-01-01

    Background Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F 8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0

  18. Early processing variations in selective attention to the color and direction of moving stimuli during 30 days head-down bed rest

    NASA Astrophysics Data System (ADS)

    Wang, Lin-Jie; He, Si-Yang; Niu, Dong-Bin; Guo, Jian-Ping; Xu, Yun-Long; Wang, De-Sheng; Cao, Yi; Zhao, Qi; Tan, Cheng; Li, Zhi-Li; Tang, Guo-Hua; Li, Yin-Hui; Bai, Yan-Qiang

    2013-11-01

    Dynamic variations in early selective attention to the color and direction of moving stimuli were explored during a 30 days period of head-down bed rest. Event-related potentials (ERPs) were recorded at F5, F6, P5, P6 scalp locations in seven male subjects who attended to pairs of bicolored light emitting diodes that flashed sequentially to produce a perception of movement. Subjects were required to attend selectively to a critical feature of the moving target, e.g., color or direction. The tasks included: a no response task, a color selective response task, a moving direction selective response task, and a combined color-direction selective response task. Subjects were asked to perform these four tasks on: the 3rd day before bed rest; the 3rd, 15th and 30th day during the bed rest; and the 5th day after bed rest. Subjects responded quickly to the color than moving direction and combined color-direction response. And they had a longer reaction time during bed rest on the 15th and 30th day during bed rest after a relatively quicker response on the 3rd day. Using brain event-related potentials technique, we found that in the color selective response task, the mean amplitudes of P1 and N1 for target ERPs decreased in the 3rd day during bed rest and 5th day after bed rest in comparison with pre-bed rest, 15th day and 30th day during bed rest. In the combined color-direction selective response task, the P1 latencies for target ERPs on the 3rd and 30th day during bed rest were longer than on the 15th day during bed rest. As 3rd day during bed rest was in the acute adaptation period and 30th day during bed rest was in the relatively adaptation stage of head-down bed rest, the results help to clarify the effects of bed rest on different task loads and patterns of attention. It was suggested that subjects expended more time to give correct decision in the head-down tilt bed rest state. A difficulty in the recruitment of brain resources was found in feature selection task

  19. Structure of cortical cytoskeleton in fibers of mouse muscle cells after being exposed to a 30-day space flight on board the BION-M1 biosatellite.

    PubMed

    Ogneva, I V; Maximova, M V; Larina, I M

    2014-05-15

    The aim of the work was to analyze changes in the organization of the cortical cytoskeleton in fibers of the mouse soleus muscle, tibialis anterior muscle and left ventricular cardiomyocytes after completion of a 30-day space flight on board the BION-M1 biosatellite (Russia, 2013). The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles did not differ significantly within the study groups compared with the vivarium control group. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes did not differ significantly within all study groups and correlated with the transversal stiffness. A similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues compared with the control levels in the postflight group, with lowered beta-actin gene expression rates in the postflight group. After completion of the space flight, the content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins from the mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this protein were decreased at the time of dissection (it was started after 13 h after landing). At the same time, the content of alpha-actinin-1 decreased in the membranous fraction and increased in the cytoplasmic fraction of proteins from the soleus muscle fibers.

  20. Coat and claws as new matrices for noninvasive long-term cortisol assessment in dogs from birth up to 30 days of age.

    PubMed

    Veronesi, M C; Comin, A; Meloni, T; Faustini, M; Rota, A; Prandi, A

    2015-09-15

    The last stage of fetal development and the neonatal period represent the most critical phases for the mammals' offspring. In the dog, the knowledge about the final intrauterine fetal development and biology, as well as about the neonatal physiology, remains scarce. Hormonal changes occurring in the last intrauterine fetal phase and during the early neonatal age are still not completely clear, probably because of the invasiveness related to the collection of the more common biological matrix, represented by circulating blood. Toward term of pregnancy, during parturition, and after birth, the hypothalamic-pituitary-adrenal axis is a key system regulating several physiological processes, and its activity was previously investigated by blood analysis, considered an invasive procedure providing a single-point measurement. In respect to animal welfare, and for a more correct long-term retrospective investigation, noninvasive hormonal studies were performed firstly on the hair of humans and coat of animals and, more recently, in the nails of human beings. This study was aimed to assess cortisol (COR) in coat and claws of newborn puppies and to evaluate the possible influence of the newborn gender, breed body size, and age on coat and claws COR concentrations. The results obtained from 165 newborn puppies evidenced that coat and claws COR levels were highly correlated each other (P < 0.0001), although the COR accumulation in the two matrices was different in relation to the class of age. Moreover, the puppies age influenced both coat and claws COR concentrations (P < 0.05), with premature puppies showing higher values when compared to term born-dead puppies or puppies dead between 1 and 30 days of age. The present study reported that COR is quantifiable in coat and claws of newborn dogs. Moreover, both matrices appear as useful tools for new, noninvasive, long-term perinatal and neonatal researches also in canine species.

  1. Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

    PubMed Central

    Shin, Rumi; Lee, Sang Mok; Sohn, Beonghoon; Lee, Dong Woon; Song, Inho; Chai, Young Jun; Lee, Hae Won; Ahn, Hye Seong; Jung, In Mok; Chung, Jung Kee

    2016-01-01

    Purpose An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation. Methods We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated. Results The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels. Conclusion Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites. PMID:28119865

  2. Copeptin Predicts Mortality in Critically Ill Patients

    PubMed Central

    Krychtiuk, Konstantin A.; Honeder, Maria C.; Lenz, Max; Maurer, Gerald; Wojta, Johann; Heinz, Gottfried; Huber, Kurt; Speidl, Walter S.

    2017-01-01

    Background Critically ill patients admitted to a medical intensive care unit exhibit a high mortality rate irrespective of the cause of admission. Besides its role in fluid and electrolyte balance, vasopressin has been described as a stress hormone. Copeptin, the C-terminal portion of provasopressin mirrors vasopressin levels and has been described as a reliable biomarker for the individual’s stress level and was associated with outcome in various disease entities. The aim of this study was to analyze whether circulating levels of copeptin at ICU admission are associated with 30-day mortality. Methods In this single-center prospective observational study including 225 consecutive patients admitted to a tertiary medical ICU at a university hospital, blood was taken at ICU admission and copeptin levels were measured using a commercially available automated sandwich immunofluorescent assay. Results Median acute physiology and chronic health evaluation II score was 20 and 30-day mortality was 25%. Median copeptin admission levels were significantly higher in non-survivors as compared with survivors (77.6 IQR 30.7–179.3 pmol/L versus 45.6 IQR 19.6–109.6 pmol/L; p = 0.025). Patients with serum levels of copeptin in the third tertile at admission had a 2.4-fold (95% CI 1.2–4.6; p = 0.01) increased mortality risk as compared to patients in the first tertile. When analyzing patients according to cause of admission, copeptin was only predictive of 30-day mortality in patients admitted due to medical causes as opposed to those admitted after cardiac surgery, as medical patients with levels of copeptin in the highest tertile had a 3.3-fold (95% CI 1.66.8, p = 0.002) risk of dying independent from APACHE II score, primary diagnosis, vasopressor use and need for mechanical ventilation. Conclusion Circulating levels of copeptin at ICU admission independently predict 30-day mortality in patients admitted to a medical ICU. PMID:28118414

  3. Postoperative intravenous morphine titration.

    PubMed

    Aubrun, F; Mazoit, J-X; Riou, B

    2012-02-01

    Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. Although morphine would not appear to be the most appropriate choice for achieving rapid pain relief, this is the sole opioid assessed in many studies of immediate postoperative pain management using titration. More than 90% of the patients have pain relief using a protocol of morphine titration and the mean dose required to obtain pain relief is 12 (7) mg, after a median of four boluses. Sedation is frequent during i.v. morphine titration and should be considered as a morphine-related adverse event and not evidence of pain relief. The incidence of ventilatory depression is very low when the criteria to limit the dose of i.v. morphine are enforced. Morphine titration can be used with caution in elderly patients, in children, or in obese patients. In practice, i.v. morphine titration allows the physician to meet the needs of individual patients rapidly and limits the risk of overdose making this method the first step in postoperative pain management.

  4. Frequency of concomitant ischemic heart disease and risk factor analysis for an early postoperative myocardial infarction after elective abdominal aortic aneurysm repair

    PubMed Central

    Han, Seung Rim; Heo, Seon-Hee; Woo, Shin-Young; Park, Yang Jin; Kim, Dong Ik; Yang, Jeonghoon; Choi, Seung-Hyuk; Kim, Duk-Kyung

    2016-01-01

    Purpose We aimed to see the frequency of concomitant ischemic heart disease (IHD) in Korean patients with abdominal aortic aneurysm (AAA) and to determine risk factors for an early postoperative acute myocardial infarction (PAMI) after elective open or endovascular AAA repair. Methods We retrospectively reviewed a database of patients who underwent elective AAA repair over the past 11 years. Patients were classified into 3 groups: control group; group I, medical IHD treatment; group II, invasive IHD treatment. Rates of PAMI and mortality at 30 days were compiled and compared between groups according to the type of AAA repair. Results Six hundred two elective repairs of infrarenal or juxtarenal AAAs were enrolled in this study. The patients were classified into control group (n = 398, 66.1%), group I (n = 73, 12.1%) and group II (n = 131, 21.8%). PAMI developed more frequently after open surgical repair (OSR) than after endovascular aneurysm repair (EVAR) (5.4% vs. 1.3%, P = 0.012). In OSR patients (n = 373), PAMI developed 2.1% in control group, 18.0% in group I and 7.1% in group II (P < 0.001). In EVAR group (n = 229), PAMI developed 0.6% in control group, 4.3% in group I and 2.2% in group II (P = 0.211). On the multivariable analysis of risk factors of PAMI, PAMI developed more frequently in patients with positive functional stress test. Conclusion The prevalence of concomitant IHD was 34% in Korean AAA patients. The risk of PAMI was significantly higher after OSR compared to EVAR and in patients with IHD compared to control group. Though we found some risk factors for PAMI, these were not applied to postoperative mortality rate. PMID:26942161

  5. Postoperative incentive spirometry use.

    PubMed

    Hassanzadeh, Hamid; Jain, Amit; Tan, Eric W; Stein, Benjamin E; Van Hoy, Megan L; Stewart, Nadine N; Lemma, Mesfin A

    2012-06-01

    The authors hypothesized that the use of incentive spirometry by orthopedic patients is less than the recommended level and is affected by patient-related factors and type of surgery. To determine its postoperative use, the authors prospectively surveyed all patients in their institution's general orthopedic ward who had undergone elective spine surgery or total knee or hip arthroplasty during a consecutive 3-month period in 2010, excluding patients with postoperative delirium or requiring a monitored bed. All 182 patients (74 men, 108 women; average age, 64.5 years; range, 32-88 years; spine group, n=55; arthroplasty group, n=127), per protocol, received preoperative spirometry education by a licensed respiratory therapist (recommended use, 10 times hourly) and reinforcement education by nurses. Patients were asked twice daily (morning and evening) regarding their spirometry use during the previous 1-hour period by a registered nurse on postoperative days 1 through 3. All data were collected by the same 2 nurses using the same standardized questionnaire. Spirometry use was correlated with surgery type, postoperative day/time, and patient's age and sex. Student's t test, Spearman test, and one-way analysis of variance were used to compare differences (P<.05). Spirometry use averaged 4.1 times per hour (range, 0-10 times). No statistical correlations were found between spirometry use and age. Sex did not influence spirometry use. The arthroplasty group reported significantly higher use than did the spine group: 4.3 and 3.5 times per hour, respectively. Mean use increased significantly between postoperative days 1, 2, and 3.

  6. Characteristics and Preliminary Observations of the Influence of Electromyostimulation on the Size and Function of Human Skeletal Muscle During 30 Days of Simulated Microgravity

    NASA Technical Reports Server (NTRS)

    Duvoisin, Marc R.; Convertino, Victor A; Buchanan, Paul; Gollinick, Philip D.; Dudley, Gary A.

    1989-01-01

    During 30 days (d) of bedrest, the practicality of using Elec- troMyoStimulation (EMS) as a deterrent to atrophy and strength loss of lower limb musculature was examined. An EMS system was developed that provided variable but quantifiable levels of EMS, and measured torque. The dominant log of three male subjects was stimulated twice daily in a 3-d on/1-d off cycle during bedrest. The non-dominant leg of each subject acted as a control. A stimulator, using a 0.3 ms monophasic 60 Hz pulse waveform, activated muscle tissue for 4 s. The output waveform from the stimulator was sequenced to the Knee Extensors (KE), Knee Flex- ors (KF), Ankle Extensors (AE), and Ankle Flexors (AF), and caused three isometric contractions of each muscle group per minute. Subject tolerance determined EMS Intensity. Each muscle group received four 5-min bouts of EMS each session with a 10 -min rest between bouts. EMS and torque levels for each muscle action were recorded directly an a computer. Overall average EMS Intensity was 197, 197, 195, and 188 mA for the KE, KF, AF, and AE, respectively. Overall average torque development for these muscle groups was 70, 16, 12, and 27 Nm, respectively. EMS intensity doubled during the study, and average torque increased 2.5 times. Average maximum torque throughout a session reached 54% of maximal voluntary for the KE and 29% for the KF. Reductions in leg volume, muscle compartment size, cross-sectional area of slow and fast-twitch fibers, strength, and aerobic enzyme activities, and increased log compliance were attenuated in the legs which received EMS during bedrest. These results indicate that similar EMS levels induce different torques among different muscle groups and that repeated exposure to EMS increases tolerance and torque development. Longer orien- tation periods, therefore, may enhance its effectiveness. Our preliminary data suggest that the efficacy of EMS as an effective countermeasure for muscle atrophy and strength loss during long

  7. Mechanical properties of non-sarcomeric cytoskeleton of mice cardiomyocytes and skeletal muscle fibers after 30-day spaceflight biosatellite BION-M1

    NASA Astrophysics Data System (ADS)

    Ogneva, Irina; Maximova, Maria; Larina, Irina

    The aim of this study was to determine transversal stiffness of the cortical cytoskeleton and cytoskeletal protein desmin content of the left ventricle cardiomyocytes, soleus and tibialis anterior muscle fibers of the mice after 30-days space flight biosatellite «BION-M1» (Russia, 2013). The dissection was made after 13-16.5 hours after landing. Transversal stiffness was measured in relaxed and calcium activated state by atomic force microscope. Desmin content was estimated by using western-blot, expression level of the gene, coding desmin, - by real time PCR. The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles (as measured using the atomic force microscopy) did not differ significantly within the study groups in comparison to the vivarium control group, except for its slight increase in tibialis anterior fibers muscle in the post-flight group of animals. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes (as detected using the western blot technique) did not differ significantly within all study groups and correlated with the transversal stiffness. Similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle, as well as correlation with the transversal stiffness of their cortical cytoskeleton was noted. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues in comparison to the control levels in the post-flight group, as well as lowered beta-actin gene expression rates in the post-flight group of animals (as detected using the RT-PCR technique). After completion of the space flight, content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins of mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this

  8. Post-operative pulmonary complications after thoracotomy

    PubMed Central

    Sengupta, Saikat

    2015-01-01

    Pulmonary complications are a major cause of morbidity and mortality in the post-operative period after thoracotomy. The type of complications and the severity of complications depend on the type of thoracic surgery that has been performed as well as on the patient's pre-operative medical status. Risk stratification can help in predicting the possibility of the post-operative complications. Certain airway complications are more prone to develop with thoracic surgery. Vocal cord injuries, bronchopleural fistulae, pulmonary emboli and post-thoracic surgery non-cardiogenic pulmonary oedema are some of the unique complications that occur in this subset of patients. The major pulmonary complications such as atelectasis, bronchospasm and pneumonia can lead to respiratory failure. This review was compiled after a search for search terms within ‘post-operative pulmonary complications after thoracic surgery and thoracotomy’ on search engines including PubMed and standard text references on the subject from 2000 to 2015. PMID:26556921

  9. Modeling the Temporal Evolution of Postoperative Complications

    PubMed Central

    Feld, Shara I.; Cobian, Alexander G.; Tevis, Sarah E.; Kennedy, Gregory D.; Craven, Mark W.

    2016-01-01

    Post-operative complications have a significant impact on patient morbidity and mortality; these impacts are exacerbated when patients experience multiple complications. However, the task of modeling the temporal sequencing of complications has not been previously addressed. We present an approach based on Markov chain models for characterizing the temporal evolution of post-operative complications represented in the American College of Surgeons National Surgery Quality Improvement Program database. Our work demonstrates that the models have significant predictive value. In particular, an inhomogenous Markov chain model effectively predicts the development of serious complications (coma longer than a day, cardiac arrest, myocardial infarction, septic shock, renal failure, pneumonia) and interventional complications (unplanned re-intubation, longer than 2 days on a ventilator and bleeding transfusion). PMID:28269851

  10. The impact of advancing age on postoperative outcomes in plastic surgery.

    PubMed

    Shih, Kevin; De Oliveira, Gildasio S; Qin, Charles; Kim, John Y

    2015-11-01

    Age has been shown to be an independent predictor of complications in general surgery patients. In contrast, the effect of age on outcomes after plastic surgery has yet to be confirmed or refuted. The objective of the current investigation was to evaluate a possible association between age and postoperative outcomes after plastic surgery. The 2005-2012 NSQIP database was retrospectively reviewed for all patients undergoing plastic surgery. Patients ≥60 years with procedures under the category of plastic surgery in NSQIP were selected for analysis. The primary outcome of interest was 30-day overall complication rates. Multivariate regression models were constructed to control for potential perioperative confounders. Of the 2,320,920 patients captured in the NSQIP database, 36,819 patients underwent plastic surgery and met inclusion criteria. The incidence of unadjusted overall complications increased with age with an overall complication rate of 9.0% in patients <60 years, 11.6% in patients 60-69 years, 13.2% in patients 70-79 years, and 15.9% in patients 80 or more years (p < 0.001). After adjusting for potential confounders, age was not independently associated with increased overall complications rates in patients 60-69 years (OR = 1.026; 95% CI = 0.927-1.135; p = 0.619) and 70-79 years (OR = 0.933; 95% CI = 0.797-0.919; p = 0.393), although patients 80 years and older experienced more medical complications (OR = 1.626; 95% CI = 1.218-2.172; p = 0.001). Age is not independently associated with overall worse outcomes in patients undergoing plastic surgery. Medical complications and mortality were more likely in extremes of age (>80 years). Age alone should not be included as a decisional factor in patients <80 years old considering plastic surgery.

  11. A Comprehensive Evaluation for Aspiration After Esophagectomy Reduces the Incidence of Post-Operative Pneumonia

    PubMed Central

    Berry, Mark F.; Atkins, B. Zane; Tong, Betty C.; Harpole, David H.; D’Amico, Thomas A.; Onaitis, Mark W.

    2011-01-01

    OBJECTIVE This study assesses the impact of using a comprehensive swallowing evaluation before starting oral feedings on aspiration detection and pneumonia occurrence after esophagectomy. METHODS The records of all esophagectomy patients between January 1996 and June 2009 were reviewed. Multivariable logistic regression analysis assessed the effect of preoperative and operative variables on the incidence of aspiration and pneumonia. Separate analyses were performed on patients before (early era, 1996–2002) and after (later era, 2003–2009) a rigorous swallowing evaluation was used routinely before starting oral feedings. RESULTS During the study period, 799 patients (379 early era, 420 later era) underwent esophagectomy; 30-day mortality was 3.5% (28 patients). Cervical anastomoses were performed in 76% of patients in the later era compared with 40% of patients in the early era. Overall, 96 patients (12%) had evidence of aspiration postoperatively, and the pneumonia incidence was 14% (113 patients). Age (odds ratio 1.05 per year, p<0.0001) and later era (odds ratio 1.90, p=0.0001) predicted aspiration in all patients in a multivariable model. In the early era, cervical anastomosis and aspiration independently predicted pneumonia. With a comprehensive swallowing evaluation in the later era, the detected incidence of aspiration increased (16% vs 7%, p<0.0001) while the incidence of pneumonia declined (11% vs 18%, p=0.004) compared to the early era, such that neither anastomotic location nor aspiration predicted pneumonia in the later era. CONCLUSIONS Esophagectomy is often associated with occult aspiration. A comprehensive swallowing evaluation for aspiration prior to initiating oral feedings significantly decreases the occurrence of pneumonia. PMID:20884018

  12. Keratophakia--postoperative astigmatism.

    PubMed

    Swinger, C A; Troutman, R C; Forman, J S

    1987-01-01

    Forty-nine cases of primary keratophakia and 13 cases of secondary keratophakia were analyzed for postoperative astigmatism. For primary cases, the surgically induced astigmatism was 1.55 D, whereas for secondary cases it was 0.19 D (insignificant). There was a tendency for both procedures to induce against-the-rule astigmatism, and both procedures were found capable of producing irregular astigmatism.

  13. Heart rate variables in the Vascular Quality Initiative are not reliable predictors of adverse cardiac outcomes or mortality after major elective vascular surgery

    PubMed Central

    Scali, Salvatore; Bertges, Daniel; Neal, Daniel; Patel, Virendra; Eldrup-Jorgensen, Jens; Cronenwett, Jack; Beck, Adam

    2015-01-01

    Objective Heart rate (HR) parameters are known indicators of cardiovascular complications after cardiac surgery, but there is little evidence of their role in predicting outcome after major vascular surgery. The purpose of this study was to determine whether arrival HR (AHR) and highest intraoperative HR are associated with mortality or major adverse cardiac events (MACEs) after elective vascular surgery in the Vascular Quality Initiative (VQI). Methods Patients undergoing elective lower extremity bypass (LEB), aortofemoral bypass (AFB), and open abdominal aortic aneurysm (AAA) repair in the VQI were analyzed. MACE was defined as any postoperative myocardial infarction, dysrhythmia, or congestive heart failure. Controlled HR was defined as AHR <75 beats/min on operating room arrival. Delta HR (DHR) was defined as highest intraoperative HR – AHR Procedure-specific MACE models were derived for risk stratification, and generalized estimating equations were used to account for clustering of center effects. HR, beta-blocker exposure, cardiac risk, and their interactions were explored to determine association with MACE or 30-day mortality. A Bonferroni correction with P < .004 was used to declare significance. Results There were 13,291 patients reviewed (LEB, n = 8155 [62%]; AFB, n = 2629 [18%]; open AAA, n = 2629 [20%]). Rates of any preoperative beta-blocker exposure were as follows: LEB, 66.5% (n = 5412); AFB, 57% (n = 1342); and open AAA, 74.2% (n = 1949). AHR and DHR outcome association was variable across patients and procedures. AHR <75 beats/min was associated with increased postoperative myocardial infarction risk for LEB patients across all risk strata (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.03–1.9; P = .03), whereas AHR<75 beats/min was associated with decreased dysrhythmia risk (OR, 0.42; 95% CI, 0.28–0.63; P = .0001) and 30-day death (OR, 0.50; 95% CI, 0.33–0.77; P = .001) in patients at moderate and high cardiac risk. These HR

  14. Intraoperative transfusion of packed red blood cells in microvascular free tissue transfer patients: assessment of 30-day morbidity using the NSQIP dataset.

