SABRINA: an interactive three-dimensional geometry-mnodeling program for MCNP

DOE Office of Scientific and Technical Information (OSTI.GOV)

West, J.T. III

SABRINA is a fully interactive three-dimensional geometry-modeling program for MCNP, a Los Alamos Monte Carlo code for neutron and photon transport. In SABRINA, a user constructs either body geometry or surface geometry models and debugs spatial descriptions for the resulting objects. This enhanced capability significantly reduces effort in constructing and debugging complicated three-dimensional geometry models for Monte Carlo analysis. 2 refs., 33 figs.

Effect of a chronic disease management service for patients with diabetes on hospitalisation and acute care costs.

PubMed

Rasekaba, Tshepo M; Lim, W Kwang; Hutchinson, Anastasia F

2012-05-01

To evaluate the effect of a diabetes-management program for patients with type 2 diabetes and related comorbidities on acute healthcare utilisation and costs. This was a retrospective administrative dataset analysis using data for patients enrolled from 2007 to 2008. Inpatient admissions for diabetes-related conditions were compared before, during and following enrolment. Costs per episode were estimated from Weighted Inlier Equivalent Separations (WIES) funding. A cost model was then developed based on admission rates per 100 patients. Data were retrieved for 357 patients; 49% males, mean age 62 years. The mean per-patient cost of the program was AU$524 (s.d. $213). The mean cost of an inpatient admission was $4357(95% CI 2743-5971) pre-enrolment and $4396 (95% CI 2888-5904) post-enrolment. Following program completion the annual costs (per 100 patients) for managing 'diabetes with multiple complications' and hypoglycaemia decreased from $10181 to $1710 and $9947 to $7800. In contrast, the annual cost of cardiovascular disorders increased from $14485 to $40071 per 100 patients. In the short-term diabetes-management programs for patients with comorbid vascular disease may reduce hospital utilisation for diabetes but not for cardiovascular disease. Longer-term follow-up is needed to determine whether intensive management of vascular complications can reduce costs.

Trauma transitional care coordination: A mature system at work.

PubMed

Hall, Erin C; Tyrrell, Rebecca L; Doyle, Karen E; Scalea, Thomas M; Stein, Deborah M

2018-05-01

We have previously demonstrated effectiveness of a Trauma Transitional Care Coordination (TTCC) Program in reducing 30-day readmission rates for trauma patients most at risk. With program maturation, we achieved improved readmission rates for specific patient populations. TTCC is a nursing driven program that supports patients at high risk for 30-day readmission. The TTCC interventions include calls to patients within 72 hours of discharge, complete medication reconciliation, coordination of medical appointments, and individualized problem solving. Account IDs were used to link TTCC patients with the Health Services Cost Review Commission database to collect data on statewide unplanned 30-day readmissions. Four hundred seventy-five patients were enrolled in the TTCC program from January 2014 to September 2016. Only 10.5% (n = 50) of TTCC enrollees were privately insured, 54.5% had Medicaid (n = 259), and 13.5% had Medicare (n = 64). Seventy-three percent had Health Services Cost Review Commission severity of injury ratings of 3 or 4 (maximum severity of injury = 4). The most common All Patient Refined Diagnosis Related Groups for participants were: lower-extremity procedures (n = 67, 14%); extensive abdominal/thoracic procedures (n = 40, 8.4%); musculoskeletal procedures (n = 37, 7.8%); complicated tracheostomy and upper extremity procedures (n = 29 each, 6.1%); infectious disease complications (n = 14, 2.9%); major chest/respiratory trauma, major small and large bowel procedures and vascular procedures (n = 13 each, 2.7%). The TTCC participants with lower-extremity injury, complicated tracheostomy, and bowel procedures had 6-point reduction (10% vs. 16%, p = 0.05), 11-point reduction (13% vs. 24%, p = 0.05), and 16-point reduction (11% vs. 27%, p = 0.05) in 30-day readmission rates, respectively, compared to those without TTCC. Targeted outpatient support for high-risk patients can decrease 30-day readmission rates. As our TTCC program matured, we reduced 30-day readmission in patients with lower-extremity injury, complicated tracheostomy and bowel procedures. This represents over one million-dollar savings for the hospital per year through quality-based reimbursement. Therapeutic/care management, level III.

Complication Rates, Hospital Size, and Bias in the CMS Hospital-Acquired Condition Reduction Program.

PubMed

Koenig, Lane; Soltoff, Samuel A; Demiralp, Berna; Demehin, Akinluwa A; Foster, Nancy E; Steinberg, Caroline Rossi; Vaz, Christopher; Wetzel, Scott; Xu, Susan

In 2016, Medicare's Hospital-Acquired Condition Reduction Program (HAC-RP) will reduce hospital payments by $364 million. Although observers have questioned the validity of certain HAC-RP measures, less attention has been paid to the determination of low-performing hospitals (bottom quartile) and the assignment of penalties. This study investigated possible bias in the HAC-RP by simulating hospitals' likelihood of being in the worst-performing quartile for 8 patient safety measures, assuming identical expected complication rates across hospitals. Simulated likelihood of being a poor performer varied with hospital size. This relationship depended on the measure's complication rate. For 3 of 8 measures examined, the equal-quality simulation identified poor performers similarly to empirical data (c-statistic approximately 0.7 or higher) and explained most of the variation in empirical performance by size (Efron's R 2 > 0.85). The Centers for Medicare & Medicaid Services could address potential bias in the HAC-RP by stratifying by hospital size or using a broader "all-harm" measure.

Object-Oriented Algorithm For Evaluation Of Fault Trees

NASA Technical Reports Server (NTRS)

Patterson-Hine, F. A.; Koen, B. V.

1992-01-01

Algorithm for direct evaluation of fault trees incorporates techniques of object-oriented programming. Reduces number of calls needed to solve trees with repeated events. Provides significantly improved software environment for such computations as quantitative analyses of safety and reliability of complicated systems of equipment (e.g., spacecraft or factories).

DOE Office of Scientific and Technical Information (OSTI.GOV)

Naylor, G.D.; Marino, G.G.; Shumway, R.C.

Radiation therapy and chemotherapy have decreased the mortality rates of cancer patients, but the morbidity associated with oral complications is high in many cases. A pretreatment oral evaluation and institution of a preventive care program reduce oral symptoms such as glossodynia considerably. When oral symptoms are minimized, the dentist can improve the patient's quality of life.40 references.

Diabetes Health Disparities

PubMed Central

Peek, Monica E.; Cargill, Algernon; Huang, Elbert S.

2008-01-01

Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time. PMID:17881626

Fitness and Mobility Exercise (FAME) Program for stroke

PubMed Central

Eng, Janice J.

2011-01-01

Given the potential of exercise to positively influence so many physical and psychosocial domains, the Fitness and Mobility Exercise (FAME) Program was developed to address the multiple impairments arising from the chronic health condition of stroke. We present the details of this exercise program and the evidence which has shown that the FAME Program can improve motor function (muscle strength, balance, walking), cardiovascular fitness, bone density, executive functions and memory. The FAME Program can help to improve the physical and cognitive abilities of people living with a stroke and reduce the risk of secondary complications such as falls, fractures and heart disease. PMID:22287825

A strategy for reducing turnaround time in design optimization using a distributed computer system

NASA Technical Reports Server (NTRS)

Young, Katherine C.; Padula, Sharon L.; Rogers, James L.