    PubMed

    Kim, Bobby D; Ver Halen, Jon P; Mlodinow, Alexei S; Kim, John Y S

    2014-02-01

    Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent microvascular free tissue transfer between 2006 and 2010. Multivariate logistic regression models were used to determine the association between intraoperative transfusion and outcomes. Upon bivariate and multivariate analyses, IOT was significantly associated with higher rates of overall complications (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.12-3.63), medical complications (OR, 3.35; 95% CI, 1.75-6.42), postoperative transfusion (OR, 6.02; 95% CI, 2.02-17.97), and reoperation (OR, 2.24; 95% CI, 1.24-4.04). IOT was not associated with either surgical complications or free flap loss. IOT significantly increases risk for adverse overall and medical complications. However, IOT was not associated with surgical complications or free flap loss. Transfusion practices in the operating room should be reevaluated to improve overall outcomes.

  15. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden.

    PubMed

    Østvoll, Eirik; Sunnergren, Ola; Ericsson, Elisabeth; Hemlin, Claes; Hultcrantz, Elisabeth; Odhagen, Erik; Stalfors, Joacim

    2015-03-01

    The objective of this retrospective cohort study was to evaluate mortality rate and cause of death after tonsil surgery in Sweden. Two national registries were used, both run by The Swedish National Board of Health and Welfare, an agency of the Ministry of Health and Social Affairs. In the National Patient register all tonsil surgeries performed in Sweden from 2004 through 2011 were identified. The result from this search was matched with the National Cause of Death Register to identify all deaths that occurred within 30 days of tonsil surgery. Personal identity numbers were used to do the matching of registers. Details on the cause of death were obtained from the Swedish National Board of Health and Welfare. Two deaths were identified in 82,527 operations. Both patients were male, otherwise healthy, children under the age of five, operated due to tonsil-related upper airway obstruction/snoring with coblation technique. Cause of death was bleeding-related airway obstruction in both cases and hemodynamic failure caused by blood loss. Both deaths occurred after discharge from the hospital within the first postoperative week. No abnormal levels of analgesics were found in the postmortal investigations. Two deaths related to tonsil surgery (performed on benign indications) were identified in 82,527 operations (2004-2011) in a well-defined national population. Both deaths were due to postoperative bleeding. Based on our findings, the frequency of post-tonsil-surgery mortality in Sweden was 1/41,263, 2004-2011. Level of evidence 2b retrospective cohort study.

  16. Association of Preoperative Biliary Drainage With Postoperative Outcome Following Pancreaticoduodenectomy

    PubMed Central

    Povoski, Stephen P.; Karpeh, Martin S.; Conlon, Kevin C.; Blumgart, Leslie H.; Brennan, Murray F.

    1999-01-01

    Objective To determine whether preoperative biliary instrumentation and preoperative biliary drainage are associated with increased morbidity and mortality rates after pancreaticoduodenectomy. Summary Background Data Pancreaticoduodenectomy is accompanied by a considerable rate of postoperative complications and potential death. Controversy exists regarding the impact of preoperative biliary instrumentation and preoperative biliary drainage on morbidity and mortality rates after pancreaticoduodenectomy. Methods Two hundred forty consecutive cases of pancreaticoduodenectomy performed between January 1994 and January 1997 were analyzed. Multiple preoperative, intraoperative, and postoperative variables were examined. Pearson chi square analysis or Fisher’s exact test, when appropriate, was used for univariate comparison of all variables. Logistic regression was used for multivariate analysis. Results One hundred seventy-five patients (73%) underwent preoperative biliary instrumentation (endoscopic, percutaneous, or surgical instrumentation). One hundred twenty-six patients (53%) underwent preoperative biliary drainage (endoscopic stents, percutaneous drains/stents, or surgical drainage). The overall postoperative morbidity rate after pancreaticoduodenectomy was 48% (114/240). Infectious complications occurred in 34% (81/240) of patients. Intraabdominal abscess occurred in 14% (33/240) of patients. The postoperative mortality rate was 5% (12/240). Preoperative biliary drainage was determined to be the only statistically significant variable associated with complications (p = 0.025), infectious complications (p = 0.014), intraabdominal abscess (p = 0.022), and postoperative death (p = 0.037). Preoperative biliary instrumentation alone was not associated with complications, infectious complications, intraabdominal abscess, or postoperative death. Conclusions Preoperative biliary drainage, but not preoperative biliary instrumentation alone, is associated with increased

  17. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer: Analysis from a Large-Scale Cohort.

    PubMed

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-03-01

    Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm²/m² for women and 40.8 cm²/m² for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P < 0.001), but not for total complications. However, sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P < 0.001) and disease-free survival (HR = 1.620, P < 0.001). Under the adjusted tumor-node-metastasis (TNM) stage, sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia

  18. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

    SciTech Connect

    Wang, Jingya; Wei, Caimiao; Tucker, Susan L.; Myles, Bevan; Palmer, Matthew; Hofstetter, Wayne L.; Swisher, Stephen G.; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing; Lin, Steven H.

    2013-08-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ{sup 2} or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation.

  19. Incidence of Post-Operative Sepsis and Role of Charlson Co-Morbidity Score for Predicting Postoperative Sepsis.

    PubMed

    Emami-Razavi, Seyed Hassan; Mohammadi, Atefeh; Alibakhshi, Abbas; Jalali, Mehdi; Ghajarzadeh, Mahsa

    2016-05-01

    Sepsis and septic shock are among mortality causes following major surgeries. The Charlson co-morbidity index consists of 19 weighted categories related to chronic health which measures the burden of co-morbidity. The goal of this study was to determine the incidence of postoperative sepsis in patients underwent gynecological and gastrointestinal cancer surgeries and predictive role of Charlson index for this situation. Two hundred and twenty-two patients who underwent gynecological and gastrointestinal cancer surgeries were evaluated. Sixty-four (28.6%) patients developed SIRS postoperatively. Forty-four (19.7%) patients developed sepsis postoperatively. Mean age, duration of hospitalization and surgery, the Charlson score were significantly higher in patients who developed sepsis than other cases. Blood transfusion and Charlson score were independent predictors of sepsis occurrence. Charlson co-morbidity index is a predictive factor for developing postoperative sepsis.

  20. Postoperative conversion disorder.

    PubMed

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations.

  1. Comorbidity, age and mortality among adults treated intensively for acute myeloid leukemia (AML)

    PubMed Central

    Tawfik, Bernard; Pardee, Timothy; Isom, Scott; Sliesoraitis, Sarunas; Winter, Allison; Lawrence, Julia; Powell, Bayard L.; Klepin, Heidi D.

    2015-01-01

    Introduction Our goal was to characterize comorbidities among adults receiving intensive therapy for AML, and investigate their association with outcomes. Methods We retrospectively analyzed 277 consecutive patients with newly diagnosed AML treated intensively at the Comprehensive Cancer Center of Wake Forest University from 2002–2009. Pretreatment comorbidities were identified by ICD-9 codes and chart review. Comorbidity burden (modified Charlson Comorbidity Index [CCI]) and specific conditions were analyzed individually. Outcomes were overall survival (OS), remission, and 30-day mortality. Covariates included age, gender, cytogenetic characteristics, hemoglobin, white cell count, lactate dehydrogenase, body mass index, and insurance type. Cox proportional hazards models were used to evaluate OS; logistic regression was used for remission and 30-day mortality. Results In this series, 144 patients were ≥60 years old (median age 70 years, median survival 8.7 months) and 133 were <60 years (median age 47 years, median survival 23.1 months). Older patients had a higher comorbidity burden (CCI≥1 58% versus 26%, p<0.001). Prevalent comorbid conditions differed by age (diabetes 19.2% versus 7.5%; cardiovascular disease 12.5% versus 4.5%, for older versus younger patients, respectively). The CCI was not independently associated with OS or 30-day mortality in either age group. Among older patients, diabetes was associated with higher 30-day mortality (33.3% vs. 12.0% in diabetic vs. non diabetic patients, p =0.006). Controlling for age, cytogenetic characteristics and other comorbidities, the presence of diabetes increased the odds of 30-day mortality by 4.9 (CI 1.6–15.2) times. Discussion Diabetes is adversely associated with 30-day survival in older AML patients receiving intensive therapy. PMID:26527394

  2. Low blood lymphocyte count at 30 days post transplant predicts worse acute GVHD and survival but not relapse in a large retrospective cohort.

    PubMed

    Gul, Z; Van Meter, E; Abidi, M; Ditah, I; Abdul-Hussein, M; Deol, A; Ayash, L; Lum, L G; Waller, E K; Ratanatharathorn, V; Uberti, J; Al-Kadhimi, Z

    2015-03-01

    Multiple reports have shown that low absolute lymphocyte count at day 30 (ALC30) after allogeneic hematopoietic SCT (AHSCT) is associated with higher risk of disease relapse and worse OS. However, these reports included heterogeneous populations with different grafts and GVHD prophylaxis. Therefore, we retrospectively evaluated the association of ALC30 with transplant outcomes in a cohort of 381 consecutive patients who underwent AHSCT between 2005 and 2010 and received T-replete PBSC grafts and Tacrolimus/Mycophenolate combination as GVHD prophylaxis. Median follow-up was 57 months. Lower ALC30 (⩽400 × 10(6)/L) was associated with lower OS and increased nonrelapse mortality (NRM) for the whole cohort as well as for recipients of SD and UD grafts separately. Lower ALC30 was associated with more severe acute GVHD (aGVHD; III-IV) for the entire cohort as well as for the SD and UD groups. No association was found between lower ALC30 and relapse. Pretransplant factors associated with lower ALC30 were: unrelated donors; HLA mismatch; older donors; lower recipient age; and lower CD34+ cell dose. In this large retrospective study, ALC30⩽400 × 10(6)/L was associated with worse OS, increased NRM and severe aGVHD.

  3. Postoperative fluid management

    PubMed Central

    Kayilioglu, Selami Ilgaz; Dinc, Tolga; Sozen, Isa; Bostanoglu, Akin; Cete, Mukerrem; Coskun, Faruk

    2015-01-01

    Postoperative care units are run by an anesthesiologist or a surgeon, or a team formed of both. Management of postoperative fluid therapy should be done considering both patients’ status and intraoperative events. Types of the fluids, amount of the fluid given and timing of the administration are the main topics that determine the fluid management strategy. The main goal of fluid resuscitation is to provide adequate tissue perfusion without harming the patient. The endothelial glycocalyx dysfunction and fluid shift to extracellular compartment should be considered wisely. Fluid management must be done based on patient’s body fluid status. Patients who are responsive to fluids can benefit from fluid resuscitation, whereas patients who are not fluid responsive are more likely to suffer complications of over-hydration. Therefore, common use of central venous pressure measurement, which is proved to be inefficient to predict fluid responsiveness, should be avoided. Goal directed strategy is the most rational approach to assess the patient and maintain optimum fluid balance. However, accessible and applicable monitoring tools for determining patient’s actual fluid need should be further studied and universalized. The debate around colloids and crystalloids should also be considered with goal directed therapies. Advantages and disadvantages of each solution must be evaluated with the patient’s specific condition. PMID:26261771

  4. Initial antifungal strategy does not correlate with mortality in patients with candidemia.

    PubMed

    Murri, R; Scoppettuolo, G; Ventura, G; Fabbiani, M; Giovannenze, F; Taccari, F; Milozzi, E; Posteraro, B; Sanguinetti, M; Cauda, R; Fantoni, M

    2016-02-01

    The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.

  5. [Effect of practical use of preoperative immunonutrition with impact on prevention of postoperative pneumonia after esophagectomy].

    PubMed

    Kano, Masayuki; Nabeya, Yoshihiro; Akutsu, Yasunori; Shuto, Kiyohiko; Uesato, Masaya; Miyazawa, Yukimasa; Matsubara, Hisahiro

    2009-11-01

    To clarify the clinical benefits of administering immune-enhancing diet, Impact,we examined retrospectively the effect of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy. In 47 patients without preoperative radiotherapy, no patient who preoperatively administered Impact>or=2,250 mL failed to develop pneumonia. The patients whose postoperative hospital stay was more than 30 days were administered Impactpostoperative pneumonia and a long hospital stay after surgery.

  6. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

    PubMed Central

    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  7. Risk factors for postoperative complications in robotic general surgery.

    PubMed

    Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

    2017-03-01

    The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value <38 [OR 1.6; 95 % CI (1.1-2.2)], previous abdominal surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

  8. [Postoperative analgesia and dexamethasone].

    PubMed

    Miralles, F S; Cárceles, M D; Micol, J A; Hernández, J; del Pino, A

    1989-01-01

    A randomized, double-blind, prospective study was carried out in 100 patients who had undergone some type of surgical treatment in order to evaluate the degree of pain and relief of pain, the degree of achieved analgesia according to the opinion of the observer and consumption of analgesic agents. The evaluation was carried out on seven occasions during the first 12 hours of the postoperative period. Patients received dexamethasone (4 mg before or after the operation or 8 mg after the operation), 6-methylprednisolone (16 mg at the end of the operation) or nothing (control group). Regardless of type, dose or timing of administration of the drugs, all patients receiving corticosteroids presented less pain, more relief of pain (expressed by themselves or in opinion of the observer) and needed lower doses of analgesics during the studied time.

  9. Imaging of postoperative shoulder instability.

    PubMed

    De Filippo, M; Pesce, A; Barile, A; Borgia, D; Zappia, M; Romano, A; Pogliacomi, F; Verdano, M; Pellegrini, A; Johnson, K

    2017-03-01

    Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.

  10. Mortality, morbidity, and disease severity of patients with aspiration pneumonia

    PubMed Central

    Lanspa, Michael J.; Jones, Barbara E.; Brown, Samuel M.; Dean, Nathan C.

    2013-01-01

    Background Aspiration pneumonia is a common syndrome, although less well characterized than other pneumonia syndromes. We describe a large population of patients with aspiration pneumonia. Methods In this retrospective population study, we queried the electronic medical record at a tertiary-care, university-affiliated hospital from 1996–2006. Patients were initially identified by ICD-9 code 507.x; subsequent physician chart review excluded patients with aspiration pneumonitis and those without a confirmatory radiograph. Patients with community-acquired aspiration pneumonia were compared to a contemporaneous population of community-acquired pneumonia (CAP) patients. We compared CURB-65 predicted mortality with actual 30-day mortality. Results We identified 628 patients with aspiration pneumonia, of which 510 were community-acquired. Median age was 77, with 30-day mortality of 21%. Compared to CAP patients, patients with community-acquired aspiration pneumonia had more frequent inpatient admission (99% vs. 58%) and ICU admission (38% vs. 14%), higher Charlson comorbidity index (3 vs. 1), and higher prevalence of “do not resuscitate/intubate” orders (24% vs. 11%). CURB-65 predicted mortality poorly in aspiration pneumonia patients (AUC 0.66). Conclusions Patients with community-acquired aspiration pneumonia are older, have more comorbidities, and demonstrate higher mortality than CAP patients, even after adjustment for age and comorbidities. CURB-65 poorly predicts mortality in this population. PMID:23184866

  11. Interpretable Topic Features for Post-ICU Mortality Prediction

    PubMed Central

    Luo, Yen-Fu; Rumshisky, Anna

    2016-01-01

    Electronic health records provide valuable resources for understanding the correlation between various diseases and mortality. The analysis of post-discharge mortality is critical for healthcare professionals to follow up potential causes of death after a patient is discharged from the hospital and give prompt treatment. Moreover, it may reduce the cost derived from readmissions and improve the quality of healthcare. Our work focused on post-discharge ICU mortality prediction. In addition to features derived from physiological measurements, we incorporated ICD-9-CM hierarchy into Bayesian topic model learning and extracted topic features from medical notes. We achieved highest AUCs of 0.835 and 0.829 for 30-day and 6-month post-discharge mortality prediction using baseline and topic proportions derived from Labeled-LDA. Moreover, our work emphasized the interpretability of topic features derived from topic model which may facilitates the understanding and investigation of the complexity between mortality and diseases. PMID:28269879

  12. [Treatment of postoperative impairment of gastrointestinal motility, cholangitis and pancreatitis].

    PubMed

    Schulze, T; Heidecke, C-D

    2015-06-01

    Although the mortality associated with major hepatopancreaticobiliary surgery has continuously decreased during the last decades, the morbidity of these procedures remains high. Functional disturbances of normal gastrointestinal motility as well as inflammation and infections of surgically treated organs are frequent complications resulting in considerably prolonged lengths of stay in hospital and increased healthcare costs. This review article highlights the therapeutic approaches and recent developments in the treatment of delayed gastric emptying, prolonged postoperative ileus, postoperative cholangitis and pancreatitis after hepatopancreaticobiliary surgery. Current practice is discussed on the basis of recent results in basic and clinical research, review articles, meta-analyses and guidelines.

  13. Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates.

    PubMed

    Yadava, Mrinal; Hughey, Andrew B; Crawford, Thomas Christopher

    2016-04-01

    Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success. A multifactorial pathophysiology is hypothesized, with inflammation and postoperative β-adrenergic activation recognized as important contributing factors. The management of POAF is complicated by a paucity of data relating to the outcomes of different therapeutic interventions in this population. This article reviews the literature on epidemiology, mechanisms, and risk factors of POAF, with a subsequent focus on the therapeutic interventions and guidelines regarding management.

  14. Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia.

    PubMed

    Thønnings, S; Knudsen, J D; Schønheyder, H C; Søgaard, M; Arpi, M; Gradel, K O; Østergaard, C

    2016-08-01

    Invasive Listeria monocytogenes infections carry a high mortality despite antibiotic treatment. The rareness of the infection makes it difficult to improve antibiotic treatment through randomized clinical trials. This observational study investigated clinical features and outcome of invasive L. monocytogenes infections including the efficacy of empiric and definitive antibiotic therapies. Demographic, clinical and biochemical findings, antibiotic treatment and 30-day mortality for all episodes of L. monocytogenes bacteraemia and/or meningitis were collected by retrospective medical record review in the North Denmark Region and the Capital Region of Denmark (17 hospitals) from 1997 to 2012. Risk factors for 30-day all-cause mortality were assessed by logistic regression. The study comprised 229 patients (median age: 71 years), 172 patients had bacteraemia, 24 patients had meningitis and 33 patients had both. Significant risk factors for 30-day mortality were septic shock (OR 3.0, 95% CI 1.4-6.4), altered mental state (OR 3.6, 95% CI 1.7-7.6) and inadequate empiric antibiotic therapy (OR 3.8, 95% CI 1.8-8.1). Cephalosporins accounted for 90% of inadequately treated cases. Adequate definitive antibiotic treatment was administered to 195 patients who survived the early period (benzylpenicillin 72, aminopenicillin 84, meropenem 28, sulfamethoxazole/trimethoprim 6, and piperacillin/tazobactam 5). Definitive antibiotic treatment with benzylpenicillin or aminopenicillin resulted in a lower 30-day mortality in an adjusted analysis compared with meropenem (OR 0.3; 95% CI 0.1-0.8). In conclusion, inadequate empiric antibiotic therapy and definitive therapy with meropenem were both associated with significantly higher 30-day mortality.

  15. TRICARE: changes included in the National Defense Authorization Act for Fiscal Year 2010; enhancement of transitional dental care for members of the Reserve Component on active duty for more than 30 days in support of a contingency operation. Final rule.

    PubMed

    2011-12-28

    The Department is publishing this final rule to implement section 703 of the National Defense Authorization Act for Fiscal Year 2010 (NDAA for FY10). Specifically, that legislation amends the transitional health care dental benefits for Reserve Component members on active duty for more than 30 days in support of a contingency operation. The legislation entitles these Reserve Component members to dental care in the same manner as a member of the uniformed services on active duty for more than 30 days, thus providing care to the Reserve member in both military dental treatment facilities and authorized private sector dental care. This final rule does not eliminate any medical or dental care that is currently covered as transitional health care for the member.

  16. Distribution and biomarkers of Carbon-14 labeled fullerene C60 ([14C(U)]C60) in female rats and mice for up to 30 days after intravenous exposure

    PubMed Central

    Sumner, Susan C. J.; Snyder, Rodney W.; Wingard, Christopher; Mortensen, Ninell P.; Holland, Nathan A.; Shannahan, Jonathan H.; Dhungana, Suraj; Pathmasiri, Wimal; Han, Li; Lewin, Anita H.; Fennell, Timothy R.

    2016-01-01

    A comprehensive distribution study was conducted in female rats and mice exposed to a suspension of uniformly carbon-14 labeled C60 ([14C(U)]C60). Rodents were administered [14C(U)]C60 (~0.9 mg /kg body weight) or 5% PVP-saline vehicle alone via a single tail vein injection. Tissues were collected at 1 hour, 1, 7, 14 and 30 days after administration. A separate group of rodents received 5 daily injections of suspensions of either [14C(U)]C60 or vehicle with tissue collection 14 days post exposure. Radioactivity was detected in over 20 tissues at all time period. The highest concentration of radioactivity in rodents at each time point was in liver, lungs and spleen. Elimination of [14C(U)]C60 was <2% in urine and feces at any 24 hour time points. [14C(U)]C60 and [14C(U)]C60-retinol were detected in liver of rats and together accounted for ~99% and ~56% of the total recovered at 1 and 30 days post exposure, respectively. The blood radioactivity at 1 hour after [14C(U)]C60 exposure was four-fold higher in rats than in mice; blood radioactivity was still in circulation at 30 days post [14C(U)]C60 exposure in both species (<1%). Levels of oxidative stress markers increased by 5 days after exposure and remained elevated, while levels of inflammation markers initially increased and then returned to control values. The level of cardiovascular marker vWF, increased in rats, but remained at control levels in mice. This study demonstrates that [14C(U)]C60 is retained in female rodents with little elimination by 30 days after i.v. exposure, and leads to systemic oxidative stress. PMID:25727383

  17. Distribution and biomarkers of carbon-14-labeled fullerene C60 ([(14) C(U)]C60 ) in female rats and mice for up to 30 days after intravenous exposure.