1988-01-01

There is a need to explore methods for reducing lengthly computer turnaround or clock time associated with engineering design problems. Different strategies can be employed to reduce this turnaround time. One strategy is to run validated analysis software on a network of existing smaller computers so that portions of the computation can be done in parallel. This paper focuses on the implementation of this method using two types of problems. The first type is a traditional structural design optimization problem, which is characterized by a simple data flow and a complicated analysis. The second type of problem uses an existing computer program designed to study multilevel optimization techniques. This problem is characterized by complicated data flow and a simple analysis. The paper shows that distributed computing can be a viable means for reducing computational turnaround time for engineering design problems that lend themselves to decomposition. Parallel computing can be accomplished with a minimal cost in terms of hardware and software.

Identification of modifiable factors for reducing readmission after colectomy: a national analysis.

PubMed

Lawson, Elise H; Hall, Bruce Lee; Louie, Rachel; Zingmond, David S; Ko, Clifford Y

2014-05-01

Rates of hospital readmission are currently used for public reporting and pay for performance. Colectomy procedures account for a large number of readmissions among operative procedures. Our objective was to compare the importance of 3 groups of clinical variables (demographics, preoperative risk factors, and postoperative complications) in predicting readmission after colectomy procedures. Patient records (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Patient demographics (n = 2), preoperative risk factors (n = 23), and 30-day postoperative complications (n = 17) were identified from ACS-NSQIP, whereas 30-day postoperative readmissions and costs were determined from Medicare. Multivariable logistic regression models were used to examine risk-adjusted predictors of colectomy readmission. Among 12,981 colectomy patients, the 30-day postoperative readmission rate was 13.5%. Readmitted patients had slightly greater rates of comorbidities and indicators of clinical severity and substantially greater rates of complications than non-readmitted patients. After risk adjustment, patients with a complication were 3.3 times as likely to be readmitted as patients without a complication. Among individual complications, progressive renal failure and organ-space surgical site infection had the highest risk-adjusted relative risks of readmission (4.6 and 4.0, respectively). Demographic, preoperative risk factor, and postoperative complication variables increased the ability to discriminate readmissions (reflected by the c-statistic) by 5.3%, 23.3%, and 35.4%, respectively. Postoperative complications after colectomy are more predictive of readmission than traditional risk factors. Focusing quality improvement efforts on preventing and managing postoperative complications may be the most important step toward reducing readmission rates. Copyright © 2014 Mosby, Inc. All rights reserved.

Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy.

PubMed

Rodriguez-Larrad, Ana; Vellosillo-Ortega, Juan Manuel; Ruiz-Muneta, Carlos; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

2016-07-01

To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Quasi-experimental study. Tertiary referral academic hospital. 208 patients undergoing lobectomy by open thoracotomy. Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

Clinical presentation and complications in patients with unsafe abortions in University of Calabar Teaching Hospital, Calabar, Nigeria.

PubMed

Ekanem, E I; Etuk, S J; Ekabua, J E; Iklaki, C

2009-01-01

Unsafe abortion still contributes significantly to high maternal morbidity and mortality particularly in developing countries despite concerted efforts being made to reduce it. Our objective is to determine the incidence, mode presentation and complications of Unsafe abortion. This prospective study was carried out by directly interviewing patients managed for unsafe abortion over one and half years period (1" June 2003, to 31st' December, 2004) in Maternity Annex of the University of Calabar Teaching Hospital Calabar, Nigeria. Incidence of Unsafe abortion of 27.6% of all gynaecological admissions was established. Most Patients (55.7%) were age 20 30 years while 25.4% were teenagers. There were 33(27.1%) students, 38.2% were single women and 38.5% had secondary education. The major reasons given for terminating the pregnancy included completion of education (25.4%), fear of parental action (18.8%) and in 17.2% the father of the pregnancy was unknown. Medical officers (32.8%) performed majority of the abortions while 10.7% were self induced by the patients themselves. Main complications encountered included retained product of conceptions, haemorrhage, sepsis, injuries to genital tracts and intra-abdomal organs. Unsafe abortion and it complications occurs in all socioeconomic groups. Efforts directed at reducing unintended pregnancy by comprehensive family planning programs and effective emergency post abortal care services will reduce the problem while the legal status of abortion is being debated.

What Are Low-Ranked Graduate Programs Good for?

ERIC Educational Resources Information Center

Cassuto, Leonard

2013-01-01

Professors revel in reputation--and nowhere does that show more clearly than in their concern about educational pedigree. That concern takes complicated forms. The author wondered what might happen if graduate admissions were reduced to a level that would only replace retiring professors. One possible consequence of such a move would be that…

Transfusion risks and transfusion-related pro-inflammatory responses.

PubMed

Despotis, George John; Zhang, Lini; Lublin, Douglas M

2007-02-01

Despite improvements in blood screening and administration techniques, serious adverse events related to transfusion continue to occur, albeit at a much lower incidence. In addition to the development and implementation of new screening and blood purification/modification techniques and implementation of an optimal blood management program, the incidence and consequences of transfusion reactions can be reduced by a basic understanding of transfusion-related complications. Although acute hemolytic transfusion reactions, transfusion-associated anaphylaxis and sepsis, and transfusion-associated acute lung injury occur infrequently, diligence in administration of blood and monitoring for development of respective signs/symptoms can minimize the severity of these potentially life-threatening complications. In addition, emerging blood-banking techniques such as psoralen-UV inactivation of pathogens and use of patient identification systems may attenuate the incidence of adverse events related to transfusion. With respect to optimizing blood management by means of an effective blood management program involving pharmacologic and nonpharmacologic strategies, the ability to reduce use of blood products and to decrease operative time or re-exploration rates has important implications for disease prevention, blood inventory and costs, and overall health care costs.