    PubMed

    Sumner, Susan C J; Snyder, Rodney W; Wingard, Christopher; Mortensen, Ninell P; Holland, Nathan A; Shannahan, Jonathan H; Dhungana, Suraj; Pathmasiri, Wimal; Han, Li; Lewin, Anita H; Fennell, Timothy R

    2015-12-01

    A comprehensive distribution study was conducted in female rats and mice exposed to a suspension of uniformly carbon-14-labeled C60 ([(14) C(U)]C60 ). Rodents were administered [(14) C(U)]C60 (~0.9 mg kg(-1) body weight) or 5% polyvinylpyrrolidone-saline vehicle alone via a single tail vein injection. Tissues were collected at 1 h and 1, 7, 14 and 30 days after administration. A separate group of rodents received five daily injections of suspensions of either [(14) C(U)]C60 or vehicle with tissue collection 14 days post exposure. Radioactivity was detected in over 20 tissues at all time points. The highest concentration of radioactivity in rodents at each time point was in liver, lungs and spleen. Elimination of [(14) C(U)]C60 was < 2% in urine and feces at any 24 h time points. [(14) C(U)]C60 and [(14) C(U)]C60 -retinol were detected in liver of rats and together accounted for ~99% and ~56% of the total recovered at 1 and 30 days postexposure, respectively. The blood radioactivity at 1 h after [(14) C(U)]C60 exposure was fourfold higher in rats than in mice; blood radioactivity was still in circulation at 30 days post [(14) C(U)]C60 exposure in both species (<1%). Levels of oxidative stress markers increased by 5 days after exposure and remained elevated, while levels of inflammation markers initially increased and then returned to control values. The level of cardiovascular marker von Willebrand factor, increased in rats, but remained at control levels in mice. This study demonstrates that [(14) C(U)]C60 is retained in female rodents with little elimination by 30 days after i.v. exposure, and leads to systemic oxidative stress.

  18. Mortality Risk Assessment of Total Knee Arthroplasty and Related Surgery After Percutaneous Coronary Intervention

    PubMed Central

    Von Keudell, Arvind G.; Thornhill, Thomas S.; Katz, Jeffrey N.; Losina, Elena

    2016-01-01

    Background: The optimal antiplatelet therapy (APT) treatment strategy after Coronary Artery Stenting (CAS) in non-cardiac surgery, such as total knee arthroplasty (TKA) or urgent TKA-related surgery remains unknown. Methods: We built a decision tree model to examine the mortality outcomes of two alternative strategies for APT after CAS use in the perioperative period namely, continuous use and discontinuation. Results: If surgery was performed in the first month after CAS placement, discontinuing APT led to an estimated 30-day post TKA mortality of 10.5%, compared to 1.0% in a strategy with continuous APT use. Mortality with both strategies decreased with longer intervals. Conclusion: Our model demonstrated that APT discontinuation in patients undergoing TKA or urgent TKA related surgery after CAS placement might lead to greater 30-day mortality up to one year. PMID:28144380

  19. Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

    PubMed Central

    Lim, Joo Hyun; Choi, Seung Ho; Seo, Ji Yeon; Kang, Hae Yeon; Yang, Jong In; Chung, Su Jin; Kim, Joo Sung

    2016-01-01

    Background/Aims A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG. Methods Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0. Results Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted. Conclusions The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy. PMID:27799884

  20. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    PubMed Central

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  1. A comparison of the surgical mortality due to colorectal perforation at different hospitals with data from 10,090 cases in the Japanese National Clinical Database

    PubMed Central

    Ohki, Takeshi; Yamamoto, Masakazu; Miyata, Hiroaki; Sato, Yasuto; Saida, Yoshihisa; Morimoto, Tsuyoshi; Konno, Hiroyuki; Seto, Yasuyuki; Hirata, Koichi

    2017-01-01

    Abstract Colorectal perforation has a high rate of mortality. We compared the incidence and fatality rates of colorectal perforation among different hospitals in Japan using data from the nationwide surgical database. Patients were registered in the National Clinical Database (NCD) between January 1st, 2011 and December 31st, 2013. Patients with colorectal perforation were identified from surgery records by examining if acute diffuse peritonitis (ADP) and diseases associated with a high probability of colorectal perforation were noted. The primary outcome measures included the 30-day postsurgery mortality and surgical mortality of colorectal perforation. We analyzed differences in the observed-to-expected mortality (O/E) ratio between the two groups of hospitals, that is, specialized and non-specialized, using the logistic regression analysis forward selection method. There were 10,090 cases of disease-induced colorectal perforation during the study period. The annual average postoperative fatality rate was 11.36%. There were 3884 patients in the specialized hospital group and 6206 in the non-specialized hospital group. The O/E ratio (0.9106) was significantly lower in the specialized hospital group than in the non-specialized hospital group (1.0704). The experience level of hospitals in treating cases of colorectal perforation negatively correlated with the O/E ratio. We conducted the first study investigating differences among hospitals with respect to their fatality rate of colorectal perforation on the basis of data from a nationwide database. Our data suggest that patients with colorectal perforation should choose to be treated at a specialized hospital or a hospital that treats five or more cases of colorectal perforation per year. The results of this study indicate that specialized hospitals may provide higher quality medical care, which in turn proves that government policy on healthcare is effective at improving the medical system in Japan. PMID:28079809

  2. Mortal assets

    SciTech Connect

    Howe, Geoffrey R.; Zablotska, Lydia B.; Fix, John J.; Egel, John N.; Buchanan, Jeffrey A.

    2005-11-01

    Workers employed in 15 utilities that generate nuclear power in the United States have been followed for up to 18 years between 1979 and 1997. Their cumulative dose from whole-body ionizing radiation has been determined from the dose records maintained by the facilities themselves and the REIRS and REMS systems maintained by the Nuclear Regulatory Commission and the Department of Energy, respectively. Mortality in the cohort from a number of causes has been analyzed with respect to individual radiation doses. The cohort displays a very substantial healthy worker effect, i.e. considerably lower cancer and noncancer mortality than the general population. Based on 26 and 368 deaths, respectively, positive though statistically nonsignificant associations were seen for mortality from leukemia (excluding chronic lymphocytic leukemia) and all solid cancers combined, with excess relative risks per sievert of 5.67 (95% confidence interval (CI) -2.56, 30.4) and 0.596 (95% CI -2.01, 4.64), respectively. These estimates are very similar to those from the atomic bomb survivors study, though the wide confidence intervals are also consistent with lower or higher risk estimates. A strong positive and statistically significant association between radiation dose and deaths from arteriosclerotic heart disease including coronary heart disease was also observed in the cohort, with an ERR of 8.78 (95% CI 2.10, 20.0). Whle associations with heart disease have been reported in some other occupational studies, the magnitude of the present association is not consistent with them and therefore needs cautious interpretation and merits further attention. At present, the relatively small number of deaths and the young age of the cohort (mean age at end of follow-up is 45 years) limit the power of the study, but further follow-up is 45 years) limit the power of the study, but further follow-up and the inclusion of the present data in an ongoing IARC combined analysis of nuclear workers from 15

  3. Association between anesthesiologist experience and mortality after orthotopic liver transplantation.

    PubMed

    Hofer, Ira; Spivack, John; Yaport, Miguel; Zerillo, Jeron; Reich, David L; Wax, David; DeMaria, Samuel

    2015-01-01

    The anesthesiologist has been recognized as an integral member of the liver transplant team, and previous studies have demonstrated that inter-anesthesiologist variability can be a driver of outcomes for high-risk patients. We hypothesized that anesthesiologist experience, defined as the number of previous liver transplants performed at our institution, the Icahn School of Medicine at Mount Sinai, would be independently associated with outcomes for liver transplant patients. Eight hundred forty-nine liver transplants performed between January 2003 and January 2013 with a total of 22 anesthesiologists were analyzed. Each transplant was assigned an incremental case number that corresponded to the number of transplants that the attending anesthesiologist had already performed at our institution. Several perioperative covariates were controlled for in the context of a generalized linear mixed effects model to detail the influence of threshold levels of the incremental case number on the primary outcome, 30-day mortality, and a secondary outcome, 30-day graft failure. Sensitivity analyses were conducted to confirm the robustness of these findings. An incremental case number ≤ 5 was associated with a significantly greater risk of 30-day mortality (odds ratio = 2.24, 95% confidence interval = 1.11-4.54, P = 0.025), and there was evidence suggestive of a greater risk of 30-day graft failure (odds ratio = 1.93, 95% confidence interval = 0.95-3.93, P = 0.071). Sensitivity analyses ruled out threats to the validity of these findings, including dropout effects and time trends in the overall performance of the transplantation unit. In conclusion, this study shows that an anesthesiologist's level of experience has a significant effect on outcomes for liver transplant recipients, with increased mortality and possibly graft failure during a provider's first 5 cases. These findings may indicate the need for increased training and supervision for

  4. [Maternal mortality and perinatal mortality].

    PubMed

    Boutaleb, Y; Mesbahi, M; Lahlou, D; Aderdour, M

    1982-01-01

    94 maternal deaths and 1546 fetal and neonatal deaths were registered among 28,706 births at the CHU Averroes in Casablanca between 1978-80. 45% of women who deliver at the clinic are very poor and only 10% are relatively well off. Obstetrical antecedents were noted in 27% of the fetal deaths. 70% of the maternal deaths occurred in women aged 20-34. 32 maternal deaths occurred among 16,232 women with 1-2 children, 30 among 6514 women with 3-5 children, and 32 among 5960 women with 6-14 children. 11,027 of the 28,706 were primaparas. Perinatal mortality was 4.46% among primaparas, 8.24% among grand multiparas, and 4.1% among secondiparas. In 58 of the 94 cases of maternal mortality the woman was hospitalized after attempting delivery at home or in a village clinic. Among women with 1 or 2 children, hemorrhage was the cause of death in 8 cases, infection in 7 cases, eclampsia in 3 cases, thromboembolism in 2 cases, uterine inversion in 2 cases, pulmonary tuberculosis in 1 case, embolism in 5 cases, and other causes 1 case each. Among women with 3-5 children hemorrhage was the cause of death in 10 cases, septicemia in 3 cases, uterine rupture in 3 cases, eclampsia in 3 cases, uterine inversion in 2 cases, viral hepatitis in 2 cases, emboli in 2 cases, and other reasons 1 case each. Among grand multiparas hemorrhage was the cause of death in 11 cases, uterine rupture in 12 cases, peritonitis in 2 cases, eclampsia in 2 cases, emboli in 2 cases, and other causes 1 case each. 19 of the maternal deaths were judged to have been avoidable with better management. Prematurity and birth weight of 1000-2500 g associated or not with other pathology were found in 714 of 1546 perinatal deaths. Of 390 cases of death in utero with retention and maceration, 68 were caused by reno-vascular syndromes, 76 by maternal infections, 33 by maternal syphilis, 26 by fetal malformation, 18 by maternal diabetes, 10 by Rh incompatability, and 159 by indeterminate causes. In 795 cases of

  5. Long-term mortality of hospitalized pneumonia in the EPIC-Norfolk cohort.

    PubMed

    Myint, P K; Hawkins, K R; Clark, A B; Luben, R N; Wareham, N J; Khaw, K-T; Wilson, A M

    2016-03-01

    Little is known about cause-specific long-term mortality beyond 30 days in pneumonia. We aimed to compare the mortality of patients with hospitalized pneumonia compared to age- and sex-matched controls beyond 30 days. Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk prospective population study. Hospitalized pneumonia cases were identified from record linkage (ICD-10: J12-J18). For this study we excluded people with hospitalized pneumonia who died within 30 days. Each case identified was matched to four controls and followed up until the end June 2012 (total 15 074 person-years, mean 6·1 years, range 0·08-15·2 years). Cox regression models were constructed to examine the all-cause, respiratory and cardiovascular mortality using date of pneumonia onset as baseline with binary pneumonia status as exposure. A total of 2465 men and women (503 cases, 1962 controls) [mean age (s.d.) 64·5 (8·3) years] were included in the study. Between a 30-day to 1-year period, hazard ratios (HRs) of all-cause and cardiovascular mortality were 7·3 [95% confidence interval (CI) 5·4-9·9] and 5·9 (95% CI 3·5-9·7), respectively (with very few respiratory deaths within the same period) in cases compared to controls after adjusting for age, sex, asthma, smoking status, pack years, systolic and diastolic blood pressure, diabetes, physical activity, waist-to-hip ratio, prevalent cardiovascular and respiratory diseases. All outcomes assessed also showed increased risk of death in cases compared to controls after 1 year; respiratory cause of death being the most significant during that period (HR 16·4, 95% CI 8·9-30·1). Hospitalized pneumonia was associated with increased all-cause and specific-cause mortality beyond 30 days.

  6. Postoperative complications of spine surgery.

    PubMed

    Swann, Matthew C; Hoes, Kathryn S; Aoun, Salah G; McDonagh, David L

    2016-03-01

    A variety of surgical approaches are available for the treatment of spine diseases. Complications can arise intraoperatively, in the immediate postoperative period, or in a delayed fashion. These complications may lead to severe or even permanent morbidity if left unrecognized and untreated [1-4]. Here we review a range of complications in the early postoperative period from more benign complications such as postoperative nausea and vomiting (PONV) to more feared complications leading to permanent loss of neurological function or death [5]. Perioperative pain management is covered in a separate review (Chapter 8).

  7. [Management of postoperative pancreatic fistula].

    PubMed

    Hackert, T; Büchler, M W

    2015-06-01

    The occurrence of a postoperative pancreatic fistula is one of the most important complications following pancreatic resections. The frequency of this complication varies between 3 % after pancreatic head resection and up to 35 % following distal pancreatectomy. In 2005, the international definition of postoperative pancreatic fistula was standardized according to the approach of the International Study Group of Pancreatic Surgery (ISGPS) including an A-C grading system of the severity. Consequently, results from different studies have become comparable and the historically reported fistula rates can be evaluated more critically. The present review summarises the currently available data on incidence, risk factors, fistula-associated complications and management of postoperative pancreatic fistula.

  8. Imaging of the Postoperative Orbit.

    PubMed

    Learned, Kim O; Nasseri, Farbod; Mohan, Suyash

    2015-08-01

    Imaging evaluation of the postoperative orbit remains challenging even for the expert neuroradiologist. This article provides a simplified framework for understanding the complex postoperative appearances of the orbit, in an attempt to enhance the diagnostic accuracy of postoperative computed tomography and MR imaging of the orbit. Readers are familiarized with the normal appearances of common eye procedures and orbit reconstructions to help avoid interpretative pitfalls. Also reviewed are imaging features of common surgical complications, and evaluation of residual/recurrent neoplasm in the setting of oncologic imaging surveillance.

  9. [Postoperative imaging of the shoulder].

    PubMed

    Wörtler, K; Rummeny, E J

    2004-06-01

    Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primary impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications.

  10. Convergent Validity of Three Methods for Measuring Postoperative Complications

    PubMed Central

    Fritz, Bradley A.; Escallier, Krisztina E.; Abdallah, Arbi Ben; Oberhaus, Jordan; Becker, Jennifer; Geczi, Kristin; McKinnon, Sherry; Helsten, Dan L.; Sharma, Anshuman; Wildes, Troy S.; Avidan, Michael S.

    2016-01-01

    Background Anesthesiologists need tools to accurately track postoperative outcomes. The accuracy of patient report in identifying a wide variety of postoperative complications after diverse surgical procedures has not previously been investigated. Methods In this cohort study, 1,578 adult surgical patients completed a survey at least 30 days after their procedure asking if they had experienced any of 18 complications while in the hospital after surgery. Patient responses were compared to the results of an automated electronic chart review and (for a random subset of 750 patients) to a manual chart review. Results from automated chart review were also compared to those from manual chart review. Forty-two randomly selected patients were contacted by telephone to explore reasons for discrepancies between patient report and manual chart review. Results Comparisons between patient report, automated chart review, and manual chart review demonstrated poor-to-moderate positive agreement (range, 0 to 58%) and excellent negative agreement (range, 82 to 100%). Discordance between patient report and manual chart review was frequently explicable by patients reporting events that happened outside the time period of interest. Conclusions Patient report can provide information about subjective experiences or events that happen after hospital discharge, but often yields different results from chart review for specific in-hospital complications. Effective in-hospital communication with patients and thoughtful survey design may increase the quality of patient-reported complication data. PMID:27028469

  11. Reduction of postoperative adhesion development.

    PubMed

    Diamond, Michael P

    2016-10-01

    Despite use of meticulous surgical techniques, and regardless of surgical access via laparotomy or laparoscopy, postoperative adhesions develop in the vast majority of women undergoing abdominopelvic surgery. Such adhesions represent not only adhesion reformation at sites of adhesiolysis, but also de novo adhesion formation at sites of surgical procedures. Application of antiadhesion adjuvants compliment the benefits of meticulous surgical techniques, providing an opportunity to further reduce postoperative adhesion development. Improved understanding of the pathophysiology of adhesion development and distinguishing variations in the molecular biologic mechanisms from adhesion-free peritoneal repair represent future opportunities to improve the reduction of postoperative adhesions. Optimization of the reduction of postoperative adhesions will likely require identification of unique, personalized approaches in each individual, representing interindividual variation in peritoneal repair processes.

  12. Obstructive Sleep Apnea: Preoperative Screening and Postoperative Care.

    PubMed

    Wolfe, Robert M; Pomerantz, Jonathan; Miller, Deborah E; Weiss-Coleman, Rebecca; Solomonides, Tony

    2016-01-01

    The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed. For adults, preoperative screening using the STOP or STOP-Bang questionnaires can help to identify adult patients at increased risk of OSA. In the pediatric setting, a question about snoring should be part of every preoperative examination. For patients with known OSA, continuous positive airway pressure should be continued postoperatively. Continuous pulse oximetry monitoring with an alarm system can help to prevent apneic catastrophes caused by OSA in the postoperative period.

  13. Shuttle flight experiment 30-day summary report

    NASA Technical Reports Server (NTRS)

    1985-01-01

    A total of 12 AFT training sessions were administered to SL 3 Payload Specialists over a 7 month period. Nine of these sessions were 2 hours in duration and three were 3 hours in duration. A total of three rotating chair tests were conducted in this time frame with four subjects. The performance of these crewmen across tests is shown. Test 1, a baseline motion sickness test, was conducted approximately 10 months prior to the mission, before any AFT was administered. Test 2 was administered after 2 hours of AFT, test 3 after 4 hours and test 4 after 6 hours (total) of training in symptom control. Improvement in performance is reflected by a subject's ability to tolerate a greater number of rotations across tests. Additional training for crewman was not possible within the constraints of the mission. Results of the mission indicate that, as predicted preflight, subject #32 was relatively symptom free inflight while subject #33 was not. Other preflight and postflight tests and analyses are reported.

  14. Stair-Climbing Test Predicts Postoperative Cardiopulmonary Complications and Hospital Stay in Patients with Non-Small Cell Lung Cancer

    PubMed Central

    Dong, Jingsi; Mao, Yousheng; Li, Jiagen; He, Jie

    2017-01-01

    Background There is currently no reliable method to predict major postoperative cardiopulmonary complications for patients with non-small cell lung cancer (NSCLC). In this study, we hypothesized that exercise oxygen desaturation (EOD) and heart rate change results in a stair-climbing test (SCT) would predict postoperative cardiopulmonary complications for patients with NSCLC. Material/Methods We examined 171 patients (41 females and 130 males) with NSCLC by preoperative SCT from January 2010 to July 2015. Among them, 27 underwent wedge resection, 122 underwent lobectomy, and 22 underwent pneumonectomy. The correlation between postoperative cardiopulmonary complications and parameters of SCT and pulmonary function test (PFT) parameters were analyzed retrospectively. Results The overall 30-day postoperative morbidity of the patients was 46/171 (26.9%), with death occurring in 3/171(1.8%). The age, FEV1%, MVV, height of climbing, EOD, and heart rate change were found to be significantly different between the group with postoperative cardiopulmonary complications and those without. Binary logistic regression analysis showed that EOD and heart rate change were independently correlated with postoperative cardiopulmonary complications. In addition, a model predicting the probability of postoperative cardiopulmonary complication based on logistic regression for multivariable analysis was used to confirm our findings. Conclusions A symptom-limited SCT with oxygen saturation monitoring is a safe, simple, and low-cost method to evaluate cardiopulmonary function preoperatively. PMID:28336909

  15. Stair-Climbing Test Predicts Postoperative Cardiopulmonary Complications and Hospital Stay in Patients with Non-Small Cell Lung Cancer.

    PubMed

    Dong, Jingsi; Mao, Yousheng; Li, Jiagen; He, Jie

    2017-03-24

    BACKGROUND There is currently no reliable method to predict major postoperative cardiopulmonary complications for patients with non-small cell lung cancer (NSCLC). In this study, we hypothesized that exercise oxygen desaturation (EOD) and heart rate change results in a stair-climbing test (SCT) would predict postoperative cardiopulmonary complications for patients with NSCLC. MATERIAL AND METHODS We examined 171 patients (41 females and 130 males) with NSCLC by preoperative SCT from January 2010 to July 2015. Among them, 27 underwent wedge resection, 122 underwent lobectomy, and 22 underwent pneumonectomy. The correlation between postoperative cardiopulmonary complications and parameters of SCT and pulmonary function test (PFT) parameters were analyzed retrospectively. RESULTS The overall 30-day postoperative morbidity of the patients was 46/171 (26.9%), with death occurring in 3/171(1.8%). The age, FEV1%, MVV, height of climbing, EOD, and heart rate change were found to be significantly different between the group with postoperative cardiopulmonary complications and those without. Binary logistic regression analysis showed that EOD and heart rate change were independently correlated with postoperative cardiopulmonary complications. In addition, a model predicting the probability of postoperative cardiopulmonary complication based on logistic regression for multivariable analysis was used to confirm our findings. CONCLUSIONS A symptom-limited SCT with oxygen saturation monitoring is a safe, simple, and low-cost method to evaluate cardiopulmonary function preoperatively.