Geriatric comanagement reduces perioperative complications and shortens duration of hospital stay after lumbar spine surgery: a prospective single-institution experience.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Moreno, Jessica; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-12-01

OBJECTIVE Geriatric patients undergoing lumbar spine surgery have unique needs due to the physiological changes of aging. They are at risk for adverse outcomes such as delirium, infection, and iatrogenic complications, and these complications, in turn, contribute to the risk of functional decline, nursing home admission, and death. Whether preoperative and perioperative comanagement by a geriatrician reduces the incidence of in-hospital complications and length of in-hospital stay after elective lumbar spine surgery remains unknown. METHODS A unique model of comanagement for elderly patients undergoing lumbar fusion surgery was implemented at a major academic medical center. The Perioperative Optimization of Senior Health (POSH) program was launched with the aim of improving outcomes in elderly patients (> 65 years old) undergoing complex lumbar spine surgery. In this model, a geriatrician evaluates elderly patients preoperatively, in addition to performing routine preoperative anesthesia surgical screening, and comanages them daily throughout the course of their hospital stay to manage medical comorbid conditions and coordinate multidisciplinary rehabilitation along with the neurosurgical team. The first 100 cases were retrospectively reviewed after initiation of the POSH protocol and compared with the immediately preceding 25 cases to assess the incidence of perioperative complications and clinical outcomes. RESULTS One hundred twenty-five patients undergoing lumbar decompression and fusion were enrolled in this pilot program. Baseline characteristics were similar between both cohorts. The mean length of in-hospital stay was 30% shorter in the POSH cohort (6.13 vs 8.72 days; p = 0.06). The mean duration of time between surgery and patient mobilization was significantly shorter in the POSH cohort compared with the non-POSH cohort (1.57 days vs 2.77 days; p = 0.02), and the number of steps ambulated on day of discharge was 2-fold higher in the POSH cohort (p = 0.04). Compared with the non-POSH cohort, the majority of patients in the POSH cohort were discharged to home (24% vs 54%; p = 0.01). CONCLUSIONS Geriatric comanagement reduces the incidence of postoperative complications, shortens the duration of in-hospital stay, and contributes to improved perioperative functional status in elderly patients undergoing elective spinal surgery for the correction of adult degenerative scoliosis.

[The microbiology laboratory: a key participant in transplantation].

PubMed

Pérez, José L; Pumarola, Tomàs

2007-04-01

Together with organ rejection, infectious complications are still the most important cause of morbidity and mortality in organ transplant recipients. Many infectious complications have an exogenous origin, including those produced by organ-transmitted pathogens, whereas others are caused by latent microorganisms that become reactivated in the recipient. Accurate pre-transplantation assessment of the organ donor as well as the recipient can prevent some infectious complications or reduce their detrimental effects during the post-transplant period. A wide range of primary and opportunistic microorganisms can affect transplant recipients, and a detailed description of these pathogens is beyond the scope of this study. However, the importance of microbiology laboratories in centers with transplant programs and the need for integration and active participation of clinical microbiologists in multidisciplinary transplant teams should be emphasized. The work of these professionals is a key requisite to establish accurate diagnoses of infectious complications, which will benefit the patient and optimize the expenditure of resources.

Enhanced recovery after surgery in children: Promising, evidence-based multidisciplinary care.

PubMed

Rove, Kyle O; Edney, John C; Brockel, Megan A

2018-06-01

Enhanced recovery after surgery (ERAS) is a multimodal approach to the care of the surgical patient focused on reducing the stress response and associated physiologic changes that accompany surgery. Over the past 20 years, ERAS programs have been found to result in reduced LOS and complications in adult patients. Despite abundant adult literature describing implementation and outcomes of enhanced recovery programs, pediatric data in this area is sparse. This educational review describes the history and elements of ERAS protocols, reviews the available evidence in adult and pediatric populations, compares and contrasts ERAS with the PSH, and offers strategies for implementation and ideas for future directions of ERAS in children. © 2018 John Wiley & Sons Ltd.

Effect of physician education and patient counseling on inpatient nonsurgical percutaneous feeding tube placement rate, indications, and outcome.

PubMed

Swaminath, Arun; Longstreth, George F; Runnman, Eva M; Yang, Su-Jau

2010-02-01

The decision to place a percutaneous feeding tube (PFT) in patients who are at the end of life is multidimensional and often complicated. We assessed the effect of physician education and counseling for patients and their surrogates on inpatient nonsurgical (endoscopic and radiologic) PFT placement rates, indications, complications, and mortality. In a pre-paid group practice, a geriatrician initiated a program of physician education and patient/surrogate counseling on the ethical and nutritional aspects of long-term enteral feeding. We compared rates of nonsurgical PFT placement (excluding those for cancer therapy or gastric decompression), indications, complications, and short- and long-term mortality in adult inpatients before (2004) and after (2005) the program. In 2004 and 2005, 115 and 60 inpatients underwent PFT placement, respectively. The annual number of hospital admissions was similar, but the rate of PFT placement declined (0.80% vs. 0.44%, P < 0.0001). The indications were cerebrovascular accident (42 [37%] versus 22 [37%]), dementia (15 [13%] versus 3 [5%]), other neurological disease (28 [24%] versus 16 [26%]), and miscellaneous disease (30 [26%] versus 19 [32%]); P > 0.05. Severe infectious complications occurred in 4 (3%) versus 0 (0%) patients, P > 0.05. Mortality (2004 versus 2005) at 30 days (23 [20%] versus 11 [18%]), 1 year (62 [54%] versus 29 [48%]) and 2 years (72 [63%] versus 31 [52%]) was similar, P > 0.05. A pilot program of educating referring physicians and counseling patients and their surrogates reduced the rate of inpatient PFT placement by nearly 50%. Indications, severe complications and short- and long-term mortality remained unchanged.

[Laparoscopic "fast-track" sigmoidectomy for diverticulitis disease in Germany. Results of a prospective quality assurance program].

PubMed

Tsilimparis, N; Haase, O; Wendling, P; Kipfmüller, K; Schmid, M; Engemann, R; Schwenk, W

2010-09-01

The natural course of sigmoid colon diverticulitis during conservative therapy and the assessment of the perioperative morbidity after sigmoid colon resection are differently evaluated by surgeons and gastroenterologists. The "fast-track" rehabilitation accelerates the reconvalescence and reduces the rate of postoperative general complications after colorectal surgery. The results of the laparoscopic "Fast-track" sigmoidectomy should be examined within a quality assurance program to better evaluate the perioperative risks following surgical management of diverticulitis. A prospective data collection within the voluntary quality assurance program "fast-track" Kolon II was performed. All participating clinics agreed on a multimodal, evidence-based standard perioperative treatment in terms of a "fast-track" rehabilitation for elective operations for sigmoid diverticulitis. Data from 846 patients undergoing laparoscopic "fast-track" sigmoid colon resection in 23 surgical departments in Germany were collected and evaluated. The mean age of the patients was 63 years (range 23 - 91). 203 patients (24 %) had severe co-morbidities (ASA classification III - IV). A conversion to conventional open surgery was necessary in 51 cases (6 %). Complications occurred in 93 patients (11 %). 76 patients suffered a surgical complication (8.9 %) and 32 patients (3.8 %) a general complication. Two patients died postoperatively due to multi-organ failure following anastomotic leaks. The patients took solid food in median on day 1 after surgery (range, 0 - 5) and passed stool on day 2 (range, 0 - 22). Predefined discharge criteria (free of pain on oral medication, normal oral feeding, stool) were met on day 4 (range, 1 - 58) and the patients were discharged on day 7 (range, 3 - 72). The 30-day re-admission rate was 3.9 %. Patients undergoing laparoscopic "fast-track" sigmoidectomy had a low rate of general complications and had a rapid reconvalescence with a short postoperative in-patient treatment as documented in a german quality assurance program. Copyright Georg Thieme Verlag KG Stuttgart . New York.

Clinical outcomes and cost-effectiveness of strategies for managing people at high risk for diabetes.