  16. Vancomycin minimum inhibitory concentration, host comorbidities and mortality in Staphylococcus aureus bacteraemia.

    PubMed

    Holmes, N E; Turnidge, J D; Munckhof, W J; Robinson, J O; Korman, T M; O'Sullivan, M V N; Anderson, T L; Roberts, S A; Warren, S J C; Gao, W; Johnson, P D R; Howden, B P

    2013-12-01

    We reported an association between elevated vancomycin MIC and 30-day mortality in patients with Staphylococcus aureus bacteraemia (SAB), including patients with methicillin-susceptible S. aureus (MSSA) treated with flucloxacillin. A detailed analysis of comorbidities and disease severity scores in the same cohort of patients was performed to ascertain if unknown clinical parameters may have influenced these results. The association between elevated vancomycin MIC and 30-day mortality in SAB remained significant (p 0.001) on multivariable logistic regression analysis even when accounting for clinical factors. In addition, the association persisted when restricting analysis to patients with MSSA bacteraemia treated with flucloxacillin. This suggests that elevated vancomycin MIC is associated with but not causally linked to an organism factor that is responsible for increased mortality.

  17. Carotid Stenosis in Cardiac Surgery-No Difference in Postoperative Outcomes.

    PubMed

    Schultheis, Molly; Saadat, Siavash; Dombrovskiy, Victor; Frenchu, Kiersten; Kanduri, Jaya; Romero, Joseph; Lemaire, Anthony; Ghaly, Aziz; Bastides, George; Rahimi, Saum; Lee, Leonard

    2016-02-23

    Background Debate over revascularization of asymptomatic carotid stenosis before cardiac surgery is ongoing. In this study, we analyze cardiac surgery outcomes in patients with asymptomatic carotid stenosis at a single hospital. Methods In this study, 1,781 patients underwent cardiac surgery from January 2012 to June 2013; 1,357 with preoperative screening carotid duplex were included. Patient demographics, comorbidities, degree of stenosis, postoperative complications, and mortality were evaluated. Chi-square test and logistic regression analysis were performed. Results Asymptomatic stenosis was found in 403/1,357 patients (29.7%; 355 moderate and 48 severe). Patients with stenosis, compared with those without, were older (71.7 ± 11 vs. 66.3 ± 12 years; p < 0.01). Females were more likely to have stenosis (odd ratio, = 1.7; 95% confidence interval, 1.4-2.2); however, patients were predominantly male in both groups. There were no significant differences in the rates of mortality and postoperative complications, including stroke and transient ischemic attack (TIA). Postoperative TIA occurred in 3/1,357(0.2%); only one had moderate stenosis. Inhospital stroke occurred in 21/1,357 (1.5%) patients; stroke rates were 2.3% (8/355) with moderate stenosis and 2.1% (1/48) severe stenosis. There were 59/1,357 (4.3%) deaths; patients with stenosis had a mortality rate of 4.2% (17/403); however, no postoperative stroke lead to death. Multivariable logistic regression analysis with adjustment for age, gender, race, comorbidities, and postoperative complications did not show an impact of carotid stenosis on postoperative mortality and development of stroke after cardiac surgery. Conclusion This study suggests that patients with asymptomatic carotid stenosis undergoing cardiac surgery are not at increased risk of postoperative complications and mortality; thus, prophylactic carotid revascularization may not be indicated.

  18. The Effect of Cuts in Medicare Reimbursement on Hospital Mortality

    PubMed Central

    Seshamani, Meena; Schwartz, J Sanford; Volpp, Kevin G

    2006-01-01

    Objective To determine if patients treated at hospitals under different levels of financial strain from the Balanced Budget Act (BBA) of 1997 had differential changes in 30-day mortality, and whether vulnerable patient populations such as the uninsured were disproportionately affected. Data Source Hospital discharge data from all general acute care hospitals in Pennsylvania from 1997 to 2001. Study Design A multivariate regression analysis was performed retrospectively on 30-day mortality rates, using hospital discharge data, hospital financial data, and death certificate information from Pennsylvania. Data Collection We used 370,017 hospital episodes with one of four conditions identified by the Agency for Healthcare Research and Quality as inpatient quality indicators were extracted. Principal Findings The average magnitude of Medicare payment reduction on overall net revenues was estimated at 1.8 percent for hospitals with low BBA impact and 3.6 percent for hospitals with a high impact in 1998, worsening to 2 and 4.8 percent, respectively, by 2001. Operating margins decreased significantly over the time period for all hospitals (p<.05). While unadjusted mortality rates demonstrated a disproportionate rise in mortality for patients from high impact hospitals from 1997 to 2000, adjusted analyses show no consistent, significant difference in the rate of change in mortality between high-impact and low-impact hospitals (p = .04–.94). Similarly, uninsured patients did not experience greater increases in mortality in high-impact hospitals relative to low-impact hospitals. Conclusions An analysis of hospitalizations in the Commonwealth of Pennsylvania did not find an adverse impact of increased financial strain from the BBA on patient mortality either among all patients or among the uninsured. PMID:16704507

  19. Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired Pneumonia

    PubMed Central

    Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin

    2012-01-01

    Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality. PMID:22677348

  20. Mortality Risk Stratification in Fontan Patients Who Underwent Heart Transplantation.

    PubMed

    Berg, Christopher J; Bauer, Brenton S; Hageman, Abbie; Aboulhosn, Jamil A; Reardon, Leigh C

    2017-03-01

    The number of patients who require orthotopic heart transplantation (OHT) for failing Fontan physiology continues to grow; however, the methods and tools to evaluate risk of OHT are limited. This study aimed to identify a set of preoperative variables and characteristics that were associated with a greater risk of postoperative mortality in patients who received OHT for failing Fontan physiology. Thirty-six Fontan patients were identified as having undergone OHT at University of California-Los Angeles Medical Center from 1991 to 2014. Data were collected retrospectively and analyzed. The primary end point was designated as postoperative mortality. After an average follow-up time of 3.5 years, 17 (44%) patients suffered postoperative mortality. Patient characteristics including (1) age <18 years at the time of OHT, (2) Fontan-OHT interval of <10 years, (3) systemic ventricular ejection fraction <20%, (4) moderate-to-severe atrioventricular valve insufficiency, (5) an elevated Model of End-stage Liver Disease, eXcluding INR score, or (6) need for advanced mechanical support before surgery were associated with an increased incidence of postoperative mortality. Using these risk factors, we present a theoretical framework to stratify risk of postoperative death in failing Fontan patients after OHT. In conclusion, a method such as this may aid in the transplantation evaluation and listing process of patients with failing Fontan physiology.

  1. Morbidity and mortality of diabetes with surgery.

    PubMed

    Chuah, L L; Papamargaritis, D; Pillai, D; Krishnamoorthy, A; le Roux, C W

    2013-03-01

    The prevalence of Type 2 diabetes mellitus (T2DM) has increased; as a result the number of patients with T2DM undergoing surgical procedures has also increased. This population is at high risk of macrovascular (cardiovascular disease, peripheral vascular disease) or microvascular (retinopathy, nephropathy or neuropathy) complications, both increasing their perioperative morbidity and mortality. Diabetes patients are more at risk of poor wound healing, respiratory infection, myocardial infarction, admission to intensive care, and increased hospital length of stay. This leads to increased inpatient costs. The outcome of perioperative glycaemia management remains a significant clinical problem without a universally accepted solution. The majority of evidence on morbidity and mortality of T2DM patients undergoing surgery comes from the setting of cardiac surgery; there was less evidence on noncardiac surgery and bariatric surgery. Bariatric surgery is increasingly performed in patients with severe obesity complicated by T2DM, but is distinguished from general surgery as it immediately improves the glucose homeostasis postoperatively. The improvements in glycaemia are thought to be independent of weight loss and this requires different postoperative management. Patients usually have to follow specific preoperative diets which lead to improvement in glycaemia immediately before surgery. Here we review the available data on the mortality and morbidity of patients with T2DM who underwent elective surgery (cardiac, non-cardiac and bariatric surgery) and the current knowledge of the impact that preoperative, intraoperative and postoperative glycaemic management has on operative outcomes.

  2. Post-operative urinary retention.

    PubMed

    Steggall, Martin; Treacy, Colm; Jones, Mark

    Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

  3. Association between Interleukin-6 Promoter Polymorphism (-174 G/C), Serum Interleukin-6 Levels and Mortality in Severe Septic Patients

    PubMed Central

    Lorente, Leonardo; Martín, María M.; Pérez-Cejas, Antonia; Barrios, Ysamar; Solé-Violán, Jordi; Ferreres, José; Labarta, Lorenzo; Díaz, César; Jiménez, Alejandro

    2016-01-01

    The association between interleukin (IL)-6 promoter polymorphism (-174 G/C), circulating IL-6 levels and mortality in septic patients has scarcely been addressed, and then only in studies of small sample size, and a direct association among them has not been previously reported. Therefore, the purpose of our study was to determine whether this association exists. An observational, prospective and multicenter study including severe septic patients was undertaken and serum IL-6 levels at severe sepsis diagnosis and IL-6 promoter polymorphism (-174 G/C) were determined. The end-point of the study was 30-day mortality. The study included 263 patients with the following genotypes of IL-6 promoter polymorphism (-174 G/C): 123 (46.8%) GG, 110 (41.8%) GC and 30 (11.4%) CC. CC homozygous patients showed lower sepsis-related organ failure assessment (SOFA) score, serum IL-6 levels and mortality at 30 days compared to those with other genotypes (GC or GG). On regression analysis, CC homozygous patients showed lower 30-day mortality than those with genotype GG (odds ratio = 0.21; 95% CI = 0.053−0.838; p = 0.03) or GC (hazard ratio = 0.28; 95% CI = 0.074−1.037; p = 0.06). The most important results of our study were that CC might be a favorable genotype in septic patients showing lower serum IL-6 levels and lower risk of death within 30 days. PMID:27834822

  4. Air Pollution and Deaths among Elderly Residents of São Paulo, Brazil: An Analysis of Mortality Displacement

    PubMed Central

    Costa, Amine Farias; Hoek, Gerard; Brunekreef, Bert; Ponce de Leon, Antônio C.M.

    2016-01-01

    Background: Evaluation of short-term mortality displacement is essential to accurately estimate the impact of short-term air pollution exposure on public health. Objectives: We quantified mortality displacement by estimating single-day lag effects and cumulative effects of air pollutants on mortality using distributed lag models. Methods: We performed a daily time series of nonaccidental and cause-specific mortality among elderly residents of São Paulo, Brazil, between 2000 and 2011. Effects of particulate matter smaller than 10 μm (PM10), nitrogen dioxide (NO2) and carbon monoxide (CO) were estimated in Poisson generalized additive models. Single-day lag effects of air pollutant exposure were estimated for 0-, 1- and 2-day lags. Distributed lag models with lags of 0–10, 0–20 and 0–30 days were used to assess mortality displacement and potential cumulative exposure effects. Results: PM10, NO2 and CO were significantly associated with nonaccidental and cause-specific deaths in both single-day lag and cumulative lag models. Cumulative effect estimates for 0–10 days were larger than estimates for single-day lags. Cumulative effect estimates for 0–30 days were essentially zero for nonaccidental and circulatory deaths but remained elevated for respiratory and cancer deaths. Conclusions: We found evidence of mortality displacement within 30 days for nonaccidental and circulatory deaths in elderly residents of São Paulo. We did not find evidence of mortality displacement within 30 days for respiratory or cancer deaths. Citation: Costa AF, Hoek G, Brunekreef B, Ponce de Leon AC. 2017. Air pollution and deaths among elderly residents of São Paulo, Brazil: an analysis of mortality displacement. Environ Health Perspect 125:349–354; http://dx.doi.org/10.1289/EHP98 PMID:27713111

  5. Detection of Respiratory Viruses in Nasopharyngeal Swab and Adenoid Tissue from Children Submitted to Adenoidectomy: Pre- and Postoperative Analysis

    PubMed Central

    Biill Primo, Osvaldo Vinícius; Lourenço, Edmir Américo; Passos, Saulo Duarte

    2014-01-01

    Introduction The presence of respiratory viruses in lymphoid tissues of the nasopharynx and oropharynx and its impact on recurrent infections and hypertrophy of these tissues are not yet fully understood. Objective To identify and determine the prevalence of major respiratory viruses in nasopharyngeal secretions and adenoid tissue pre- and postoperatively of children undergoing adenoidectomy. Methods A prospective observational study was conducted in 36 patients under 12 years of age with upper airway lymphoid hypertrophy who were undergoing adenoidectomy, in which various respiratory viruses were investigated using real-time polymerase chain reaction in adenoid tissue and nasopharyngeal secretions collected preoperatively and 30 days postoperatively. Results At least 1 viral agent was isolated in any of the samples collected in 58.3% of children and 25.9% of total samples. Respiratory viruses were identified in 33.8% of preoperative nasopharyngeal specimens and in 19.8% of postoperative secretion. Of the 21 patients with positive results for any respiratory virus, 6 (28.6%) had more than 1 virus. Considering all 36 respiratory viruses found, the main agent isolated was rhinovirus (27.8%), followed by bocavirus (22.2%). Conclusion The virus found more frequently in all samples was rhinovirus. After removal of adenoid tissue, there was a decrease in the prevalence of the virus contained in nasopharyngeal secretion 30 days after surgery. PMID:25992082

  6. Postoperative discomfort of dental rehabilitation under general anesthesia

    PubMed Central

    Cantekin, Kenan; Yildirim, Mustafa Denizhan; Delikan, Ebru; Çetin, Seçil

    2014-01-01

    Objective: To find out postoperative discomfort in children undergoing dental rehabilitation under general anesthesia (DRGA). Methods: This study involved 78 (4 to 10 year-old) healthy patients who were scheduled for DRGA and were needed extensive dental treatment because of severe caries, and showed high dental fear and/or behavioral management problems. The children had to be fit for DRGA administration by fulfilling the American Society of Anesthesiologists physical status I or II and no associated mental health or communication problems. Data were collected by structured interview either face to face (immediately post operation) or using a telephone (post operation after discharge). One of the study’s investigators recorded all data related to the immediate postoperative period during the child’s stay in the post-anesthesia care unit (PACU). The questionnaire consisted of questions related to postoperative problems experienced by the patient in the period after their day-stay attendance. The questionnaire, consisting of questions regarding and generally related to the child’s activities. In addition, pain was assessed using the face, legs, activity, cry, consolability (FLACC) scale. Results: The prevalence of postoperative problems was 46 out of 78 (59%). The mean FLACC score was 1.8 (SD=2.1). Some of the patients having more than one reported problem. Forty-one percent of the children showed nasal discomfort (P<0.01). Thirty-three percent and 43% of the children experienced throat or mouth discomfort. The most common experienced postoperative symptom after DRGA was bleeding. Nasal bleeding, however, was an uncommon complication and did not cause serious morbidity or mortality in children intubated nasotracheally. In addition, postoperative discomfort was related to number of the extractions. Children who had 4 or more extractions were more likely to experience pain. Findings associated with other bodily functions were assessed. Nausea and vomiting were

  7. Perioperative Non-Invasive Indocyanine Green-Clearance Testing to Predict Postoperative Outcome after Liver Resection

    PubMed Central

    Haegele, Stefanie; Reiter, Silvia; Wanek, David; Offensperger, Florian; Pereyra, David; Stremitzer, Stefan; Fleischmann, Edith; Brostjan, Christine; Gruenberger, Thomas; Starlinger, Patrick

    2016-01-01

    Background Postoperative liver dysfunction may lead to morbidity and mortality after liver resection. Preoperative liver function assessment is critical to identify preexisting liver dysfunction in patients prior to resection. The aim of this study was to evaluate the predictive potential of perioperative indocyanine green (ICG)-clearance testing to prevent postoperative liver dysfunction and morbidity using standardized outcome parameters in a routine Western-clinical-setting. Study Design 137 patients undergoing partial hepatectomy between 2011 and 2013, at the general hospital of Vienna, were included. ICG-clearance was recorded one day prior to surgery as well as on the first and fifth postoperative day. Postoperative liver dysfunction was defined according to the International Study Group of Liver Surgery and evaluation of morbidity was based on the Dindo-Clavien classification. Statistical analyses were based on non-parametric tests. Results Preoperative reduced ICG—plasma disappearance rate (PDR) as well as increased ICG—retention rate at 15 min (R15) were able to significantly predict postoperative liver dysfunction (Area under the curve = PDR: 0.716, P = 0.018; R15: 0.719, P = 0.016). Furthermore, PDR <17%/min. or R15 >8%, were able to accurately predict postoperative complications prior to surgery. In addition to this, ICG-clearance on postoperative day 1 comparably predicted postoperative liver dysfunction (Area under the curve = PDR: 0.895; R15: 0.893; both P <0.001), specifically, PDR <10%/min or R15 >20% on postoperative day 1 predicted poor postoperative outcome. Conclusion PDR and R15 may represent useful parameters to distinguish preoperative high and low risk patients in a Western collective as well as on postoperative day 1, to identify patients who require closer monitoring for potential complications. PMID:27812143

  8. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons.

    PubMed

    Ruggiero, C; Bonamassa, L; Pelini, L; Prioletta, I; Cianferotti, L; Metozzi, A; Benvenuti, E; Brandi, G; Guazzini, A; Santoro, G C; Mecocci, P; Black, D; Brandi, M L

    2017-02-01

    This study investigates the relationship between cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality among 514 hip fracture hospitalized older persons. Patients with early cognitive dysfunction or delirium experienced a 2-fold increased mortality risk. Early post-operative cognitive dysfunction and delirium are negative prognostic factors for mortality.

  9. Postoperative singultus: an osteopathic approach.

    PubMed

    Petree, Kristie; Bruner, Jonathan

    2015-03-01

    Singultus, or hiccups, is a common medical condition. Despite exponential leaps in medicine, the pathophysiologic cause remains poorly defined. Persistent singultus has been associated with conditions such as pulmonary embolism and myocardial infarction. Singultus is also a well-known postoperative complication. The criterion standard of care for patients with singultus involves ruling out lethal pathologic causes, attempting physical stimulation with Valsava maneuvers or drinking water, and, if no relief has been achieved, administering drugs to ease the symptoms. The authors report a case of a man whose postoperative singultus was successfully managed with osteopathic manipulative treatment. This approach addresses many of the possible underlying neuromechanical causes of the aberrant reflex with minimal potential for adverse effects. Physicians should consider osteopathic manipulative treatment in the care of patients with singultus.

  10. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    PubMed

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  11. Postoperative pain assessment after septorhinoplasty.

    PubMed

    Wittekindt, D; Wittekindt, C; Schneider, G; Meissner, W; Guntinas-Lichius, O

    2012-06-01

    Postoperative pain after septorhinoplasty and its optimal management has not been described in detail. Fifty-two adult septorhinoplasty patients were included in a prospective cohort single center study. Patients' and surgical characteristics were evaluated. Outcome and process parameters were analyzed using the questionnaires of the German-wide project Quality Improvement in Postoperative Pain Management (QUIPS) on the first postoperative day. Pain during the first operative day after septorhinoplasty was moderate. Pain management predominately consisted of remifentanil intraoperatively, metamizole in the recovery room, in combination with piritramide in one-third of the patients, and metamizole on ward. Patients younger than 31 years were less satisfied with pain management (P = 0.018). Open rhinoplasty was associated with less satisfaction with pain management (P = 0.007). Use of rib grafts led to more mobility, breathing, sleeping and mood disturbances (P = 0.003, 0.047; 0.047; 0.022, respectively). Preoperative pain counseling was followed by higher satisfaction, less breathing and mood disturbances after surgery (P = 0.021; 0.004; 0.046, respectively). Opioids in the recovery room in addition to non-opioids and treatment with non-opioids on ward led to less maximal pain (P = 0.027 and 0.040, respectively). We conclude that QUIPS is an easy tool to evaluate the quality of postoperative pain management following rhinoplasty. Preoperative pain counseling, specific care for patients with rib grafts, consequent use of opioids in the recovery room in addition to non-opioids, and use of non-opioids on ward seem to be effective to improve pain management after septorhinoplasty.

  12. Postoperative (pressure) alopecia following sacrocolpopexy.

    PubMed

    Bagaria, Madhu; Luck, Ali Maria

    2015-06-01

    Postoperative alopecia is a rare occurrence seen after a variety of surgical procedures performed under general anesthesia. The speculated cause is pressure-induced ischemia due to prolonged head immobilization. This case describes a patient who developed this complication after undergoing sacrocolpopexy. A 57-year-old postmenopausal Caucasian female was consented to undergo a robotic-assisted sacrocolpopexy, perineoplasty, and midurethral sling with possible conversion to an open procedure. The indication was symptomatic proximal and distal rectocele with foreshortened vagina. It was converted to laparotomy due to difficult presacral dissection. Her total operative time was 540 with 240 min in the Trendelenburg position. No intraoperative hypotension or excessive blood loss was noted. She started complaining of scalp pain in the postoperative recovery area. She developed soreness, crusting, and later alopecia in the same area. It was noted at her 3-week office visit. Referral was made for dermatology and anesthesiology evaluation. There was spontaneous full recovery by the 5th month. Postoperative alopecia is a rare condition mimicking alopecia areata but it is preceded by inciting events. There is some evidence to suggest that it is a preventable condition by frequent head repositioning during surgery. This case report is intended to increase the surgeon's awareness about this rare complication as its occurrence can be distressing for the patient.

  13. Mortality table construction

    NASA Astrophysics Data System (ADS)

    Sutawanir

    2015-12-01

    Mortality tables play important role in actuarial studies such as life annuities, premium determination, premium reserve, valuation pension plan, pension funding. Some known mortality tables are CSO mortality table, Indonesian Mortality Table, Bowers mortality table, Japan Mortality table. For actuary applications some tables are constructed with different environment such as single decrement, double decrement, and multiple decrement. There exist two approaches in mortality table construction : mathematics approach and statistical approach. Distribution model and estimation theory are the statistical concepts that are used in mortality table construction. This article aims to discuss the statistical approach in mortality table construction. The distributional assumptions are uniform death distribution (UDD) and constant force (exponential). Moment estimation and maximum likelihood are used to estimate the mortality parameter. Moment estimation methods are easier to manipulate compared to maximum likelihood estimation (mle). However, the complete mortality data are not used in moment estimation method. Maximum likelihood exploited all available information in mortality estimation. Some mle equations are complicated and solved using numerical methods. The article focus on single decrement estimation using moment and maximum likelihood estimation. Some extension to double decrement will introduced. Simple dataset will be used to illustrated the mortality estimation, and mortality table.

  14. Comparative evaluation of honey, chlorhexidine gluconate (0.2%) and combination of xylitol and chlorhexidine mouthwash (0.2%) on the clinical level of dental plaque: A 30 days randomized control trial

    PubMed Central

    Jain, Ankita; Bhaskar, Dara John; Gupta, Devanand; Agali, Chandan; Gupta, Vipul; Gupta, Rajendra Kumar; Yadav, Priyanka; Lavate, Akash B.; Chaturvedi, Mudita

    2015-01-01

    Aim: To compare the effect of honey, chlorhexidine mouthwash and combination of xylitol chewing gum and chlorhexidine mouthwash on the dental plaque level. Materials and Methods: Ninety healthy dental students, both male and female, aged between 21 to 25 years participated in the study. The subjects were randomly divided into three groups, i.e. the honey group, the chlorhexidine gluconate mouthwash group and the combination of xylitol chewing gum and chlorhexidine (CHX) mouthwash group. The data was collected at the baseline, 15th day and 30th day; the plaque was disclosed using disclosing solution and their scores were recorded at six sites per tooth using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Statistical analysis was carried out later to compare the effect of all the three groups. P ≤ 0.05 was considered as statistically significant. Results: Our result showed that all the three groups were effective in reducing the plaque but post-hoc LSD (Least Significant Difference) showed that honey group and chlorhexidine + xylitol group were more effective than chlorhexidine group alone. The results demonstrated a significant reduction of plaque indices in honey group and chlorhexidine + xylitol group over a period of 15 and 30 days as compared to chlorhexidine. PMID:25657903

  15. Intelligent postoperative morbidity prediction of heart disease using artificial intelligence techniques.

    PubMed

    Hsieh, Nan-Chen; Hung, Lun-Ping; Shih, Chun-Che; Keh, Huan-Chao; Chan, Chien-Hui

    2012-06-01

    Endovascular aneurysm repair (EVAR) is an advanced minimally invasive surgical technology that is helpful for reducing patients' recovery time, postoperative morbidity and mortality. This study proposes an ensemble model to predict postoperative morbidity after EVAR. The ensemble model was developed using a training set of consecutive patients who underwent EVAR between 2000 and 2009. All data required for prediction modeling, including patient demographics, preoperative, co-morbidities, and complication as outcome variables, was collected prospectively and entered into a clinical database. A discretization approach was used to categorize numerical values into informative feature space. Then, the Bayesian network (BN), artificial neural network (ANN), and support vector machine (SVM) were adopted as base models, and stacking combined multiple models. The research outcomes consisted of an ensemble model to predict postoperative morbidity after EVAR, the occurrence of postoperative complications prospectively recorded, and the causal effect knowledge by BNs with Markov blanket concept.

  16. Metabonomics Analysis of Plasma Reveals the Lactate to Cholesterol Ratio as an Independent Prognostic Factor of Short-Term Mortality in Acute Heart Failure

    PubMed Central

    Desmoulin, Franck; Galinier, Michel; Trouillet, Charlotte; Berry, Matthieu; Delmas, Clément; Turkieh, Annie; Massabuau, Pierre; Taegtmeyer, Heinrich; Smih, Fatima; Rouet, Philippe

    2013-01-01

    Objective Mortality in heart failure (AHF) remains high, especially during the first days of hospitalization. New prognostic biomarkers may help to optimize treatment. The aim of the study was to determine metabolites that have a high prognostic value. Methods We conducted a prospective study on a training cohort of AHF patients (n = 126) admitted in the cardiac intensive care unit and assessed survival at 30 days. Venous plasmas collected at admission were used for 1H NMR–based metabonomics analysis. Differences between plasma metabolite profiles allow determination of discriminating metabolites. A cohort of AHF patients was subsequently constituted (n = 74) to validate the findings. Results Lactate and cholesterol were the major discriminating metabolites predicting 30-day mortality. Mortality was increased in patients with high lactate and low total cholesterol concentrations at admission. Accuracies of lactate, cholesterol concentration and lactate to cholesterol (Lact/Chol) ratio to predict 30-day mortality were evaluated using ROC analysis. The Lact/Chol ratio provided the best accuracy with an AUC of 0.82 (P < 0.0001). The acute physiology and chronic health evaluation (APACHE) II scoring system provided an AUC of 0.76 for predicting 30-day mortality. APACHE II score, Cardiogenic shock (CS) state and Lact/Chol ratio ≥ 0.4 (cutoff value with 82% sensitivity and 64% specificity) were significant independent predictors of 30-day mortality with hazard ratios (HR) of 1.11, 4.77 and 3.59, respectively. In CS patients, the HR of 30-day mortality risk for plasma Lact/Chol ratio ≥ 0.4 was 3.26 compared to a Lact/Chol ratio of < 0.4 (P  =  0.018). The predictive power of the Lact/Chol ratio for 30-day mortality outcome was confirmed with the independent validation cohort. Conclusion This study identifies the plasma Lact/Chol ratio as a useful objective and simple parameter to evaluate short term prognostic and could be integrated into quantitative

  17. Challenge of Fetal Mortality

    MedlinePlus

    ... Mortality Series 21. Data on Natality, Marriage, and Divorce Series 22. Data from the National Natality and ... Compilations of Data on Natality, Mortality, Marriage, and Divorce Vital Statistics Rapid Release Quarterly Provisional Estimates Dashboard ...

  18. A propensity score analysis shows that empirical treatment with linezolid does not increase the thirty-day mortality rate in patients with Gram-negative bacteremia.

    PubMed

    Ternavasio-de la Vega, Hugo-Guillermo; Mateos-Díaz, Ana-María; Martinez, Jose-Antonio; Almela, Manel; Cobos-Trigueros, Nazaret; Morata, Laura; De-la-Calle, Cristina; Sala, Marta; Mensa, Josep; Marcos, Miguel; Soriano, Alex

    2014-12-01

    The role of linezolid in empirical therapy of suspected bacteremia remains unclear. The aim of this study was to evaluate the influence of empirical use of linezolid or glycopeptides in addition to other antibiotics on the 30-day mortality rates in patients with Gram-negative bacteremia. For this purpose, 1,126 patients with Gram-negative bacteremia in the Hospital Clinic of Barcelona from 2000 to 2012 were included in this study. In order to compare the mortality rates between patients who received linezolid or glycopeptides, the propensity scores on baseline variables were used to balance the treatment groups, and both propensity score matching and propensity-adjusted logistic regression were used to compare the 30-day mortality rates between the groups. The overall 30-day mortality rate was 16.0% during the study period. Sixty-eight patients received empirical treatment with linezolid, and 1,058 received glycopeptides. The propensity score matching included 64 patients in each treatment group. After matching, the mortality rates were 14.1% (9/64) in patients who received glycopeptides and 21.9% (14/64) in those who received linezolid, and a nonsignificant association between empirical linezolid treatment and mortality rate (odds ratio [OR], 1.63; 95% confidence interval [CI], 0.69 to 3.82; P = 0.275, McNemar's test) was found. This association remained nonsignificant when variables that remained unbalanced after matching were included in a conditional logistic regression model. Further, the stratified propensity score analysis did not show any significant relationship between empirical linezolid treatment and the mortality rate after adjustment by propensity score quintiles or other variables potentially associated with mortality. In conclusion, the propensity score analysis showed that empirical treatment with linezolid compared with that with glycopeptides was not associated with 30-day mortality rates in patients with Gram-negative bacteremia.

  19. An enhanced treatment program with markedly reduced mortality after a transtibial or higher non-traumatic lower extremity amputation

    PubMed Central

    Kristensen, Morten T; Holm, Gitte; Krasheninnikoff, Michael; Jensen, Pia S; Gebuhr, Peter

    2016-01-01

    Background and purpose Historically, high 30-day and 1-year mortality post-amputation rates (> 30% and 50%, respectively) have been reported in patients with a transtibial or higher non-traumatic lower extremity amputation (LEA). We evaluated whether allocating experienced staff and implementing an enhanced, multidisciplinary recovery program would reduce the mortality rates. We also determined factors that influenced mortality rates. Patients and methods 129 patients with a LEA were consecutively included over a 2-year period, and followed after admission to an acute orthopedic ward. Mortality was compared with historical and concurrent national controls in Denmark. Results The 30-day and 1-year mortality rates were 16% and 37%, respectively, in the intervention group, as compared to 35% and 59% in the historical control group treated in the same orthopedic ward. Cox proportional harzards models adjusted for age, sex, residential and health status, the disease that caused the amputation, and the index amputation level showed that 30-day and 1-year mortality risk was reduced by 52% (HR =0.48, 95% CI: 0.25–0.91) and by 46% (HR =0.54, 95% CI: 0.35–0.86), respectively, in the intervention group. The risk of death was increased for patients living in a nursing home, for patients with a bilateral LEA, and for patients with low health status. Interpretation With similarly frail patient groups and instituting an enhanced program for patients after LEA, the risks of death by 30 days and by 1 year after LEA were markedly reduced after allocating staff with expertise. PMID:27088484

  20. Effects of ketoprofen for prevention of postoperative cognitive dysfunction in aged rats.

    PubMed

    Kawano, Takashi; Takahashi, Tetsuya; Iwata, Hideki; Morikawa, Akihiro; Imori, Satoko; Waki, Sayaka; Tamura, Takahiko; Yamazaki, Fumimoto; Eguchi, Satoru; Kumagai, Naoko; Yokoyama, Masataka

    2014-12-01

    Postoperative cognitive dysfunction is a common geriatric complication that may be associated with increased mortality. Here, we investigated the effects of postoperative analgesia with ketoprofen on cognitive functions in aged animals and compared its effectiveness to morphine. Rats were randomly allocated to one of four groups: isoflurane anesthesia without surgery (group C), isoflurane anesthesia with laparotomy (group IL), and isoflurane anesthesia with laparotomy plus postoperative analgesia with ketoprofen or morphine. There was no difference in postoperative locomotor activity among groups. In group IL, postoperative pain levels assessed by the Rat Grimace Scale significantly increased until 8 h after surgery, which was similarly inhibited by both ketoprofen and morphine. Cognitive function was assessed using radial arm maze testing for 12 consecutive days from postoperative day 3. Results showed that the number of memory errors in group IL were significantly higher than those in goup C. However, both ketoprofen and morphine could attenuate the increase in memory errors following surgery to a similar degree. Conversely, ketoprofen showed no effect on cognitive function in the nonsurgical rats that did not experience pain. Our findings suggest that postoperative analgesia with ketoprofen can prevent the development of surgery-associated memory deficits via its pain-relieving effects.

  1. Race and Mortality.

    ERIC Educational Resources Information Center

    Scanlan, James P.

    2000-01-01

    Discusses increasing racial and socioeconomic disparities in mortality despite general declines in mortality, examining disparities in infant mortality and explaining that whenever two groups differ in their susceptibility to some condition, the less prevalent the condition, the greater will be the disparity in rates of experiencing the condition.…

  2. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: a revisional study

    PubMed Central

    Priola, Adriano Massimiliano; Priola, Sandro Massimo; Boccuzzi, Francesco; Dervishi, Najada; Lisi, Elena; Veltri, Andrea; Ardissone, Francesco

    2016-01-01

    In the post-operative course of the interventions of lung resection for primary tumor, complications of different nature and severity can arise, recognizing different pathogenetic mechanisms and differing according to the type of resection performed and to the time elapsed after surgery. The low diagnostic accuracy of chest radiography requires a thorough knowledge of the radiologist about all radiographic findings, both normal and pathological, which can be found in the immediate post-operative period (within 30 days after surgery). This article aims to describe the incidence, the clinical features and the radiological aspects of immediate complications following pulmonary resections, with specific reference to those in which the diagnostic imaging provides a fundamental contribution. PMID:27621893

  3. Predictors of Early Post-discharge Mortality in Critically Ill Patients: A Retrospective Cohort Study from the California Intensive Care Outcomes Project

    PubMed Central

    Vasilevskis, Eduard E.; Kuzniewicz, Michael W.; Cason, Brian A.; Lane, Rondall K.; Dean, Mitzi L.; Clay, Ted; Rennie, Deborah J.; Dudley, R. Adams

    2013-01-01

    Purpose Existing intensive care unit (ICU) mortality measurement systems address in-hospital mortality only. However, early post-discharge mortality contributes significantly to overall 30-day mortality. Factors associated with early post-discharge mortality are unknown. Methods We performed a retrospective study of 8,484 ICU patients. Our primary outcome was early post-discharge mortality: death after hospital discharge and ≤ 30 days from ICU admission. Cox regression models assessed the association between patient, hospital, and utilization factors and the primary outcome. Results In multivariate analyses, the hazard for early post-discharge mortality increased with rising severity of illness and decreased with full code status (HR = 0.33, 95% CI 0.21 to 0.49). Compared to discharges home, early post-discharge mortality was highest for acute care transfers (HR 3.18, 95% CI 2.45 to 4.12). Finally, patients with very short ICU length of stay (< 1 day) had greater early post-discharge mortality (HR 1.86, 95% CI 1.32 to 2.61) than those with longest stays (≥ 7 days). Conclusions Early post-discharge mortality is associated with patient preferences (full-code status) and decisions regarding timing and location of discharge. These findings have important implications for anyone attempting to measure or improve ICU performance and who rely upon in-hospital mortality measures to do so. PMID:20716477

  4. Association between Serum Malondialdehyde Levels and Mortality in Patients with Severe Brain Trauma Injury

    PubMed Central

    Martín, María M.; Abreu-González, Pedro; Ramos, Luis; Argueso, Mónica; Cáceres, Juan J.; Solé-Violán, Jordi; Lorenzo, José M.; Molina, Ismael; Jiménez, Alejandro

    2015-01-01

    Abstract There is a hyperoxidative state in patients with trauma brain injury (TBI). Malondialdehyde (MDA) is an end-product formed during oxidative stress, concretely lipid peroxidation. In small studies (highest sample size 50 patients), higher levels of MDA have been found in nonsurviving than surviving patients with TBI. An association between serum MDA levels and mortality in patients with TBI, however, has not been reported. Thus, the objective of this prospective, observational, multicenter study, performed in six Spanish intensive care units, was to determine whether MDA serum levels are associated with early mortality in a large series of patients with severe TBI. Serum MDA levels were measured in 100 patients with severe TBI on day 1 and in 75 healthy controls. The end-point of the study was 30-day mortality. We found higher serum MDA levels in patients with severe TBI than in healthy controls (p<0.001). Nonsurviving patients with TBI (n=27) showed higher serum MDA levels (p<0.001) than survivors (n=73). Logistic regression analysis showed that serum MDA levels were associated with 30-day mortality (odds ratio [OR]=4.662; 95% confidence interval [CI]=1.466–14.824; p=0.01), controlling for Glasgow Coma Score, age, and computed tomography findings. Survival analysis showed that patients with serum MDA levels higher than 1.96 nmol/mL presented increased 30-day mortality than patients with lower levels (hazard ratio=3.5; 95% CI=1.43–8.47; p<0.001). Thus, the most relevant new finding of our study, the largest to date on serum MDA levels in patients with severe TBI, was an association between serum MDA levels and early mortality. PMID:25054973

  5. [Postoperative radiotherapy of prostate cancer].

    PubMed

    Guérif, S; Latorzeff, I; Lagrange, J-L; Hennequin, C; Supiot, S; Garcia, A; François, P; Soulié, M; Richaud, P; Salomon, L

    2014-10-01

    Between 10 and 40% of patients who have undergone a radical prostatectomy may have a biologic recurrence. Local or distant failure represents the possible patterns of relapse. Patients at high-risk for local relapse have extraprostatic disease, positive surgical margins or seminal vesicles infiltration or high Gleason score at pathology. Three phase-III randomized clinical trials have shown that, for these patients, adjuvant irradiation reduces the risk of tumoral progression without higher toxicity. Salvage radiotherapy for late relapse allows a disease control in 60-70% of the cases. Several research in order to improve the therapeutic ratio of the radiotherapy after prostatectomy are evaluate in the French Groupe d'Étude des Tumeurs Urogénitales (Gétug) and of the French association of urology (Afu). The Gétug-Afu 17 trial will provide answers to the question of the optimal moment for postoperative radiotherapy for pT3-4 R1 pN0 Nx patients, with the objective of comparing an immediate treatment to a differed early treatment initiated at biological recurrence. The Gétug-Afu 22 questions the place of a short hormonetherapy combined with image-guided, intensity-modulated radiotherapy (IMRT) in adjuvant situation for a detectable prostate specific antigen (PSA). The implementation of a multicenter quality control within the Gétug-Afu in order to harmonize a modern postoperative radiotherapy will allow the development of a dose escalation IMRT after surgery.

  6. The association of subclinical hypocalcemia, negative energy balance and disease with bodyweight change during the first 30 days post-partum in dairy cows milked with automatic milking systems.

    PubMed

    Caixeta, L S; Ospina, P A; Capel, M B; Nydam, D V

    2015-05-01

    In a prospective cohort study, the daily bodyweight (BW) and milk production of 92 cows were recorded using automatic milking systems. The objectives were to characterize calcium serum concentration variability on days 1-3 post-partum and to evaluate the association between subclinical hypocalcemia (SHPC) and change in BW over the first 30 days in milk (DIM) in Holstein dairy cows, while controlling for concurrent disease and negative energy balance (NEB). SHPC was defined as total serum calcium concentration between 6 and 8 mg/dL, NEB was defined as non-esterified fatty acids (NEFA) > 0.7 mEq/L or β-hydroxybutyrate (BHB) ≥ 1.2 mmol/L. The peak incidence of SHPC was at 1 DIM for all groups (11%, 42% and 60% for parities 1, 2, and ≥3, respectively). All parity groups lost weight (21, 33, and 34 kg) during the first 30 DIM. Parity 1 animals with disease compared with those without disease lost the most weight (2.6 kg/day BW loss vs. <1.9 kg/day, respectively). Normocalcemic parity 2 animals with either NEB or disease lost the most weight (>5 kg/day) compared with those in the SHPC group (≤4.5 kg/day). In parity ≥ 3 animals, SHPC was an important factor for BW loss; SHPC animals lost the most weight (>3.7 kg/day) vs. normocalcemic cows (≤3.3 kg/day) regardless of NEB or disease status. Even though all animals lost weight during early lactation the effect of disease, NEB, and SHPC on BW loss was different in each parity group.

  7. The 2013 German-Russian Bion-M1 Joint Flight Project: Altered cAMP/PKA Signaling Pathway in Skeletal Muscle during Exposure to Real Microgravity in Mice Housed for 30 Days in a Biosatellite on Orbit

    NASA Astrophysics Data System (ADS)

    Salanova, Michele; Blottner, Dieter; Shenkman, Boris S.; Lomonosova, Yulia

    Exposure to real microgravity (muG) results in an impaired skeletal muscle structure and function. We here hypothesized that the cAMP/PKA cell signaling pathway, which triggers a multitude of intracellular effects in response to a variety of extracellular stimuli and which further promote muscle growth, play an important role during Spaceflight- induced disuse atrophy. Particularly, we hypothesized that different effectors of the cAMP-PKA signaling machinery, which are highly compartmentalized into subcellular functional microdomains in order to guarantee signal specificity, are altered after long term exposure to real µG. Taking advantage of the Bion-M1 Spaceflight program which provided us an excellent opportunity to explore mice skeletal muscle exposed for 30 days to real µG, by investigating at the cAMP-dependent protein kinase A (PKA) subcellular localization we compared muscle soleus (SOL) and extensor digitorum longus (EDL) of C57/black mice of a Bion-flight (n=5) group with a Bion-ground control (n=5) group and a ground control (n=5) group which was housed in a standard cage considered as vivarium control. Preliminary results of our experiments showed that different cAMP-PKA micro pools were normally detectable using high-resolution images of immunofluorescence experiments in different subcellular compartments of both SOL and EDL of Bion-ground and ground control groups which were not any longer detectable in Bion-flight group. In summary, our data indicate that an efficient organization in microdomains of the cAMP/PKA pathway may exist in skeletal muscle on ground and that such compartmentalization may be altered in response to prolonged exposure to real muG. National Sponsors: Federal Ministry of Economics and Technology (BMWi) via the German AeroSpace Board, DLR e.V., Bonn-Oberkassel, Germany (#50WB1121 to DB); Contract RAS-IMPB/Charité Berlin # Bion-M1/2013

  8. Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

    PubMed Central

    Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

    2017-01-01

    Introduction Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe. PMID:28344618

  9. Intracerebral hemorrhage mortality is not changing despite declining incidence

    PubMed Central

    Lisabeth, Lynda D.; Sánchez, Brisa N.; Smith, Melinda A.; Brown, Devin L.; Garcia, Nelda M.; Skolarus, Lesli E.; Meurer, William J.; Burke, James F.; Adelman, Eric E.; Morgenstern, Lewis B.

    2014-01-01

    Objective: To determine trends in incidence and mortality of intracerebral hemorrhage (ICH) in a rigorous population-based study. Methods: We identified all cases of spontaneous ICH in a South Texas community from 2000 to 2010 using rigorous case ascertainment methods within the Brain Attack Surveillance in Corpus Christi Project. Yearly population counts were determined from the US Census, and deaths were determined from state and national databases. Age-, sex-, and ethnicity-adjusted incidence was estimated for each year with Poisson regression, and a linear trend over time was investigated. Trends in 30-day case fatality and long-term mortality (censored at 3 years) were estimated with log-binomial or Cox proportional hazards models adjusted for demographics, stroke severity, and comorbid disease. Results: A total of 734 cases of ICH were included. The age-, sex-, and ethnicity-adjusted ICH annual incidence rate was 5.21 per 10,000 (95% confidence interval [CI] 4.36, 6.24) in 2000 and 4.30 per 10,000 (95% CI 3.21, 5.76) in 2010. The estimated 10-year change in demographic-adjusted ICH annual incidence rate was −31% (95% CI −47%, −11%). Yearly demographic-adjusted 30-day case fatality ranged from 28.3% (95% CI 19.9%, 40.3%) in 2006 to 46.5% (95% CI 35.5, 60.8) in 2008. There was no change in ICH case fatality or long-term mortality over time. Conclusions: ICH incidence decreased over the past decade, but case fatality and long-term mortality were unchanged. This suggests that primary prevention efforts may be improving over time, but more work is needed to improve ICH treatment and reduce the risk of death. PMID:24838789

  10. Disbalance between mortality and non-fatal vascular events in the CHAMPION-PHOENIX trial: the cangrelor efficacy challenge.