PubMed

Eddy, David M; Schlessinger, Leonard; Kahn, Richard

2005-08-16

Lifestyle modification can forestall diabetes in high-risk people, but the long-term cost-effectiveness is uncertain. To estimate the effects of the lifestyle modification program used in the Diabetes Prevention Program (DPP) on health and economic outcomes. Cost-effectiveness analysis using the Archimedes model. Published basic and epidemiologic studies, clinical trials, and Kaiser Permanente administrative data. Adults at high risk for diabetes (body mass index >24 kg/m2, fasting plasma glucose level of 5.2725 to 6.9375 mmol/L [95 to 125 mg/dL], 2-hour glucose tolerance test result of 7.77 to 11.0445 mmol/L [140 to 199 mg/dL]). 5 to 30 years. Patient, health plan, and societal. No prevention, DPP's lifestyle modification program, lifestyle modification begun after a person develops diabetes, and metformin. Diagnosis and complications of diabetes. Compared with no prevention program, the DPP lifestyle program would reduce a high-risk person's 30-year chances of getting diabetes from about 72% to 61%, the chances of a serious complication from about 38% to 30%, and the chances of dying of a complication of diabetes from about 13.5% to 11.2%. Metformin would deliver about one third the long-term health benefits achievable by immediate lifestyle modification. Compared with not implementing any prevention program, the expected 30-year cost/quality-adjusted life-year (QALY) of the DPP lifestyle intervention from the health plan's perspective would be about 143,000 dollars. From a societal perspective, the cost/QALY of the lifestyle intervention compared with doing nothing would be about 62,600 dollars. Either using metformin or delaying the lifestyle intervention until after a person develops diabetes would be more cost-effective, costing about 35,400 dollars or 24,500 dollars per QALY gained, respectively, compared with no program. Compared with delaying the lifestyle program until after diabetes is diagnosed, the marginal cost-effectiveness of beginning the DPP lifestyle program immediately would be about 201,800 dollars. Variability and uncertainty deriving from the structure of the model were tested by comparing the model's results with the results of real clinical trials of diabetes and its complications. The most critical element of uncertainty is the effectiveness of the lifestyle program, as expressed by the 95% CI of the DPP study. The most important potentially controllable factor is the cost of the lifestyle program. Compared with no program, lifestyle modification for high-risk people can be made cost-saving over 30 years if the annual cost of the intervention can be reduced to about 100 dollars. Results depend on the accuracy of the model. Lifestyle modification is likely to have important effects on the morbidity and mortality of diabetes and should be recommended to all high-risk people. The program used in the DPP study may be too expensive for health plans or a national program to implement. Less expensive methods are needed to achieve the degree of weight loss seen in the DPP.

Duty hour restrictions and surgical complications for head and neck key indicator procedures.

PubMed

Smith, Aaron; Jain, Nikhita; Wan, Jim; Wang, Lei; Sebelik, Merry

2017-08-01

Graduate medical education has traditionally required long work hours, allowing trainees little time for adequate rest. Based on concerns over performance deterioration with sleep deprivation and its effect on patient outcomes, duty hour restrictions have been mandated. We sought to characterize complications from otolaryngology key indicator procedures performed before and after duty hour reform. Retrospective cross-sectional analysis of National Inpatient Sample (NIS). The NIS was queried for procedure codes associated with head and neck key indicator groupings for the years 2000-2002 (45,363 procedures) and 2006-2008 (51,144 procedures). Hospitals were divided into three groups: nonteaching hospitals (NTH), teaching hospitals without otolaryngology programs (TH), and teaching hospitals with otolaryngology programs (TH-OTO). Surgical complication rates, length of stay, and mortality rates were analyzed using logistic and linear regression. The number of procedures increased (12.7%), with TH-OTO contributing more in postrestriction years (21% to 30%). Overall complication rates between the two periods revealed no difference, regardless of hospital setting. Subset analysis showed some variation within each complication within each grouping. Length of stay increased at TH-OTO (2.75 to 2.78 days) and decreased at NTH (2.28 to 2.24 days) and TH (2.39 to 2.36 days). Mortality did not increase among the three hospital types (NTH, P < .58; TH, P < .96; TH-OTO, P < .06). During the latter period, TH-OTO procedures showed lower mortality (P < .0038, odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.27-0.77). Increasing Charlson comorbidity index increased overall mortality rate (P < .0001, OR = 2.63, 95% CI = 2.4-2.89). Overall complication rates did not change for head and neck key indicator procedures. Moreover, concerns about reduced surgical case numbers appear unfounded, especially for otolaryngology programs. 2c Laryngoscope, 127:1797-1803, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Competence of birth attendants at providing emergency obstetric care under India’s JSY conditional cash transfer program for institutional delivery: an assessment using case vignettes in Madhya Pradesh province

PubMed Central

2014-01-01

Background Access to emergency obstetric care by competent staff can reduce maternal mortality. India has launched the Janani Suraksha Yojana (JSY) conditional cash transfer program to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries-from 40% in 2004 to 73% in 2012. However, maternal mortality reduction follows a secular trend. Competent management of complications, when women deliver in facilities under the JSY, is essential for reduction in maternal mortality and therefore to a successful program outcome. We investigate, using clinical vignettes, whether birth attendants at institutions under the program are competent at providing appropriate care for obstetric complications. Methods A facility based cross-sectional study was conducted in three districts of Madhya Pradesh (MP) province. Written case vignettes for two obstetric complications, hemorrhage and eclampsia, were administered to 233 birth attendant nurses at 73 JSY facilities. Their competence at (a) initial assessment, (b) diagnosis, and (c) making decisions on appropriate first-line care for these complications was scored. Results The mean emergency obstetric care (EmOC) competence score was 5.4 (median = 5) on a total score of 20, and 75% of participants scored below 35% of the maximum score. The overall score, although poor, was marginally higher in respondents with Skilled Birth Attendant (SBA) training, those with general nursing and midwifery qualifications, those at higher facility levels, and those conducting >30 deliveries a month. In all, 14% of respondents were competent at assessment, 58% were competent at making a correct clinical diagnosis, and 20% were competent at providing first-line care. Conclusions Birth attendants in the JSY facilities have low competence at EmOC provision. Hence, births in the JSY program cannot be considered to have access to competent EmOC. Urgent efforts are required to effectively increase the competence of birth attendants at managing obstetric complications in order to translate large gains in coverage of institutional delivery services under JSY into reductions in maternal mortality in Madhya Pradesh, India. PMID:24885817

Which postoperative complications matter most after bariatric surgery? Prioritizing quality improvement efforts to improve national outcomes.

PubMed

Daigle, Christopher R; Brethauer, Stacy A; Tu, Chao; Petrick, Anthony T; Morton, John M; Schauer, Philip R; Aminian, Ali

2018-05-01

National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. To quantify the impact of specific bariatric surgery complications on key clinical outcomes. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery VTE has the greatest potential to reduce mortality and readmission rates. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Transtracheal oxygen therapy.