    PubMed

    Serebruany, Victor L; Pokov, Alex N; Fortmann, Seth D; DiNicolantonio, James J

    2014-01-01

    The recently published, largest trial with cangrelor, the Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION)-PHOENIX, suggested that the experimental agent significantly reduced the rate of stent thrombosis (ST) and myocardial infarction (MI) during PCI at 48 hours (h) and 30 days. However, the declared impressive cangrelor vascular non-fatal benefit was contradicted by identical deaths at 48 h, and a trend toward excess mortality at 30 days. We analysed the mismatch between outcomes in the CHAMPION-PHOENIX trial. The trial reported identical mortality (18 death in each arm; odds ratio [OR] 1.00 (0.52-1.92); p>0.999) at 48 h, but more deaths, 60 vs 55, after cangrelor at 30 days. There was a significant reduction of ST from 0.8% (n=46) of the patients in the cangrelor group versus 1.4% (n=74) in the clopidogrel group (odds ratio, 0.62; 95% CI, 0.43 to 0.90; p= 0.01) at 48 h, and a persistent but less impressive ST prevention benefit OR of 0.68 (0.50=0.92, p = 0.01) at 30 days. There were also 48 less MI's following cangrelor usage enforced by a significant difference (odds ratio 0.80 (0.67-0.97) p = 0.02), which was also less prevalent at 30 days (OR 0.82 (0.68-0.98), p = 0.03). The reported ST/MI advantage should result in at least a trend towards numerically less deaths after cangrelor at 30 days follow-up, which was opposite of the results reported in CHAMPION-PHOENIX trial. Efficacy of cangrelor is challenged by the disproportional "reduction" of ST and MI conflicting with identical mortality at 48 h and worsened at day 30 fatalities. The dissociation between vascular mortality and non-fatal vascular ischaemic occlusions, unless compensated by some other unreported cause(s) of death, should be explored and explained. Unadjudicated 30-day outcomes, and all ST types should be fully disclosed. The ongoing FDA cangrelor review should focus on appropriate event count and/or possible mismatch between site-reported and

  11. Cancer mortality in Brazil

    PubMed Central

    Barbosa, Isabelle R.; de Souza, Dyego L.B.; Bernal, María M.; Costa, Íris do C.C.

    2015-01-01

    Abstract Cancer is currently in the spotlight due to their heavy responsibility as main cause of death in both developed and developing countries. Analysis of the epidemiological situation is required as a support tool for the planning of public health measures for the most vulnerable groups. We analyzed cancer mortality trends in Brazil and geographic regions in the period 1996 to 2010 and calculate mortality predictions for the period 2011 to 2030. This is an epidemiological, demographic-based study that utilized information from the Mortality Information System on all deaths due to cancer in Brazil. Mortality trends were analyzed by the Joinpoint regression, and Nordpred was utilized for the calculation of predictions. Stability was verified for the female (annual percentage change [APC] = 0.4%) and male (APC = 0.5%) sexes. The North and Northeast regions present significant increasing trends for mortality in both sexes. Until 2030, female mortality trends will not present considerable variations, but there will be a decrease in mortality trends for the male sex. There will be increases in mortality rates until 2030 for the North and Northeast regions, whereas reductions will be verified for the remaining geographic regions. This variation will be explained by the demographic structure of regions until 2030. There are pronounced regional and sex differences in cancer mortality in Brazil, and these discrepancies will continue to increase until the year 2030, when the Northeast region will present the highest cancer mortality rates in Brazil. PMID:25906105

  12. Computed tomography of the postoperative lumbar spine

    SciTech Connect

    Teplick, J.G.; Haskin, M.E.

    1983-11-01

    In the postoperative patient ordinary radiographs of the spine generally add very little information, revealing the usual postoperative bone changes and often postoperative narrowing of the intervertebral space. Myelography may sometimes be informative, showing evidence of focal arachnoiditis or a focal defect at the surgical site. However, the latter finding is difficult to interpret. As experience with high-resolution CT scanning of the lumbar spine has been increasing, it is becoming apparent that this noninvasive and easily performed study can give considerably more information about the postoperative spine than any of the other current imaging methods. About 750 patients with previous lumbar laminectomies had CT scanning within a 28 month period.

  13. Forecasting Flooding in the Brahmaputra and Ganges Delta of Bangladesh on Short (1-10 days), Medium (20-30 days) and Seasonal Time Scales (1-6 months)

    NASA Astrophysics Data System (ADS)

    Webster, P. J.; Hoyos, C. D.; Hopson, T. M.; Chang, H.; Jian, J.

    2007-12-01

    Following the devastating flood years of 1998 during which 60% of Bangladesh was under water for a period of 3 months, the Climate Forecast Applications in Bangladesh (CFAB) project was formed with funding by USAID and NSF which eventually resulted in a joint project with the European Centre for Medium Range Weather Forecasting (ECMWF), the Asian Disaster Preparedness Centre (ADPC) and the Bangladesh Flood Forecasting and Warning Centre. The project was organized and developed through the Georgia Institute of Technology. The aim of CFAB was to develop innovative methods of extending the warning of flooding in Bangladesh noting that there was a unique problem: India provided no upstream discharge data to Bangladesh so that before CFAB the maximum lead time of a forecast was that given by measuring river discharge at the India-Bangladesh border: no lead-time at the border and 2 days in the southern parts of the country. Given that the Brahmaputra and Ganges catchment areas had to be regarded as essentially unguaged, it was clear that innovative techniques had to be developed. On of the basic criterion was that the system should provide probabilistic forecasts in order for the Bangladeshis to assess risk. A three-tier system was developed to allow strategic and tactical decisions to be made for agricultural purposes and disaster mitigation: seasonal (1-6 months: strategic), medium range (20-30 days: strategic/tactical) and short range (1-10 days: tactical). The system that has been developed brings together for the first time operational meteorological forecasts (ensemble forecasts from ECMWF), with satellite and discharge data and a suite of hydrological models. In addition, with ADPC and FFWC we have developed an in-country forecast dispersion system that allows a rapid dissemination. The system has proven to be rather successful, especially in the short range. The flooding events of 2004 were forecast with all forecasting tiers at the respective lead time. In

  14. Effect of oral taurine on morbidity and mortality in elderly hip fracture patients: a randomized trial.

    PubMed

    Van Stijn, Mireille F M; Bruins, Arnoud A; Vermeulen, Mechteld A R; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G; De Bandt, Jean Pascal; Twisk, Jos W R; Van Leeuwen, Paul A M; Houdijk, Alexander P J

    2015-05-29

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): -0.54; 95% CI: -1.08--0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00-3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: -1.10; 95% CI: -2.33-0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality.

  15. Effect of Oral Taurine on Morbidity and Mortality in Elderly Hip Fracture Patients: A Randomized Trial

    PubMed Central

    Van Stijn, Mireille F. M.; Bruins, Arnoud A.; Vermeulen, Mechteld A. R.; Witlox, Joost; Teerlink, Tom; Schoorl, Margreet G.; De Bandt, Jean Pascal; Twisk, Jos W. R.; Van Leeuwen, Paul A. M.; Houdijk, Alexander P. J.

    2015-01-01

    Hip fracture patients represent a large part of the elderly surgical population and face severe postoperative morbidity and excessive mortality compared to adult surgical hip fracture patients. Low antioxidant status and taurine deficiency is common in the elderly, and may negatively affect postoperative outcome. We hypothesized that taurine, an antioxidant, could improve clinical outcome in the elderly hip fracture patient. A double blind randomized, placebo controlled, clinical trial was conducted on elderly hip fracture patients. Supplementation started after admission and before surgery up to the sixth postoperative day. Markers of oxidative status were measured during hospitalization, and postoperative outcome was monitored for one year after surgery. Taurine supplementation did not improve in-hospital morbidity, medical comorbidities during the first year, or mortality during the first year. Taurine supplementation lowered postoperative oxidative stress, as shown by lower urinary 8-hydroxy-2-deoxyguanosine levels (Generalized estimating equations (GEE) analysis average difference over time; regression coefficient (Beta): −0.54; 95% CI: −1.08–−0.01; p = 0.04), blunted plasma malondialdehyde response (Beta: 1.58; 95% CI: 0.00–3.15; p = 0.05) and a trend towards lower lactate to pyruvate ratio (Beta: −1.10; 95% CI: −2.33–0.12; p = 0.08). We concluded that peri-operative taurine supplementation attenuated postoperative oxidative stress in elderly hip fracture patients, but did not improve postoperative morbidity and mortality. PMID:26035756

  16. Serum Malondialdehyde Levels in Patients with Malignant Middle Cerebral Artery Infarction Are Associated with Mortality

    PubMed Central

    Lorente, Leonardo; Martín, María M.; Abreu-González, Pedro; Ramos, Luis; Argueso, Mónica; Solé-Violán, Jordi; Riaño-Ruiz, Marta; Jiménez, Alejandro

    2015-01-01

    Objective Malondialdehyde (MDA) is an end-product formed during lipid peroxidation, due to degradation of cellular membrane phospholipids. MDA is released into extracellular space and finally into the blood; it has been used as an effective biomarker of lipid oxidation. High circulating levels of MDA have been previously described in patients with ischemic stoke than in controls, and an association between circulating MDA levels and neurological functional outcome in patients with ischemic stoke. However, an association between serum MDA levels and mortality in patients with ischemic stroke has not been previously reported, and that was the objective of this study. Methods Observational, prospective and multicenter study performed in six Intensive Care Units. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as Glasgow Coma Scale (GCS) lower than 9. We measured serum MDA levels in 50 patients with severe MMCAI at the time of diagnosis and in 100 healthy subjects. Mortality at 30 days was the end point of the study. Results We found that patients with severe MMCAI showed higher serum MDA levels than healthy subjects (p<0.001). We found higher serum MDA levels (p<0.001) in non-surviving MMCAI patients (n=26) than in survivors (n=24). The area under the curve for prediction of 30-day mortality for serum MDA levels was 0.77 (95% CI = 0.63-0.88; p<0.001). Serum MDA levels >2.27 nmol/mL were associated with 30-day mortality (OR=7.23; 95% CI=1.84-28.73; p=0.005) controlling for GCS and age on multiple binomial logistic regression analysis. Conclusions To our knowledge, this is the first study showing that serum malondialdehyde levels in patients with MMCAI are associated with early mortality. PMID:25933254

  17. Perioperative morbidity and mortality after noncardiac surgery in young adults with congenital or early acquired heart disease: a retrospective cohort analysis of the National Surgical Quality Improvement Program database.

    PubMed

    Maxwell, Bryan G; Wong, Jim K; Lobato, Robert L

    2014-04-01

    An increasing number of patients with congenital heart disease survive to adulthood. Expert opinion suggests that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Using the National Surgical Quality Improvement Program database, we identified a cohort of patients aged 18 to 39 years with prior heart surgery who underwent noncardiac surgery between 2005 and 2010. A comparison cohort with no prior cardiovascular surgery was matched on age, sex, race/ethnicity, operation year, American Society of Anesthesiologists physical status, and Current Procedural Terminology code. A study cohort consisting of 1191 patients was compared with a cohort of 5127 patients. Baseline dyspnea, inpatient status at the time of surgery, and a prior operation within 30 days were more common in the study cohort. Postoperative outcomes were less favorable in the study cohort. Observed rates of death, perioperative cardiac arrest, myocardial infarction, stroke, respiratory complications, renal failure, sepsis, venous thromboembolism, perioperative transfusion, and reoperation were significantly higher in the study cohort (P < 0.01 for all). Mean postoperative length of stay was greater in the study cohort (5.8 vs 3.6 days, P < 0.01). Compared with a matched control cohort, young adult patients with a history of prior cardiac surgery experienced significantly greater perioperative morbidity and mortality after noncardiac surgery. A history of prior cardiac surgery represents a marker of substantial perioperative risk in this young population that is not accounted for by the matched variables. These results suggest that adult patients with congenital heart disease are at risk for adverse outcomes and support the need for further registry-based investigations.

  18. On forecasting mortality.

    PubMed

    Olshansky, S J

    1988-01-01

    Official forecasts of mortality made by the U.S. Office of the Actuary throughout this century have consistently underestimated observed mortality declines. This is due, in part, to their reliance on the static extrapolation of past trends, an atheoretical statistical method that pays scant attention to the behavioral, medical, and social factors contributing to mortality change. A "multiple cause-delay model" more realistically portrays the effects on mortality of the presence of more favorable risk factors at the population level. Such revised assumptions produce large increases in forecasts of the size of the elderly population, and have a dramatic impact on related estimates of population morbidity, disability, and health care costs.

  19. Association of frontal QRS-T angle--age risk score on admission electrocardiogram with mortality in patients admitted with an acute coronary syndrome.

    PubMed

    Lown, Mark T; Munyombwe, Theresa; Harrison, Wendy; West, Robert M; Hall, Christiana A; Morrell, Christine; Jackson, Beryl M; Sapsford, Robert J; Kilcullen, Niamh; Pepper, Christopher B; Batin, Phil D; Hall, Alistair S; Gale, Chris P

    2012-02-01

    Risk assessment is central to the management of acute coronary syndromes. Often, however, assessment is not complete until the troponin concentration is available. Using 2 multicenter prospective observational studies (Evaluation of Methods and Management of Acute Coronary Events [EMMACE] 2, test cohort, 1,843 patients; and EMMACE-1, validation cohort, 550 patients) of unselected patients with acute coronary syndromes, a point-of-admission risk stratification tool using frontal QRS-T angle derived from automated measurements and age for the prediction of 30-day and 2-year mortality was evaluated. Two-year mortality was lowest in patients with frontal QRS-T angles <38° and highest in patients with frontal QRS-T angles >104° (44.7% vs 14.8%, p <0.001). Increasing frontal QRS-T angle-age risk (FAAR) scores were associated with increasing 30-day and 2-year mortality (for 2-year mortality, score 0 = 3.7%, score 4 = 57%; p <0.001). The FAAR score was a good discriminator of mortality (C statistics 0.74 [95% confidence interval 0.71 to 0.78] at 30 days and 0.77 [95% confidence interval 0.75 to 0.79] at 2 years), maintained its performance in the EMMACE-1 cohort at 30 days (C statistics 0.76 (95% confidence interval 0.71 to 0.8] at 30 days and 0.79 (95% confidence interval 0.75 to 0.83] at 2 years), in men and women, in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, and compared favorably with the Global Registry of Acute Coronary Events (GRACE) score. The integrated discrimination improvement (age to FAAR score at 30 days and at 2 years in EMMACE-1 and EMMACE-2) was p <0.001. In conclusion, the FAAR score is a point-of-admission risk tool that predicts 30-day and 2-year mortality from 2 variables across a spectrum of patients with acute coronary syndromes. It does not require the results of biomarker assays or rely on the subjective interpretation of electrocardiograms.

  20. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  1. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    violations. VI ABSTRACT Postoperative pain is an unwanted side effect of surgery, and is associated with many postoperative complications...This descriptive study was conducted to determine which surgical patients experienced the most analgesia with the fewest side effects when...epidural medication, side effects , incidence of breakthrough pain, and treatments were recorded and cross-tabulated. The following surgical categories

  2. [Morbidity and mortality of carotid endarterectomy].

    PubMed

    Rodríguez Pérez, A; Cabrera Morán, V; Abad Vázquez, C; Muñoz Falcón, L; Hernández Ruiz, A; Hermida Anllo, M; Cárdenes Romero, I

    1993-01-01

    In order to investigate the peroperative complications in carotid surgery, a cohort of 64 patients operated of carotid endarterectomy (EC) were evaluated. A total 78 EC were performed, 56 unilateral (EC-U) and 11 bilateral (EC-B). All the cases were managed in a similar manner regarding surgical technique, monitoring, anesthetic management and pre and postoperative care. A temporary shunt was inserted in 6 cases. The hospital mortality has been 0. We registered the following postoperative complications: arterial hypertension in 23.1 of EC-U and 18.2% of EC-B, cervical hematoma in 5.3% (EC-U) and 13.6% (EC-B), TIA in 5.3% (EC-U) and 4.5% (EC-B), stroke 1.7% (EC-U) and 4.5% (EC-B), vocal cord injury in 3.5% of EC-U and chest pain with angina in 1.7% of EC-U. A review of the mortality and morbidity in carotid surgery is done.

  3. Postoperative surgical complications of lymphadenohysterocolpectomy

    PubMed Central

    Marin, F; Pleşca, M; Bordea, CI; Voinea, SC; Burlănescu, I; Ichim, E; Jianu, CG; Nicolăescu, RR; Teodosie, MP; Maher, K; Blidaru, A

    2014-01-01

    Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer – group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer

  4. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative

  5. Is Left Atrial Size a Predictor of Mortality after Coronary Artery Bypass Surgery? A Single Center Study

    PubMed Central

    Ibrahim, Khalid S.; Mayyas, Fadia A.; Kheirallah, Khalid; AlWaqfi, Nizar R.; Van Wagoner, David R.

    2017-01-01

    Background To investigate the left atrial (LA) size as an independent predictor of mortality following coronary artery bypass surgery (CABG). Methods This single center study evaluated determinants of mortality in 1070 patients who underwent isolated CABG from 2005-2014. Clinical, laboratory and demographic data were obtained from medical records. Collinearity between enlarged LA size (diameter ≥ 4 cm) and covariates was identified. The adjusted effects of enlarged LA size on 30-day mortality post CABG were tested using multiple logistic regression models. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were reported. Results The mean age was 59 ± 9.8 years, and 238 patients were female. Two multivariate logistic regression models were evaluated. In Model A, mitral regurgitation (MR), ejection fraction, intensive care unit length-of-stay and variables found to be collinear with LA size as predictors of mortality were excluded. In model B, the collinear variables were included. By multivariate analysis (Model A), the statistically significant independent predictors of 30-day mortality after CABG were: enlarged LA size (OR 4.82, 95% CI 2.16-10.79), emergency CABG (OR 3.54, 95% CI 1.75-7.18), prolonged inotropic support (OR 2.79, 95% CI 1.38-5.6), diuretic use ≥ 1 month (OR 1.29, 95% CI 1.3-8.42), and use of clopidogrel within a week before surgery (OR 3.27, 95% CI 1.28-8.36. In Model B, enlarged LA and moderate MR were identified as independent predictors of 30-day mortality. Conclusions Increased LA size is a strong independent predictor of mortality after isolated CABG. PMID:28344424

  6. Recovery from post-operative anaemia.

    PubMed

    Wallis, J P; Wells, A W; Whitehead, S; Brewster, N

    2005-10-01

    Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.

  7. Using a Mobile App for Monitoring Post-Operative Quality of Recovery of Patients at Home: A Feasibility Study

    PubMed Central

    Sharpe, Sarah; Murnaghan, M Lucas; Theodoropoulos, John; Metcalfe, Kelly A

    2015-01-01

    Background Mobile apps are being viewed as a new solution for post-operative monitoring of surgical patients. Mobile phone monitoring of patients in the post-operative period can allow expedited discharge and may allow early detection of complications. Objective The objective of the current study was to assess the feasibility of using a mobile app for the monitoring of post-operative quality of recovery at home following surgery in an ambulatory setting. Methods We enrolled 65 consecutive patients (n=33, breast reconstruction surgery; n=32, orthopedic surgery) and asked them to use a mobile phone daily to complete a validated quality of recovery scale (QoR-9) and take photographs of the surgical site for the first 30 days post-op. Surgeons were asked to review patient-entered data on each patient in their roster daily. A semistructured questionnaire was administered to patients and surgeons to assess satisfaction and feasibility of the mobile device. Results All 65 patients completed the study. The mean number of logins was 23.9 (range 7-30) for the breast patients and 19.3 (range 5-30) for the orthopedic patients. The mean number of logins was higher in the first 14 days compared to the 15-30 days post-op for both breast patients (13.4 vs 10.5; P<.001) and for the orthopedic patients (13.4 vs 6.0; P<.001). The mean score for overall satisfaction with using the mobile device was 3.9 for breast patients and 3.7 for orthopedic patients (scored from 1 (poor) to 4 (excellent)). Surgeons reported on the easy-to-navigate design, the portability to monitor patients outside of hospital, and the ability of the technology to improve time efficiency. Conclusions The use of mobile apps for monitoring the quality of recovery in post-operative patients at home was feasible and acceptable to patients and surgeons in the current study. Future large scale studies in varying patient populations are required. PMID:25679749

  8. Postoperative radicular neuroma. Case report.

    PubMed

    Erman, T; Tuna, M; Göçer, A I; Idan, F; Akgül, E; Zorludemir, S

    2001-11-15

    Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the "failed back surgery syndrome." The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

  9. Hypothermic anesthesia attenuates postoperative proteolysis.

    PubMed Central

    Johnson, D J; Brooks, D C; Pressler, V M; Hulton, N R; Colpoys, M F; Smith, R J; Wilmore, D W

    1986-01-01

    The catabolic response that commonly occurs after major operation is characterized by net skeletal muscle proteolysis and accelerated nitrogen excretion. This response was absent in patients undergoing cardiac surgical procedures associated with the combination of cardiopulmonary bypass, narcotic anesthesia, neuromuscular blockade, and hypothermia. Forearm nitrogen release was 422 +/- 492 nmol/100 ml X min on the first postoperative day, approximately 25% of preoperative values (1677 +/- 411, p less than 0.05). Nitrogen excretion and the degree of negative nitrogen balance were comparable to levels observed in nonstressed, fasting subjects. The potential role of hypothermia, high-dose fentanyl anesthesia, and neuromuscular blockade in modifying the catabolic response to laparotomy and retroperitoneal dissection was further evaluated in animal studies. Six hours after operation, amino acid nitrogen release from the hindquarter was 84% less than control values (p less than 0.05). Nitrogen excretion and urea production were also reduced compared to normothermic controls. It is concluded that the combination of hypothermia, narcotic anesthesia, and neuromuscular blockade attenuates the catabolic response to injury and thus may be useful in the care of critically ill surgical patients. PMID:3767477

  10. Management of postoperative spinal infections

    PubMed Central

    Hegde, Vishal; Meredith, Dennis S; Kepler, Christopher K; Huang, Russel C

    2012-01-01

    Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique, prophylactic antibiotics, avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinal instrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure. PMID:23330073

  11. Surgical Management in Elderly Patients with Tuberculous Spondylodiscitis: Ten Year Mortality Audit Study

    PubMed Central

    Kothari, Manish Kundanmal; Tikoo, Agnivesh; Nene, Abhay Madhusudan

    2016-01-01

    Study Design Retrospective study. Purpose To evaluate the factors affecting immediate postoperative mortality in elderly patients with tuberculous spondylodiscitis. Overview of Literature Treatment of spinal tuberculosis in the elderly involves consideration of age and co-morbidities, and often leads to an extended conservative management. Surgical intervention in these patients becomes a complex decision. There are no studies on risk factors of mortality in surgically treated elderly with tuberculous spondylodiscitis. Methods Two hundred and seventy-six patients with spondylodiscitis were operated between 2005 and 2015. 20 consecutive patients over 70 years of age with and proven tuberculosis who met the inclusion/exclusion criteria were included. Demographic, clinical and radiological profile data with operative details of instrumentation, blood loss, surgical duration, and mortality were noted. There were 20 patients (6 males, 14 females) with a mean age of 73.5 years. The patients were divided into those with mortality (M) and those who survived (non-mortality, NM). Various variables were statistically tested for immediate postoperative medical complications and mortality. Results There were four mortalities (20%). Age, sex, number of medical co-morbidities, American Society of Anaesthesiologists grade, Frankel grade C or worse, number of vertebrae involved, number of levels fused, blood loss and operative time did not have statistically significant impact on immediate postoperative mortality. Only preoperative immobility duration was statistically higher in the M group (p=0.016) than in the NM group. Conclusions Preoperative immobility is associated with immediate postoperative mortality in elderly patients with spinal tuberculosis undergoing surgery. The findings identify preoperative immobility as a risk factor for mortality, which could contribute to a more detailed prognostic discussion between surgeon and patient before surgery. PMID:27790320

  12. [Artificial respiration for the postoperative care after major surgery (author's transl)].

    PubMed

    Hack, G; Rommelsheim, K

    1976-02-01

    An analysis was made of the postoperative course of 158 cases of major surgery performed during 1971-1973. The operations comprised thoraco-abdominal resection of the oesophageal and cardia, abdominal duodenopancreatectomy, partial gastrectomy and enterectomy and partial hepatectomy. 63 per cent of the patients were given artificial respiration either prophylactically immediately after the operation (47 per cent) or at a later stage (53 per cent) on account of respiratory complications (arterial hypoxia below 55 mm Hg pO2). Postoperative mortality for the group of patients who did not have artificial respiration was 46 per cent, as compared with 32 per cent for the artifically ventilated patients - a difference of 14 per cent. The causes for this discrepancy, and especially the role of non-respiratory complications are discussed and the indications for prophylactic postoperative artificial respiration are reviewed.

  13. Association between hypoalbuminemia and mortality among subjects treated with ertapenem versus other carbapenems: prospective cohort study.

    PubMed

    Zusman, O; Farbman, L; Tredler, Z; Daitch, V; Lador, A; Leibovici, L; Paul, M

    2015-01-01

    The aim of this study was to determine whether ertapenem, being highly protein bound, is less effective than other carbapenems in the presence of hypoalbuminemia. In a prospective cohort study, we included adults with clinically and microbiologically documented infections caused by carbapenem-susceptible Enterobacteriaceae who were hospitalized in a tertiary medical center from March 2010 to September 2012. We tested whether hypoalbuminemia (serum albumin <2.5 g/dL) had a larger effect on 30-day mortality in subjects treated with ertapenem compared to those treated with meropenem or imipenem (I/M). Logistic regression analysis was used to identify independent risk factors for death including the carbapenem drug and the interaction between albumin and the carbapenem. Of 279 individual subjects included, 173 were treated with ertapenem and 106 with I/M. The odds ratio (OR) for 30-day mortality with hypoalbuminemia was 4.6 (95% confidence interval (CI) 2.1-10.1) among subjects with ertapenem versus 1.2 (95% CI 0.5-2.70) with I/M (p = 0.02 for difference between groups). In the regression model, the interaction between carbapenem type and albumin levels was significant (p = 0.03); for ertapenem lower albumin levels were associated with increased 30-day mortality (OR 2.45, 95% CI 1.19-5.05), while for I/M the change was not significant (OR 0.67, 95% CI 0.31-1.41). The model suggests that the risk of death for ertapenem-treated subjects quintupled when albumin was 2 g/dL compared to 4 g/dL. Hypoalbuminemia was associated with mortality significantly more among subjects treated with ertapenem compared to subjects treated with I/M. The effectiveness of current dosing schemes of ertapenem in subjects with significant hypoalbuminemia should be revisited.

  14. Deep brain stimulation: postoperative issues.

    PubMed

    Deuschl, Günther; Herzog, Jan; Kleiner-Fisman, Galit; Kubu, Cynthia; Lozano, Andres M; Lyons, Kelly E; Rodriguez-Oroz, Maria C; Tamma, Filippo; Tröster, Alexander I; Vitek, Jerrold L; Volkmann, Jens; Voon, Valerie

    2006-06-01

    Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.

  15. [Postoperative complications in plastic surgery].

    PubMed

    Vogt, P M

    2009-09-01

    aspects of postoperative complication management in plastic surgery.

  16. The relationship between hospital market competition, evidence-based performance measures, and mortality for chronic heart failure.

    PubMed

    Maeda, Jared Lane K; Lo Sasso, Anthony T

    2012-01-01

    Using data from the Joint Commission's ORYX initiative and the Medicare Provider Analysis and Review file from 2003 to 2006, this study employed a fixed-effects approach to examine the relationship between hospital market competition, evidence-based performance measures, and short-term mortality at seven days, 30 days, 90 days, and one year for patients with chronic heart failure. We found that, on average, higher adherence with most of the Joint Commission's heart failure performance measures was not associated with lower mortality; the level of market competition also was not associated with any differences in mortality. However, higher adherence with the discharge instructions and left ventricular function assessment indicators at the 80th and 90th percentiles of the mortality distribution was associated with incrementally lower mortality rates. These findings suggest that targeting evidence-based processes of care might have a stronger impact in improving patient outcomes.

  17. A Rare Cause of Pulmonary Edema in the Postoperative Period

    PubMed Central

    Chatterjee, Kshitij; Mittadodla, Penchala S.; Colaco, Clinton; Jagana, Rajani

    2017-01-01

    With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS. PMID:28250610

  18. A Rare Cause of Pulmonary Edema in the Postoperative Period.

    PubMed

    Chatterjee, Kshitij; Mittadodla, Penchala S; Colaco, Clinton; Jagana, Rajani

    2017-02-01

    With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.

  19. Pathophysiology of Post-Operative Low Cardiac Output Syndrome.

    PubMed

    Epting, Conrad L; McBride, Mary E; Wald, Eric L; Costello, John M

    2016-01-01

    Low cardiac output syndrome frequently complicates the post-operative care of infants and children following cardiac surgery. The onset of low cardiac output follows a predictable course in the hours following cardiopulmonary bypass, as myocardial performance declines in the face of an elevated demand for cardiac output. When demand outstrips supply, shock ensues, and early recognition and intervention can decrease mortality. Multifactorial in etiology, this article will discuss the pathophysiology of low cardiac output syndrome, including myocardial depression following bypass, altered cardiac loading conditions, and inflammation driving a hypermetabolic state. Contributions from altered neurohormonal, thyroid, and adrenal axes will also be discussed. Sources included the clinical experiences of four cardiac intensivists, supported throughout by primary sources and relevant reviews obtained through PubMed searches and from seminal textbooks in the field. This article addresses the second of eight topics comprising the special issue entitled "Pharmacologic strategies with afterload reduction in low cardiac output syndrome after pediatric cardiac surgery".

  20. Mortality in HIV-Infected Alcohol and Drug Users in St. Petersburg, Russia

    PubMed Central

    Fairbairn, Nadia S.; Walley, Alexander Y.; Cheng, Debbie M.; Quinn, Emily; Bridden, Carly; Chaisson, Christine; Blokhina, Elena; Lioznov, Dmitry; Krupitsky, Evgeny; Raj, Anita; Samet, Jeffrey H.

    2016-01-01

    In Russia, up to half of premature deaths are attributed to hazardous drinking. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described. Criminalization and stigmatization of substance use in Russia may also contribute to mortality. We explored whether alcohol, drug use and risk environment factors are associated with short-term mortality in HIV-infected Russians who use substances. Secondary analyses were conducted using prospective data collected at baseline, 6 and 12-months from HIV-infected people who use substances recruited between 2007–2010 from addiction and HIV care settings in a single urban setting of St. Petersburg, Russia. We used Cox proportional hazards models to explore associations between 30-day alcohol hazardous drinking, injection drug use, polysubstance use and environmental risk exposures (i.e. past incarceration, police involvement, selling sex, and HIV stigma) with mortality. Among 700 participants, 59% were male and the mean age was 30 years. There were 40 deaths after a median follow-up of 12 months (crude mortality rate 5.9 per 100 person-years). In adjusted analyses, 30-day NIAAA hazardous drinking was significantly associated with mortality compared to no drinking [adjusted Hazard Ratio (aHR) 2.60, 95% Confidence Interval (CI): 1.24–5.44] but moderate drinking was not (aHR 0.95, 95% CI: 0.35–2.59). No other factors were significantly associated with mortality. The high rates of short-term mortality and the strong association with hazardous drinking suggest a need to integrate evidence-based alcohol interventions into treatment strategies for HIV-infected Russians. PMID:27898683

  1. Battery of behavioral tests in mice to study postoperative delirium

    PubMed Central

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R.; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  2. Battery of behavioral tests in mice to study postoperative delirium.

    PubMed

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-07-20

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium.

  3. Mortality among professional drivers.

    PubMed

    Rafnsson, V; Gunnarsdóttir, H

    1991-10-01

    The mortality of truck drivers and taxi drivers was studied in Reykjavík. The national mortality rate was used for comparison, and the follow-up lasted until 1 December 1988. The 868 truck drivers (28,788.0 person-years) had an excess of lung cancer deaths [24 observed, 11.2 expected, standardized mortality ratio (SMR) 2.14], but fewer deaths than expected from respiratory diseases (15 observed versus 30.1 expected). The SMR from lung cancer did not steadily increase as the duration of employment increased, nor did it change with the length of follow-up. The SMR values did not deviate substantially from unity for the taxi drivers. Since the high mortality from lung cancer among the truck drivers did not seem to be due to their smoking habits, it might have been caused by one or more occupational factors, especially in light of this group's exposure to engine exhaust gases.

  4. Weather-Related Mortality

    PubMed Central

    Anderson, Brooke G.; Bell, Michelle L.

    2012-01-01

    Background Many studies have linked weather to mortality; however, role of such critical factors as regional variation, susceptible populations, and acclimatization remain unresolved. Methods We applied time-series models to 107 US communities allowing a nonlinear relationship between temperature and mortality by using a 14-year dataset. Second-stage analysis was used to relate cold, heat, and heat wave effect estimates to community-specific variables. We considered exposure timeframe, susceptibility, age, cause of death, and confounding from pollutants. Heat waves were modeled with varying intensity and duration. Results Heat-related mortality was most associated with a shorter lag (average of same day and previous day), with an overall increase of 3.0% (95% posterior interval: 2.4%–3.6%) in mortality risk comparing the 99th and 90th percentile temperatures for the community. Cold-related mortality was most associated with a longer lag (average of current day up to 25 days previous), with a 4.2% (3.2%–5.3%) increase in risk comparing the first and 10th percentile temperatures for the community. Mortality risk increased with the intensity or duration of heat waves. Spatial heterogeneity in effects indicates that weather–mortality relationships from 1 community may not be applicable in another. Larger spatial heterogeneity for absolute temperature estimates (comparing risk at specific temperatures) than for relative temperature estimates (comparing risk at community-specific temperature percentiles) provides evidence for acclimatization. We identified susceptibility based on age, socioeconomic conditions, urbanicity, and central air conditioning. Conclusions Acclimatization, individual susceptibility, and community characteristics all affect heat-related effects on mortality. PMID:19194300

  5. [Ruptured aneurysms of the abdominal aorta. A study of their incidence and mortality].

    PubMed

    Acea Nebril, B; Tovar Martín, E; Díaz Pardeiro, P; Fernández Pintos, J; Caamaño Martínez, S

    1993-01-01

    Between 1986 and 1992, 133 patients with abdominal aneurysms presented to our Department of Vascular Surgery. Of these, 97 (73%) were elective cases and 36 (27%) had ruptured. In all these patients resections were undertaken. Postoperative complications occurred in 28 patients (28%) for elective resection and in 17 patients (47%) for ruptured aneurysms (p < 0.05), with mortality rates of 46 and 94%, respectively (p < 0.005). The postoperative mortality for elective resection was 13% and for rupture 44% (p < 0.001).

  6. Epidural Analgesia in the Postoperative Period

    DTIC Science & Technology

    2001-10-01

    an unwanted side effect of surgery, and is associated with many postoperative complications. This descriptive study was conducted to determine which...surgical patients experienced the most analgesia with the fewest side effects when receiving epidural analgesia in the postoperative period. A...hospital. A description of the patients age, gender, type of surgery, type of epidural medication, side effects , incidence of breakthrough pain, and

  7. [Caloric substrates in postoperative parenteral nutrition].

    PubMed

    De Salvo, L; Romairone, E; Ansaldo, G L; Mattioli, G

    1991-05-31

    The paper describes the carbohydrate, lipidic and nitrogen metabolism of the postoperative period which is subdivided into an early and a late phase. Since the metabolism of caloric substrates in the early postoperative period is a stress metabolism with glucose intolerance and wide protein catabolism, the authors emphasise that an insufficient caloric intake is worse than the fasting state and suggest that alternative caloric sources, such as branched chain amino acids, fatty acids and, even, ketonic bodies, should be used.

  8. Association between Serum Tissue Inhibitor of Matrix Metalloproteinase-1 Levels and Mortality in Patients with Severe Brain Trauma Injury

    PubMed Central

    Lorente, Leonardo; Martín, María M.; López, Patricia; Ramos, Luis; Blanquer, José; Cáceres, Juan J.; Solé-Violán, Jordi; Solera, Jorge; Cabrera, Judith; Argueso, Mónica; Ortiz, Raquel; Mora, María L.; Lubillo, Santiago; Jiménez, Alejandro; Borreguero-León, Juan M.; González, Agustín; Orbe, Josune; Rodríguez, José A.; Páramo, José A.

    2014-01-01

    Objective Matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) play a role in neuroinflammation after brain trauma injury (TBI). Previous studies with small sample size have reported higher circulating MMP-2 and MMP-9 levels in patients with TBI, but no association between those levels and mortality. Thus, the aim of this study was to determine whether serum TIMP-1 and MMP-9 levels are associated with mortality in patients with severe TBI. Methods This was a multicenter, observational and prospective study carried out in six Spanish Intensive Care Units. Patients with severe TBI defined as Glasgow Coma Scale (GCS) lower than 9 were included, while those with Injury Severity Score (ISS) in non-cranial aspects higher than 9 were excluded. Serum levels of TIMP-1, MMP-9 and tumor necrosis factor (TNF)-alpha, and plasma levels of tissue factor (TF) and plasminogen activator inhibitor (PAI)-1 plasma were measured in 100 patients with severe TBI at admission. Endpoint was 30-day mortality. Results Non-surviving TBI patients (n = 27) showed higher serum TIMP-1 levels than survivor ones (n = 73). We did not find differences in MMP-9 serum levels. Logistic regression analysis showed that serum TIMP-1 levels were associated 30-day mortality (OR = 1.01; 95% CI = 1.001–1.013; P = 0.03). Survival analysis showed that patients with serum TIMP-1 higher than 220 ng/mL presented increased 30-day mortality than patients with lower levels (Chi-square = 5.50; P = 0.02). The area under the curve (AUC) for TIMP-1 as predictor of 30-day mortality was 0.73 (95% CI = 0.624–0.844; P<0.001). An association between TIMP-1 levels and APACHE-II score, TNF- alpha and TF was found. Conclusions The most relevant and new findings of our study, the largest series reporting data on TIMP-1 and MMP-9 levels in patients with severe TBI, were that serum TIMP-1 levels were associated with TBI mortality and could be used as a

  9. Legal abortion mortality.

    PubMed

    Kestelman, P

    1978-04-01

    Statistics on legal abortion in Britain between 1968-1974 are presented. There was a mortality rate of 10+ or -2 per 100,000 abortions: 27+ or -11 in 1968-1969, 12+ or -4 in 1970-1972, and 6+ or -3 in 1973-1974. Legal abortion mortality increased from 4+ or -3 when performed at gestation under 9 weeks to 5+ or -2 at 9-12 weeks, 13+ or -7 at 13-16 weeks, and 62+ or -33 at 17 weeks and over. The ratio was 11+ or -6 for women under 20 years of age, increasing to 5+ or -3 at age 20-29, 10+ or -6 at age 30-39, and 23+ or -19 at age 40 and over. The parity had little influence on abortion mortality, but the technique used had a great influence. Hysterotomy, hypertonic saline, and abortifacient paste were the most dangerous, in increasing order, with mortality rates of 39+ or -30, 106+ or -75, and 152+ or -89, respectively. The rates for aspiration and curretage were 4+ or -2 and 4+ or -3, respectively. There was a higher mortality risk with abortion with sterilization. The main causes of legal abortion mortality were infection, pulmonary embolism, and complications of general anesthesia. The high incidence of mortality associated with legal abortion in Britain is partially caused by: 1) high incidence of concurrent sterilization, 2) former use of dangerous techniques, 3) significant incidence of second trimester abortion, 4) routine use of general anesthesia, and 5) previous ill health of some of the women.

  10. Predictors of in-hospital mortality following redo cardiac surgery: Single center experience

    PubMed Central

    Coskun, Isa; Cayli, Murat; Gulcan, Oner

    2015-01-01

    Purpose Redo cardiac operations represent one of the main challenges in heart surgery. The purpose of the study was to analyze the predictors of in-hospital mortality in patients undergoing reoperative cardiac surgery by a single surgical team. Methods A total of 1367 patients underwent cardiac surgical procedures and prospectively entered into a computerized database. Patients were divided into 2 groups based on the reoperative cardiac surgery (n = 109) and control group (n = 1258). Uni- and multivariate logistic regression analysis were performed to evaluate the possible predictors of hospital mortality. Results Mean age was 56 ± 13, and 46% were female in redo group. In-hospital mortality was 4.6 vs. 2.2%, p = 0.11. EuroSCORE (6 vs. 3; p < 0.01), cardiopulmonary bypass time (90 vs. 71 min; p < 0.01), postoperative bleeding (450 vs. 350 ml; p < 0.01), postoperative atrial fibrillation (AF) (29 vs. 16%; p < 0.01), and inotropic support (58 vs. 31%; p = 0.001) were significantly different. These variables were entered into uni- and multivariate regression analysis. Postoperative AF (OR1.76, p = 0.007) and EuroSCORE (OR 1.42, p < 0.01) were significant risk factors predicting hospital mortality. Conclusions Reoperative cardiac surgery can be performed under similar risks as primary operations. Postoperative AF and EuroSCORE are predictors of in-hospital mortality for redo cases. PMID:26527452

  11. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    PubMed

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  12. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

    PubMed Central

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13–30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9–43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention. PMID:27855225

  13. Cholesterol trials and mortality.

    PubMed

    Warren, John B; Dimmitt, Simon B; Stampfer, Hans G

    2016-07-01

    An overview of clinical trials can reveal a class effect on mortality that is not apparent from individual trials. Most large trials of lipid pharmacotherapy are not powered to detect differences in mortality and instead assess efficacy with composite cardiovascular endpoints. We illustrate the importance of all-cause mortality data by comparing survival in three different sets of the larger controlled lipid trials that underpin meta-analyses. These trials are for fibrates and statins. Fibrate treatment in five of the six main trials was associated with a decrease in survival, one fibrate trial showed a non-significant reduction in mortality that can be explained by a different target population. In secondary prevention, statin treatment increased survival in all five of the main trials, absolute mean increase ranged from 0.43% to 3.33%, the median change was 1.75%, which occurred in the largest trial. In primary prevention, statin treatment increased survival in six of the seven main trials, absolute mean change in survival ranged from -0.09% to 0.89%, median 0.49%. Composite safety endpoints are rare in these trials. The failure to address composite safety endpoints in most lipid trials precludes a balanced summary of risk-benefit when a composite has been used for efficacy. Class effects on survival provide informative summaries of the risk-benefit of lipid pharmacotherapy. We consider that the presentation of key mortality/survival data adds to existing meta-analyses to aid personal treatment decisions.

  14. Kinship, maternal effects, and management: Juvenile mortality and survival in captive African painted dogs, Lycaon pictus.

    PubMed

    Yordy, Jennifer; Mossotti, Regina H

    2016-09-01

    In 77 African painted dog (Lycaon pictus) litters born in North American zoos since 1998, pup mortality at 30 days was 53% (n = 478). More alarmingly, 52% of those 77 litters had zero pups surviving at 30 days. Many variables may have the potential to affect pup mortality in captivity, including kinship, maternal age, prior maternal breeding experience, and numerous social and husbandry factors. Data on these variables were obtained from the North American Regional Studbook, with supplemental information compiled from a survey sent to painted dog breeding facilities in North America. Survival curve analysis revealed significant effects for maternal age and kinship, with kinship being most significant (χ(2) , df = 19.71, 1; P < 0.0001). Pups born to unrelated parents had a median age at death two orders of magnitude higher than pups born to parents who were related to each other. Pup mortality was also lower for experienced mothers and for females under 2.5 years or between 4.5 and 6.5 years old. Follow-up analyses of these findings indicated that among first-time mothers, the youngest females achieved the lowest juvenile mortality, while juvenile mortality for experienced mothers was relatively low in all age classes until 6.5 years old. Regression analysis indicated that chances of survival are improved for pups born to younger mothers, unrelated parents, and in packs of >2 individuals. Enclosure size and area per animal may also be important factors. Our findings indicate that specific characteristics can be used to predict and potentially reduce pup mortality in captive African painted dogs. Zoo Biol. 35:367-377, 2016. © Wiley Periodicals, Inc.

  15. Vancomycin 24-Hour Area under the Curve/Minimum Bactericidal Concentration Ratio as a Novel Predictor of Mortality in Methicillin-Resistant Staphylococcus aureus Bacteremia.