PubMed

Christopher, Kent L; Schwartz, Michael D

2011-02-01

Transtracheal oxygen therapy (TTO) has been used for long-term oxygen therapy for nearly 30 years. Numerous investigators have explored the potential benefits of TTO. Those results are reviewed in this article. TTO is best viewed not as a catheter but as a program for care. This article discusses patient selection for TTO. Publications evaluating complications are reviewed. In the past, a modified Seldinger technique (MST) was used for the creation of the tracheocutaneous fistula. The rather long program required for tract maturation with MST was labor-intensive and required substantial patient education and monitoring, particularly during the immature tract phase. Minor complications were not infrequent. More recently, the Lipkin method has been used to create a surgical tract under conscious sedation with topical anesthesia. The procedure is safe and well tolerated. Transtracheal oxygen is initiated the day following the procedure. Similarly, the tract matures in 7 to 10 days rather than the 6 to 8 weeks with MST. More rapid healing time and superior tract characteristics substantially reduce complications. The TTO program tailored for the Lipkin procedure is shortened, streamlined, and much less labor-intensive. Optimal outcomes with the TTO program require a committed pulmonologist, respiratory therapist, nurse, and surgeon (for the Lipkin procedure). This article discusses new directions in the use of transtracheal gas delivery, including the management of obstructive sleep apnea. Preliminary investigations regarding transtracheal augmented ventilation are presented. These include nocturnal use in severe chronic lung disease and liberation from prolonged mechanical ventilation.

Improved Real-Time Monitoring Using Multiple Expert Systems

NASA Technical Reports Server (NTRS)

Schwuttke, Ursula M.; Angelino, Robert; Quan, Alan G.; Veregge, John; Childs, Cynthia

1993-01-01

Monitor/Analyzer of Real-Time Voyager Engineering Link (MARVEL) computer program implements combination of techniques of both conventional automation and artificial intelligence to improve monitoring of complicated engineering system. Designed to support ground-based operations of Voyager spacecraft, also adapted to other systems. Enables more-accurate monitoring and analysis of telemetry, enhances productivity of monitoring personnel, reduces required number of such personnel by performing routine monitoring tasks, and helps ensure consistency in face of turnover of personnel. Programmed in C language and includes commercial expert-system software shell also written in C.

Women-focused development intervention reduces delays in accessing emergency obstetric care in urban slums in Bangladesh: a cross-sectional study.

PubMed

Nahar, Shamsun; Banu, Morsheda; Nasreen, Hashima E

2011-01-30

Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC. This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed. The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities. Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

Effect Of Preoperative Intravenous Steroids On Seroma Formation After Modified Radical Mastectomy.

PubMed

Khan, Maryam Alam

2017-01-01

With the steep increase in breast cancer incidence globally and regionally, there has been a trend toward reducing patient morbidity by meticulous surgical techniques to obviate complications like seroma formation; use to pre-operative steroids seems to be convenient, cost effective and shows promising results in trials. This randomized clinical trial was conducted at Surgical Department of Khyber Teaching Hospital Peshawar, from January 2012 to April 2014 on 65 patients randomly allocated to Group A and Group B using lottery method. Group A underwent MRM+AD in the conventional manner while Group B received a 120 mg of injection Depomedrol intravenously 1 hour before the surgery. The two were compared in terms of total drainage, days of drainage, wound complications and incidence of seroma. Data was entered and analysed using statistical program SPSS-21. The mean age in group A was 34.2±10.1 years and B was 32.3±9.1 years. The mean drainage in intervention group was significantly reduced as compared to control group (755.4±65ml vs 928.3±102.5). Total drainage days were reduced (6.5±1.6 days vs 10.2±2.2 days) and incidence of seroma was also reduced (A=18.75% vs B=6.06%). However, three patients in group B had wound infection. Seroma formation is the most common complication of Mastectomy and among the methods used to reduce its incidence, steroid administration seems to be the most cost effective and shows promising results.

Cost-benefit and extended cost-effectiveness analysis of a comprehensive adolescent pregnancy prevention program in Zambia: study protocol for a cluster randomized controlled trial.

PubMed

Mori, Amani Thomas; Kampata, Linda; Musonda, Patrick; Johansson, Kjell Arne; Robberstad, Bjarne; Sandøy, Ingvild

2017-12-19

Early marriages, pregnancies and births are the major cause of school drop-out among adolescent girls in sub-Saharan Africa. Birth complications are also one of the leading causes of death among adolescent girls. This paper outlines a protocol for a cost-benefit analysis (CBA) and an extended cost-effectiveness analysis (ECEA) of a comprehensive adolescent pregnancy prevention program in Zambia. It aims to estimate the expected costs, monetary and non-monetary benefits associated with health-related and non-health outcomes, as well as their distribution across populations with different standards of living. The study will be conducted alongside a cluster-randomized controlled trial, which is testing the hypothesis that economic support with or without community dialogue is an effective strategy for reducing adolescent childbearing rates. The CBA will estimate net benefits by comparing total costs with monetary benefits of health-related and non-health outcomes for each intervention package. The ECEA will estimate the costs of the intervention packages per unit health and non-health gain stratified by the standards of living. Cost data include program implementation costs, healthcare costs (i.e. costs associated with adolescent pregnancy and birth complications such as low birth weight, pre-term birth, eclampsia, medical abortion procedures and post-abortion complications) and costs of education and participation in community and youth club meetings. Monetary benefits are returns to education and averted healthcare costs. For the ECEA, health gains include reduced rate of adolescent childbirths and non-health gains include averted out-of-pocket expenditure and financial risk protection. The economic evaluations will be conducted from program and societal perspectives. While the planned intervention is both comprehensive and expensive, it has the potential to produce substantial short-term and long-term health and non-health benefits. These benefits should be considered seriously when evaluating whether such a program can justify the required investments in a setting with scarce resources. The economic evaluations outlined in this paper will generate valuable information that can be used to guide large-scale implementation of programs to address the problem of the high prevalence of adolescent childbirth and school drop-outs in similar settings. ClinicalTrials.gov, NCT02709967. Registered on 2 March 2016. ISRCTN, ISRCTN12727868. Registered on 4 March 2016.

Determinants of pediatric cataract program outcomes and follow-up in a large series in Mexico.

PubMed

Congdon, Nathan G; Ruiz, Sergio; Suzuki, Maki; Herrera, Veronica

2007-10-01

To report determinants of outcomes and follow-up in a large Mexican pediatric cataract project. Hospital Luis Sanchez Bulnes, Mexico City, Mexico. Data were collected prospectively from a pediatric cataract surgery program at the Hospital Luis Sanchez Bulnes, implemented by Helen Keller International. Preoperative data included age, sex, baseline visual acuity, type of cataract, laterality, and presence of conditions such as amblyopia. Surgical data included vitrectomy, capsulotomy, complications, and use of intraocular lenses (IOLs). Postoperative data included final visual acuity, refraction, number of follow-up visits, and program support for follow-up. Of 574 eyes of 415 children (mean age 7.1 years +/- 4.7 [SD]), IOLs were placed in 416 (87%). At least 1 follow-up was attended by 408 patients (98.3%) (mean total follow-up 3.5 +/- 1.8 months); 40% of eyes achieved a final visual acuity of 6/18 or better. Children living farther from the hospital had fewer postoperative visits (P = .04), while children receiving program support had more visits (P = .001). Factors predictive of better acuity included receiving an IOL during surgery (P = .04) and provision of postoperative spectacles (P = .001). Predictive of worse acuity were amblyopia (P = .003), postoperative complications (P = .0001), unilateral surgery (P = .0075), and female sex (P = .045). The results underscore the importance of surgical training in reducing complications, early intervention before amblyopia (observed in 40% of patients) can develop, and vigorous treatment if amblyopia is present. The positive impact of program support on follow-up is encouraging, although direct financial support may pose a problem for sustainability. More work is needed to understand reasons for worse outcomes in girls.

The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care.

PubMed

Ouslander, Joseph G; Bonner, Alice; Herndon, Laurie; Shutes, Jill

2014-03-01

Interventions to Reduce Acute Care Transfers (INTERACT) is a publicly available quality improvement program that focuses on improving the identification, evaluation, and management of acute changes in condition of nursing home residents. Effective implementation has been associated with substantial reductions in hospitalization of nursing home residents. Familiarity with and support of program implementation by medical directors and primary care clinicians in the nursing home setting are essential to effectiveness and sustainability of the program over time. In addition to helping nursing homes prevent unnecessary hospitalizations and their related complications and costs, and thereby continuing to be or becoming attractive partners for hospitals, health care systems, managed care plans, and accountable care organizations, effective INTERACT implementation will assist nursing homes in meeting the new requirement for a robust quality assurance performance improvement program, which is being rolled out by the federal government over the next year. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Association of assisted reproductive technology with adverse pregnancy outcomes

PubMed Central

Jie, Zhang; Yiling, Ding; Ling, Yu

2015-01-01

Background: More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC). Objective: The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes. Materials and Methods: In this prospective population-based cohort study,3216 pregnant women with gestational age ≤12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications. Results: When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP. Conclusion: ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe. PMID:26000008

[A reduction in the invasiveness during surgical revascularization: the harvesting of the great saphenous vein by a video endoscopic technic].

PubMed

Terrini, A; Graffigna, A; Martinelli, L

2000-05-01

The authors report their preliminary experience of endoscopic saphenous vein harvesting as part of a program devoted to reducing the invasivity of surgical myocardial revascularization. This method allows us to minimize the cutaneous incisions in the inferior limbs necessary to harvest the saphenous vein, thus reducing the incidence of complications. The study includes 41 patients who underwent endoscopic saphenous vein harvesting from October 1998 to September 1999 and, as a control group, 20 patients with similar characteristics operated on with the traditional technique during the same period. The variables considered were: the time necessary to harvest the saphenous vein, the incidence of complications, and the postoperative mobilization. All the endoscopically harvested grafts were adequate for the scheduled procedure. The only complication occurred in a patient operated on with the traditional technique. The time of harvesting and the day of mobilization were similar in the two groups. The reduction of surgical trauma allowed a fast deambulation recovery and better esthetic results. When complete arterial revascularization is not feasible, the endoscopic harvesting of the required saphenous vein segment allows for a significant reduction in the invasivity of the procedure.

[Psychoprophylaxis and the rate of cesarean section].

PubMed

Oyuela-García, Juana; Hernández-Herrera, Ricardo Jorge

2010-01-01

The psychoprophylactic programs (PPP) have been widely used in women to face the fear-tension-pain cycle, reducing anxiety and pain during labour. The aim was to demonstrate if a PPP reduces the caesarean rate. 300 low risk pregnant women were included; 100 in the PPP group and 200 in the control group. The PPP participants attended theory and practical sessions; they visited labor, delivery, recovery and hospitalization areas. Chi-square, Student's t test and odds ratio were applied. Pregnancy ended by caesarean section in 35/100 of PPP group and in 99/200 (49.5%) in control group (p < 0.02, OR = 1.8, IC = 1.1-2.9). Maternal complications occurred in 13/100 in the PPP group, and 42/200 (21%) in control group (p = 0.09, RM = 0.56). The newborn (NB) complications were observed in 9/100 in PPP and 46/200 (23%) in control group (p < 0.02, OR = 0.33). In the PPP group, 70% assisted to three or more sessions. Hospital stance in control group, accumulated 17 days more in mothers and 171 days more in NB than in the PPP group. In PPP group observed a caesarean rate reduction with fewer maternal and perinatal complications.

[Accelerated recovery program after hip fracture surgery].

PubMed

Rasmussen, Sten; Kristensen, Billy B; Foldager, Susanne; Myhrmann, Lis; Kehlet, Henrik

2002-12-30

A multimodal approach to minimise the effect of the surgical stress response can reduce complications and hospital stay after abdominal surgery and hip arthroplasty. The aim of the study was to assess the results of a well-defined rehabilitation programme after hip fracture. In an open intervention study, we entered 200 consecutive patients with hip fracture allowing full weight-bearing after operative treatment. The effect of a revised, optimised perioperative care programme with continuous epidural analgesia, early oral nutrition, oxygen supplementation, restricted volume and transfusion therapy, and intensive physiotherapy and mobilisation was assessed (n = 100) and compared with the conventional perioperative treatment programme before the intervention (n = 100). The median age was 82 (56-96) years in the control group and 82 (63-101) years in the accelerated multimodal perioperative treatment group. The median hospital stay was reduced from 21 (range 1-162, mean 32) to 11 (range 1-100, mean 17) days. The total use of days in hospital was reduced from 3211 to 1667. There were fewer complications, whereas the need for home care after discharge was unchanged. An accelerated clinical pathway with focus on pain relief, oral nutrition, and rehabilitation may reduce hospital stay and improve recovery after hip fracture.

Emergency medicine tools to manage smallpox (vaccinia) vaccination complications: clinical practice guideline and policies and procedures.

PubMed

Thorne, Craig D; Hirshon, Jon Mark; Himes, Carrie D; McDiarmid, Melissa A

2003-11-01

In December 2002, the federal government began a program to immunize approximately 500000 civilian public health and health care workers with smallpox (vaccinia) vaccine as a part of our pre-event defense against bioterrorism. First responders will likely follow, and the general US population might be offered vaccination in the next 1 to 2 years. Recent reports that suggest the possible association of the vaccine to adverse cardiac events (including deaths), liability concerns for hospitals, and the availability of compensation for workers with vaccine complications have significantly reduced voluntary participation. Vaccinees might experience robust primary takes or serious adverse events, including viral or even bacterial cellulitides, encephalitis, progressive skin destruction, and other life-threatening complications. With the increasing prevalence of immune suppression from both diseases and immunosuppressive medications, complications might be seen in higher frequency than previously reported. Emergency medicine providers and staff must become familiar with clinical presentations and management of vaccine complications. In addition, policies and procedures must be developed to prevent unimmunized providers from inadvertently contacting the active vaccination sites of their patients and, if the providers themselves have active vaccination sites, to protect their patients and their own families.