    PubMed

    Britt, Nicholas S; Patel, Nimish; Horvat, Rebecca T; Steed, Molly E

    2016-05-01

    While previous studies have examined the association between vancomycin (VAN) exposure and MIC with regard to outcomes in methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B), none have explored if a relationship exists with the VAN minimum bactericidal concentration (MBC). The objective of this study was to evaluate the VAN 24-h area under the curve (AUC24)/MBC ratio as a pharmacodynamic predictor of mortality. This retrospective cohort study included patients treated with VAN for MRSA-B with the primary outcome of 30-day all-cause mortality. Data collected included patient demographics, comorbidities, antimicrobial treatment data, therapeutic drug levels, and laboratory and microbiological data. Vancomycin MICs and MBCs were determined by Etest (MIC only) and broth microdilution (BMD). The vancomycin AUC24 was determined by pharmacokinetic maximum a posteriori probability Bayesian (MAP-Bayesian) analysis. The most significant breakpoint for 30-day mortality was determined by classification and regression tree (CART) analysis. The association between pharmacodynamic parameters (VAN AUC24/MICBMD, VAN AUC24/MICEtest, and AUC24/MBCBMD) and mortality were determined by χ(2) and multivariable Poisson regression. Overall mortality in this cohort (n = 53) was 20.8% (n = 11/53), and all corresponding MRSA blood isolates were VAN susceptible (MIC range, 0.5 to 2 μg/ml; MIC50, 1 μg/ml; MIC90, 1 μg/ml). The CART-derived breakpoints for mortality were 176 (VAN AUC24/MBC) and 334 (VAN AUC24/MICBMD). In multivariable analysis, the association between a VAN AUC24/MBC of ≥176 and survival persisted, but VAN AUC24/MICBMD values (≥334 or ≥400) were not associated with improved mortality. In conclusion, VAN AUC24/MBC was a more important predictor of 30-day mortality than VAN AUC24/MIC for MRSA-B.

  16. Soluble urokinase plasminogen activator receptor (suPAR) in acute care: a strong marker of disease presence and severity, readmission and mortality. A retrospective cohort study

    PubMed Central

    Rasmussen, Line Jee Hartmann; Ladelund, Steen; Haupt, Thomas Huneck; Ellekilde, Gertrude; Poulsen, Jørgen Hjelm; Iversen, Kasper; Eugen-Olsen, Jesper; Andersen, Ove

    2016-01-01

    Objective Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker associated with presence and progression of disease and with increased risk of mortality. We aimed to evaluate the unspecific biomarker suPAR as a prognostic marker in patients admitted to acute care. Methods This registry-based retrospective cohort study included 4343 consecutively admitted patients from the Acute Medical Unit at a large Danish university hospital. Time to readmission and death were analysed by multiple Cox regression. Results were reported as HRs for 30-day and 90-day follow-up. Results During 30-day follow-up, 782 patients (18.0%) were readmitted and 224 patients (5.2%) died. Comparing 30-day readmission and mortality between patients in the highest and lowest suPAR quartiles yielded HRs of 2.11 (95% CI 1.70 to 2.62) and 4.11 (95% CI 2.46 to 6.85), respectively, when adjusting for age, sex, Charlson score and C reactive protein. Area under the curve for receiver operating characteristics curve analysis of suPAR for 30-day mortality was 0.84 (95% CI 0.81 to 0.86). Furthermore, in the entire cohort, women had slightly higher suPAR compared with men, and suPAR was associated with age, admission time, admission to intensive care unit and Charlson score. Conclusions In this large unselected population of acute medical patients, suPAR is strongly associated with disease severity, readmission and mortality after adjusting for all other risk factors, indicating that suPAR adds information to established prognostic indicators. While patients with low suPAR levels have low risk of readmission and mortality, patients with high suPAR levels have a high risk of adverse events. PMID:27590986

  17. Neonatal mortality in Utah.

    PubMed

    Woolley, F R; Schuman, K L; Lyon, J L

    1982-09-01

    A cohort study of neonatal mortality (N = 106) in white singleton births (N = 14,486) in Utah for January-June 1975 was conducted. Using membership and activity in the Church of Jesus Christ of Latter-day Saints (LDS or Mormon) as a proxy for parental health practices, i.e., tobacco and alcohol abstinence, differential neonatal mortality rates were calculated. The influence of potential confounding factors was evaluated. Low activity LDS members were found to have an excess risk of neonatal death five times greater than high activity LDS, with an upper bound of a two-sided 95% confidence interval of 7.9. The data consistently indicate a lower neonatal mortality rate for active LDS members. Non-LDS were found to have a lower rate than either medium or low activity LDS.

  18. The mortality of companies

    PubMed Central

    Daepp, Madeleine I. G.; Hamilton, Marcus J.; West, Geoffrey B.; Bettencourt, Luís M. A.

    2015-01-01

    The firm is a fundamental economic unit of contemporary human societies. Studies on the general quantitative and statistical character of firms have produced mixed results regarding their lifespans and mortality. We examine a comprehensive database of more than 25 000 publicly traded North American companies, from 1950 to 2009, to derive the statistics of firm lifespans. Based on detailed survival analysis, we show that the mortality of publicly traded companies manifests an approximately constant hazard rate over long periods of observation. This regularity indicates that mortality rates are independent of a company's age. We show that the typical half-life of a publicly traded company is about a decade, regardless of business sector. Our results shed new light on the dynamics of births and deaths of publicly traded companies and identify some of the necessary ingredients of a general theory of firms. PMID:25833247

  19. Mortality scoring in ITU.

    PubMed

    Niewiński, Grzegorz; Kański, Andrzej

    2012-01-01

    Chronic shortage of ITU beds makes decisions on admission difficult and responsible. The use of computer-based mortality scoring should help in decision-making and for this purpose, a number of different scoring systems have been created; in principle, they should be easy to use, adaptable to all populations of patients and suitable for predicting the risk of mortality during both ITU and hospital stay. Most of existing scales and scoring systems were included in this review. They are frequently used in ITUs and become a necessary tool to describe ITU populations and to explain differences in mortality. As there are several pitfalls related to the interpretation of the numbers supplied by the systems, they should be used with the knowledge on the severity scoring science. Moreover, the cost and significant workload limit the use of scoring systems; in many cases an extra person has to be employed for collection and analysis of data only.

  20. Autoantibodies, mortality and ageing.

    PubMed

    Richaud-Patin, Y; Villa, A R

    1995-01-01

    Immunological failure may be the cause of predisposition to certain infections, neoplasms, and vascular diseases in adulthood. Mortality risks through life may reflect an undetermined number of causes. This study describes the prevalence of positivity of autoantibodies through life, along with general and specific mortality causes in three countries with different socioeconomic development (Guatemala, Mexico and the United States). Prevalence of autoantibodies by age was obtained from previous reports. In spite of having involved different ethnic groups, the observed trends in prevalence of autoantibodies, as well as mortality through life, showed a similar behavior. Thus, both the increase in autoantibody production and death risk as age rises, may share physiopathological phenomena related to the ageing process.

  1. Myocardial revascularisation in women: evaluation of hospital mortality and morbidity

    PubMed Central

    Cloin, E.C.W.; Noyez, L.

    2006-01-01

    Background Although women are reported to be at higher risk for mortality and morbidity after coronary artery bypass graft (CABG), there is no consensus in literature. Method Pre-, peri- and postoperative hospital data of 8578 patients undergoing an isolated myocardial revascularisation from January 1987 to December 2004 were analysed. Of these patients, 2083 (24.3%) were female. Results Female patients were significantly older (p=0.001), and risk factors as diabetes (p=0.001), hypertension (p=0.001), hyperlipidaemia (p=0.001) were significantly more prevalent than in men. The incidence of preoperative myocardial infarction (p=0.001) and triple-vessel disease (p=0.001) was lower, but the incidence of unstable angina (NYHA IV) (p=0.001) was significantly higher than in men. Significantly fewer women (p=0.04) received an arterial graft. Postoperatively, there was no significant difference in the registered morbidity, with the exception of a lower incidence of female patients with non-sinus rhythm (p=0.001) and a higher incidence of pulmonary problems (p=0.006). Hospital mortality was not significantly different between the genders: 3.5 vs. 3.4% (p=0.9). A preoperative myocardial infarction was identified as the only independent predictor for hospital mortality. Conclusion The preoperative profiles of women and men undergoing CABG are dissimilar. However, the incidences of hospital mortality, and morbidity were not statistically different. Female gender was not identified as predictor for death or adverse outcome. PMID:25696593

  2. Determinants of perioperative morbidity and mortality after pneumonectomy

    SciTech Connect

    Wahi, R.; McMurtrey, M.J.; DeCaro, L.F.; Mountain, C.F.; Ali, M.K.; Smith, T.L.; Roth, J.A. )

    1989-07-01

    A total of 197 consecutive patients undergoing pneumonectomy at the M.D. Anderson Cancer Center from 1982 to 1987 were reviewed. Sixty-five variables were analyzed for the predictive value for perioperative risk. The operative mortality rate was 7% (14/197). Patients having a right pneumonectomy (n = 95) had a higher operative mortality rate (12%) than patients having a left pneumonectomy (1%, p less than 0.05). The extent of resection correlated with the operative mortality rate (chest wall resection or extrapleural pneumonectomy, n = 39, 15%; versus simple or intrapericardial pneumonectomy, n = 158, 5%; p less than 0.05). Patients whose predicted postoperative pulmonary function, by spirometry and xenon 133 regional pulmonary function studies, was a forced expiratory volume in 1 second greater than 1.65 L, forced expiratory volume in 1 second greater than 58% of the preoperative value, forced vital capacity greater than 2.5 L, or forced vital capacity greater than 60% of the preoperative value had a lower operative mortality rate (p less than 0.05). Atrial arrhythmia was the most common postoperative complication (23%). Xenon 133 regional pulmonary function studies are useful in predicting the risks of pneumonectomy.

  3. Serum Levels of Substance P and Mortality in Patients with a Severe Acute Ischemic Stroke

    PubMed Central

    Lorente, Leonardo; Martín, María M.; Almeida, Teresa; Pérez-Cejas, Antonia; Ramos, Luis; Argueso, Mónica; Riaño-Ruiz, Marta; Solé-Violán, Jordi; Hernández, Mariano

    2016-01-01

    Substance P (SP), a member of tachykinin family, is involved in the inflammation of the central nervous system and in the appearance of cerebral edema. Higher serum levels of SP have been found in 18 patients with cerebral ischemia compared with healthy controls. The aim of our multi-center study was to analyze the possible association between serum levels of SP and mortality in ischemic stroke patients. We included patients with malignant middle cerebral artery infarction (MMCAI) and a Glasgow Coma Scale (GCS) lower than 9. Non-surviving patients at 30 days (n = 31) had higher serum concentrations of SP levels at diagnosis of severe MMCAI than survivors (n = 30) (p < 0.001). We found in multiple regression an association between serum concentrations of SP higher than 362 pg/mL and mortality at 30 days (Odds Ratio = 5.33; 95% confidence interval = 1.541–18.470; p = 0.008) after controlling for age and GCS. Thus, the major novel finding of our study was the association between serum levels of SP and mortality in patients suffering from severe acute ischemic stroke. PMID:27338372

  4. One-year mortality among Danish intensive care patients with acute kidney injury: a cohort study

    PubMed Central

    2012-01-01

    Introduction There are few studies on long-term mortality among intensive care unit (ICU) patients with acute kidney injury (AKI). We assessed the prevalence of AKI at ICU admission, its impact on mortality during one year of follow-up, and whether the influence of AKI varied in subgroups of ICU patients. Methods We identified all adults admitted to any ICU in Northern Denmark (approximately 1.15 million inhabitants) from 2005 through 2010 using population-based medical registries. AKI was defined at ICU admission based on the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) classification, using plasma creatinine changes. We included four severity levels: AKI-risk, AKI-injury, AKI-failure, and without AKI. We estimated cumulative mortality by the Kaplan-Meier method and hazard ratios (HRs) using a Cox model adjusted for potential confounders. We computed estimates for all ICU patients and for subgroups with different comorbidity levels, chronic kidney disease status, surgical status, primary hospital diagnosis, and treatment with mechanical ventilation or with inotropes/vasopressors. Results We identified 30,762 ICU patients, of which 4,793 (15.6%) had AKI at ICU admission. Thirty-day mortality was 35.5% for the AKI-risk group, 44.2% for the AKI-injury group, and 41.0% for the AKI-failure group, compared with 12.8% for patients without AKI. The corresponding adjusted HRs were 1.96 (95% confidence interval (CI) 1.80-2.13), 2.60 (95% CI 2.38 to 2.85) and 2.41 (95% CI 2.21 to 2.64), compared to patients without AKI. Among patients surviving 30 days (n = 25,539), 31- to 365 day mortality was 20.5% for the AKI-risk group, 23.8% for the AKI-injury group, and 23.2% for the AKI-failure group, compared with 10.7% for patients without AKI, corresponding to adjusted HRs of 1.33 (95% CI 1.17 to 1.51), 1.60 (95% CI 1.37 to1.87), and 1.64 (95% CI 1.42 to 1.90), respectively. The association between AKI and 30-day mortality was evident in

  5. Nursing documentation of postoperative pain management.

    PubMed

    Idvall, Ewa; Ehrenberg, Anna

    2002-11-01

    Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation. The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines. The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden. The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines. The result showed that pain assessment was based mainly on patients' self-report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines. The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware.

  6. [Mortality in metropolitan regions].

    PubMed

    Simoes Ccds

    1980-01-01

    Data from the 1970 census and a 1974-1975 survey carried out in Brazil by the Fundacao Instituto Brasileiro de Geografia e Estatistica are used to examine recent mortality trends in urban areas. Specifically, life expectancy in nine metropolitan areas is analyzed in relation to income, diet, and sanitary facilities in the home.

  7. Adolescents, Egocentrism, and Mortality

    ERIC Educational Resources Information Center

    Hanna, Jennie L.

    2017-01-01

    Adolescents are often described as egocentric, but a major source of this external behavior is the internal fear of adolescents have about feeling invisible, being different, and even their own mortality. Facing this fear through a curricular focus on death can help to combat this behavior. This can be accomplished through novel studies of books…

  8. Mortality among Swedish Journalists.

    ERIC Educational Resources Information Center

    Furhoff, Anna-Karin; Furhoff, Lars

    1987-01-01

    Charts the various environmental factors that might influence the mortality rate of Swedish journalists. Concludes that, although there may be a slightly higher death rate among Swedish journalists in the 50-59 age group, the death rate for journalists is the same as for the population in general. (MM)

  9. VLAP: results immediately post-op

    NASA Astrophysics Data System (ADS)

    Cowles, Robert S.

    1996-05-01

    Visual laser ablation of the prostate (VLAP) has been shown to be as effective with fewer complications than TURP in the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia. Questions have been raised about VLAP regarding prolonged irritative and obstructive voiding symptoms postoperatively. It is postulated that these symptoms are due to the slow slough of necrotic debris following VLAP. In an effort to improve upon the technique of VLAP, patients underwent lasing of the prostate in the routine manner (2, 4, 8, and 10 o'clock positions with sixty watts for sixty seconds) using Nd:YAG free beam energy. A bladder neck incision was then performed using a contact laser fiber. International prostate symptom score assessments were done preoperatively; one week and six weeks postoperatively. Post void residual urine volumes and prostate size were also evaluated. The findings indicate that symptom scores and post void residual urine volumes have significantly improved within ten days postoperatively using this technique.

  10. Postoperative maladaptive behavioral changes in children.

    PubMed

    Yuki, Koichi; Daaboul, Dima G

    2011-06-01

    Induction of anesthesia can be a very stressful period for a child and his family and can be associated with increased risk of psychological disturbances. These disturbances are categorized as preoperative anxiety, emergence delirium and postoperative behavioral changes. Several tools have been developed to measure these psychological manifestations as well as the baseline personality traits of these patients. Postoperative negative behavioral changes, such as sleep and eating disorders, separation anxiety, temper tantrum, aggression toward authorities, may occur in up to 60% of all children undergoing general anesthesia. Several studies found a strong association between these postoperative behavioral changes, the distress of the child on induction and his individual personality characteristics, although a cause-effect relationship could not be determined. Understanding the risk factors for behavior changes helps us determine the best way for prevention and treatment of these changes in the perioperative period.

  11. Management of postoperative complications: general approach.

    PubMed

    Sanguineti, V Ana; Wild, Jason R; Fain, Mindy J

    2014-05-01

    The goal of postoperative management is to promote early mobility and avoid postoperative complications, recognizing the potentially devastating impact of complications on elderly patients with hip fracture. The recommended approach involves early mobilization; freedom from tethers (indwelling urinary catheters and other devices); effective pain control; treating malnutrition; preventing pressure ulcers; reducing risk for pulmonary, urinary, and wound infections; and managing cognition. This carefully structured and patient-centered management provides older, vulnerable patients their best chance of returning to their previous level of functioning as quickly and safety as possible.

  12. Pathogenesis of postoperative oral surgical pain.

    PubMed Central

    Ong, Cliff K. S.; Seymour, R. A.

    2003-01-01

    Pain is a major postoperative symptom in many oral surgical procedures. It is a complex and variable phenomenon that can be influenced by many factors. Good management of oral surgical pain requires a detailed understanding of the pathogenesis of surgical pain. This article aims at reviewing postoperative pain from a broad perspective by looking into the nociception, neuroanatomy, neurophysiology, and neuropharmacology of pain. Therapeutic recommendations are made after reviewing the evidence from the literature for maximizing the efficacy of pain management techniques for oral surgical pain. PMID:12722900

  13. Postoperative global amnesia reversed with flumazenil.

    PubMed

    Rinehart, Joseph B; Baker, Brandee; Raphael, Darren

    2012-07-01

    Global postoperative amnesia (profound anterograde and retrograde amnesia) is rare and usually attributed to transient global amnesia-a poorly understood condition with no broadly accepted mechanism. We report an incident of probable transient global amnesia in a patient after endoscopic retrograde cholangiopancreatogram under general anesthesia, which was successfully treated with flumazenil. On the basis of the results of flumazenil administration in this and a previous case report, we would recommend a trial dose of 0.2 mg for cases of global postoperative amnesia, repeated if the first dose seems effective.

  14. Mortality in Relation to Frailty in Patients Admitted to a Specialized Geriatric Intensive Care Unit

    PubMed Central

    Zeng, An; Song, Xiaowei; Dong, Jiahui; Mitnitski, Arnold; Liu, Jian; Guo, Zhenhui; Rockwood, Kenneth

    2015-01-01

    Background. In older adults admitted to intensive care units (ICUs), frailty influences prognosis. We examined the relationship between the frailty index (FI) based on deficit accumulation and early and late survival. Methods. Older patients (≥65 years) admitted to a specialized geriatric ICU at the Liuhuaqiao Hospital, Guangzhou, China between July–December 2011 (n = 155; age 82.7±7.1 y; 87.1% men) were followed for 300 days. The FI was calculated as the proportion present of 52 health deficits. FI performance was compared with that of several prognostic scores. Results. The 90-day death rate was 38.7% (n = 60; 27 died within 30 days). The FI score was correlated with the Glasgow Coma Scale, Karnofsky Scale, Palliative Performance Scale, Acute Physiology Score—APACHE II and APACHE IV (r 2 = 0.52 to 0.72, p < 0.001). Patients who died within 30 days had higher mean FI scores (0.41±0.11) than those who survived to 300 days (0.22±0.11; F = 38.91, p < 0.001). Each 1% increase in the FI from the previous level was associated with an 11% increase in the 30-day mortality risk (95% CI: 7%–15%) adjusting for age, sex, and the prognostic scores. The FI discriminated patients who died in 30 days from those who survived with moderately high accuracy (AUC = 0.89±0.03). No one with an FI score >0.46 survived past 90 days. Conclusion. ICU survival was strongly associated with the level of frailty at admission. An FI based on health deficit accumulation may help improve critical care outcome prediction in older adults. PMID:26400736

  15. Influence of a Multi-parametric Optimization Strategy for General Anesthesia on Postoperative Morbidity and Mortality

    ClinicalTrials.gov

    2017-01-12

    Coronary; Ischemic; Arrhythmias, Cardiac; Heart Failure; Peripheral Vascular Diseases; Dementia; Stroke; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency; Alcoholism; Cancer; Diabetes; Renal Insufficiency

  16. Impact of preoperative analytical values on post-operative mortality rate of intertrochanteric fractures.

    PubMed

    Borges, Ana; Torres, João; São Simão, Ricardo; Cabral, Abel Trigo; Pinto, Rui

    2014-01-01

    Introdução: A incidência das fraturas intertrocantéricas tem aumentado ao longo dos últimos anos, bem como todos os problemas a elas associados. É importante pesquisar possíveis formas de reduzir quer co-morbilidades, quer a mortalidade pós-operatória. Decidimos avaliar o impacto de alguns valores analíticos pré-operatórios na mortalidade pós-operatória de doentes com fractura intertrocantérica, com idade igual ou superior a 65 anos.Material e Métodos: De todas as fracturas intertrocantéricas admitidas entre Janeiro de 2007 e Maio 2012, 160 doentes foram incluídos no estudo. As variáveis estudadas foram idade, género, tempo de internamento, e dados analíticos, como hemoglobina, contagem de leucócitos e plaquetas, níveis de ureia e creatinina e concentração de sódio plasmática. Informação relativa à mortalidade foi obtida através do registo civil e, considerando um ponto de corte de seis meses após a cirurgia, os doentes foram divididos em dois grupos de acordo com a sua sobrevida. Os testes de Mann-Whitney e Chi-quadrado foram utilizados para estudar a associação entre as nossas variáveis e a sobrevida dos doentes.Resultados: A nossa população apresentava uma idade mediana de 82 anos de idade e uma maioria de mulheres (79,4%). Nos primeiros 6 meses após a cirurgia, 27 doentes dos iniciais 160 (16,1%) faleceram. A mortalidade estava relacionada com valores baixos de hemoglobina, elevados de plaquetas, elevados de creatinina e baixa concentração de sódio plasmático.Conclusão: A taxa de mortalidade pos-operatória da cirurgia da anca é elevada. Os nossos resultados podem ser utilizados parareduzir esta taxa, corrigindo valores analíticos pré-operatórios.

  17. The role of age and comorbidities in postoperative outcome of mitral valve repair

    PubMed Central

    Bonnet, Vincent; Boisselier, Clément; Saplacan, Vladimir; Belin, Annette; Gérard, Jean-Louis; Fellahi, Jean-Luc; Hanouz, Jean-Luc; Fischer, Marc-Olivier

    2016-01-01

    Abstract The average age of patients undergoing mitral valve repair is increasing each year. This retrospective study aimed to compare postoperative complications of mitral valve repair (known to be especially high-risk) between 2 age groups: under and over the age of 80. Patients who underwent mitral valve repair we