School Meal Programs: Changes to Federal Agencies' Procedures Could Reduce Risk of School Children Consuming Recalled Food. Report to Congressional Requesters. GAO-09-649

ERIC Educational Resources Information Center

US Government Accountability Office, 2009

2009-01-01

Over the past few years, several food recalls, such as for beef and peanut products, have affected schools. It is especially important that recalls affecting schools be carried out efficiently and effectively because young children have a higher risk of complications from food-borne illnesses. GAO was asked to determine how federal agencies (1)…

Impact of a colorectal enhanced recovery program implementation on clinical outcomes and institutional costs: A prospective cohort study with retrospective control.

PubMed

Portinari, Mattia; Ascanelli, Simona; Targa, Simone; Dos Santos Valgode, Elisabete Maria; Bonvento, Barbara; Vagnoni, Emidia; Camerani, Stefano; Verri, Marco; Volta, Carlo Alberto; Feo, Carlo V

2018-05-01

The enhanced recovery program for perioperative care of the surgical patient reduces postoperative metabolic response and organ dysfunction, accelerating functional recovery. The aim of this study was to determine the impact on postoperative recovery and cost-effectiveness of implementing a colorectal enhanced recovery program in an Italian academic centre. A prospective series of consecutive patients (N = 100) undergoing elective colorectal resection completing a standardized enhanced recovery program in 2013-2015 (ERP group) was compared to patients (N = 100) operated at the same institution in 2010-2011 (Pre-ERP group) before introducing the program. The exclusion criteria were: >80 years old, ASA score of IV, a stage IV TNM, and diagnosis of inflammatory bowel disease. The primary outcome was hospital length of stay which was used as a proxy of functional recovery. Secondary outcomes included: postoperative complications, 30-day readmission and mortality, protocol adherence, nursing workload, cost-effectiveness, and factors predicting prolonged hospital stay. The ERP group patient satisfaction was also evaluated. Hospital stay was significantly reduced in the ERP versus the Pre-ERP group (4 versus 8 days) as well as nursing workload, with no increase in postoperative complications, 30-day readmission or mortality. ERP group protocol adherence (81%) and patient satisfaction were high. Conventional perioperative protocol was the only independent predictor of prolonged hospital stay. Total mean direct costs per patient were significantly higher in the Pre-ERP versus the ERP group (6796.76 versus 5339.05 euros). Implementing a colorectal enhanced recovery program is feasible, efficient for functional recovery and hospital stay reduction, safe, and cost-effective. High patient satisfaction and nursing workload reduction may also be expected, but high protocol adherence is necessary. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Evaluation of high myopia complications prevention program in university freshmen

PubMed Central

Tseng, Gow-Lieng; Chen, Cheng-Yu

2016-01-01

Abstract High myopia is a global eye health problem because of its high incidence of sight-threatening complications. Due to the role of awareness, self-examination, and preventive behavior in prevention of morbidity of high myopia complications, promoting knowledge, capabilities, and attitude of high myopic personnel are required in this regard. In this quasi-experiment study, 31 freshmen with high myopia in a national university were enrolled in 2014. The data were collected by validated and reliable questionnaire based on health belief model (HBM) and self-efficacy theory. The intervention program consisted of 1 educational session lasting 150 minutes by lecturing of high myopia complications, virtual reality experiencing, similarity modeling, and quibbling a film made on high myopia complications preventive concepts. Implementing the educational program showed immediate effect in knowledge, perceived susceptibility, perceived severity, self-efficacy, and preventive behavior intention. While 6 weeks after the educational program, significant increases were observed in cues to action, self-efficacy, and preventive behavior intention. This article provided that, after a single session, there was positive improvement in high myopia complication prevention behavior intention among participants. These positive effects confirmed the efficacy of the education program and will probably induce behavior change. PMID:27749586

Evaluation of high myopia complications prevention program in university freshmen.

PubMed

Tseng, Gow-Lieng; Chen, Cheng-Yu

2016-10-01

High myopia is a global eye health problem because of its high incidence of sight-threatening complications. Due to the role of awareness, self-examination, and preventive behavior in prevention of morbidity of high myopia complications, promoting knowledge, capabilities, and attitude of high myopic personnel are required in this regard.In this quasi-experiment study, 31 freshmen with high myopia in a national university were enrolled in 2014. The data were collected by validated and reliable questionnaire based on health belief model (HBM) and self-efficacy theory. The intervention program consisted of 1 educational session lasting 150 minutes by lecturing of high myopia complications, virtual reality experiencing, similarity modeling, and quibbling a film made on high myopia complications preventive concepts.Implementing the educational program showed immediate effect in knowledge, perceived susceptibility, perceived severity, self-efficacy, and preventive behavior intention. While 6 weeks after the educational program, significant increases were observed in cues to action, self-efficacy, and preventive behavior intention.This article provided that, after a single session, there was positive improvement in high myopia complication prevention behavior intention among participants. These positive effects confirmed the efficacy of the education program and will probably induce behavior change.

Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

PubMed

Chaudhary, Muhammad Ali; Lange, Jeffrey K; Pak, Linda M; Blucher, Justin A; Barton, Lauren B; Sturgeon, Daniel J; Koehlmoos, Tracey; Haider, Adil H; Schoenfeld, Andrew J

2018-05-22

Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%. We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA. An analysis of adult TRICARE beneficiaries who underwent TJA (2006-2014) was performed. TRICARE is the insurance program of the Department of Defense, covering > 9 million beneficiaries. ED use within 90 days of surgery was the primary outcome and postoperative outpatient orthopaedic care the primary explanatory variable. Patient demographics (age, sex, race, beneficiary category), clinical characteristics (length of hospital stay, prior comorbidities, complications), and environment of care were used as covariates. Logistic regression adjusted for all covariates was performed to determine factors associated with ED use. We found that orthopaedic outpatient care (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68-0.77) was associated with lower odds of ED use within 90 days. We also found that index hospital length of stay (OR, 1.07; 95% CI, 1.04-1.10), medical comorbidities (OR, 1.16; 95% CI, 1.08-1.24), and complications (OR, 2.47; 95% CI, 2.24-2.72) were associated with higher odds of ED use. When considering that at 90 days, only 3928 patients sustained a complication, a substantial number of ED visits (11,486 of 15,414 [75%]) after TJA may be avoidable. Enhancing access to appropriate outpatient care with improved discharge planning may reduce ED use after TJA. Further research should be directed toward unpacking the situations, outside of complications, that drive patients to access the ED and devise interventions that could mitigate such behavior. Level III, therapeutic study.

[Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program].

PubMed

Pérez-Cuevas, Ricardo; Jasso Gutiérrez, Luis; Doubova, Svetlana; Flores Hernández, Sergio; Mantilla Trollé, Clara; González Guerra, Eduardo; Muñoz Hernández, Onofre

Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Health Risk Reduction Programs in Employer-Sponsored Health Plans: Part I—Efficacy

PubMed Central

Rothstein, Mark A.; Harrell, Heather L.

2011-01-01

Objective We sought to determine whether workplace health risk reduction programs (HRRPs) using health risk assessments (HRAs), individually focused risk reduction, and financial incentives succeeded in improving employee health and reducing employer health benefit costs. Methods We reviewed the proprietary HRA available to us and conducted a literature review to determine the efficacy of HRRPs using HRAs, individualized employee interventions, and financial incentives for employee participation. Results There is some evidence that HRRPs in employer-sponsored programs improve measures of employee health, but the results of these studies are somewhat equivocal. Conclusion Employer-sponsored HRRPs may have some benefits, but problems in plan design and in the studies assessing their efficacy complicate drawing conclusions. PMID:19625972

A multi-institutional, propensity-score-matched comparison of post-operative outcomes between general anesthesia and monitored anesthesia care with intravenous sedation in umbilical hernia repair.

PubMed

Vu, M M; Galiano, R D; Souza, J M; Du Qin, C; Kim, J Y S

2016-08-01

Monitored anesthesia care with intravenous sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of oversedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005-2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals.

PubMed

Govaert, J A; Fiocco, M; van Dijk, W A; Scheffer, A C; de Graaf, E J R; Tollenaar, R A E M; Wouters, M W J M

2015-08-01

Healthcare providers worldwide are struggling with rising costs while hospitals budgets are under stress. Colorectal cancer surgery is commonly performed, however it is associated with a disproportionate share of adverse events in general surgery. Since adverse events are associated with extra hospital costs it seems important to explicitly discuss the costs of complications and the risk factors for high-costs after colorectal surgery. Retrospective analysis of clinical and financial outcomes after colorectal cancer surgery in 29 Dutch hospitals (6768 patients). Detailed clinical data was derived from the 2011-2012 population-based Dutch Surgical Colorectal Audit database. Costs were measured uniform in all participating hospitals and based on Time-Driven Activity-Based Costing. Of total hospital costs in this study, 31% was spent on complications and the top 5% most expensive patients were accountable for 23% of hospitals budgets. Minor and severe complications were respectively associated with a 26% and 196% increase in costs as compared to patients without complications. Independent from other risk factors, ASA IV, double tumor, ASA III, short course preoperative radiotherapy and TNM-4 stadium disease were the top-5 attributors to high costs. This article shows that complications after colorectal cancer surgery are associated with a substantial increase in costs. Although not all surgical complications can be prevented, reducing complications will result in considerable cost savings. By providing a business case we show that investments made to develop targeted quality improvement programs will pay off eventually. Results based on this study should encourage healthcare providers to endorse quality improvement efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Flexible Architecture for FPGAs in Embedded Systems

NASA Technical Reports Server (NTRS)

Clark, Duane I.; Lim, Chester N.

2012-01-01

Commonly, field-programmable gate arrays (FPGAs) being developed in cPCI embedded systems include the bus interface in the FPGA. This complicates the development because the interface is complicated and requires a lot of development time and FPGA resources. In addition, flight qualification requires a substantial amount of time be devoted to just this interface. Another complication of putting the cPCI interface into the FPGA being developed is that configuration information loaded into the device by the cPCI microprocessor is lost when a new bit file is loaded, requiring cumbersome operations to return the system to an operational state. Finally, SRAM-based FPGAs are typically programmed via specialized cables and software, with programming files being loaded either directly into the FPGA, or into PROM devices. This can be cumbersome when doing FPGA development in an embedded environment, and does not have an easy path to flight. Currently, FPGAs used in space applications are usually programmed via multiple space-qualified PROM devices that are physically large and require extra circuitry (typically including a separate one-time programmable FPGA) to enable them to be used for this application. This technology adds a cPCI interface device with a simple, flexible, high-performance backend interface supporting multiple backend FPGAs. It includes a mechanism for programming the FPGAs directly via the microprocessor in the embedded system, eliminating specialized hardware, software, and PROM devices and their associated circuitry. It has a direct path to flight, and no extra hardware and minimal software are required to support reprogramming in flight. The device added is currently a small FPGA, but an advantage of this technology is that the design of the device does not change, regardless of the application in which it is being used. This means that it needs to be qualified for flight only once, and is suitable for one-time programmable devices or an application specific integrated circuit (ASIC). An application programming interface (API) further reduces the development time needed to use the interface device in a system.

A comprehensive postpartum follow-up health care program for women with history of preeclampsia: protocol for a mixed methods research.

PubMed

Kamravamanesh, Mastaneh; Kohan, Shahnaz; Rezavand, Negin; Farajzadegan, Ziba

2018-05-18

Long-term postpartum follow-up is of great importance since women with preeclampsia history are at high risk of upcoming health complications. However, postpartum follow-up rates are poor. According to evidences, preeclampsia is not just a transient health problem; rather it causes short term and long term complications, which affect women's life for years after delivery. Although it seems the problem is solved by the end of pregnancy, the follow-up of subjects should not be stopped after delivery. Postpartum is the best possible time to provide necessary care to these women who are at the risk of future complications. Due to importance of well-designed follow-up plan for women suffering preeclampsia, this study will carry out to provide a postpartum follow-up health care program for subjected women. This study is a qualitative-quantitative mixed sequencing exploratory study that consists of three consecutive phases. In this study, following a qualitative approach, the researcher will explain the needs and strategies related to promoting the health of women with preeclampsia history in the postpartum period. By entering the second phase, the researcher will design a comprehensive follow-up health care program in the postpartum period in which, in addition to using the qualitative study results, related papers and texts will be also used. The proposed program is designed by a panel of experts based on prioritization guidelines. Finally, after passing different stages of program finalizing, its effectiveness on the lifestyle of women with preeclampsia history will be investigated in a semi-experimental study in the third phase of the study. It is expected conducting a mixed method study to design and execute an interventional program to follow up women with preeclampsia history improve their health status and well-being, while reducing their health care costs through prevention in various levels within the current structure of health care services. If this program is effective, it could be included in the postpartum health care guidelines. IRCT20170927036445N2 Registered 10 March 2018.

The Effect of Smoking on Thirty-Day Postoperative Complications After Total Joint Arthroplasty: A Propensity Score-Matched Analysis.

PubMed

Sahota, Shawn; Lovecchio, Francis; Harold, Ryan E; Beal, Matthew D; Manning, David W

2018-01-01

Total joint arthroplasty (TJA) is a highly successful treatment, but is burdensome to the national healthcare budget. National quality initiatives seek to reduce costly complications. Smoking's role in perioperative complication after TJA is less well known. This study aims to identify smoking's independent contribution to the risk of short-term complication after TJA. All patients undergoing primary TJA between 2011 and 2012 were selected from the American College of Surgeon's National Surgical Quality Improvement Program's database. Outcomes of interest included rates of readmission, reoperation, mortality, surgical complications, and medical complications. To eliminate confounders between smokers and nonsmokers, a propensity score was used to generate a 1:1 match between groups. A total of 1251 smokers undergoing TJA met inclusion criteria. Smokers in the combined total hip and knee arthroplasty cohort had higher 30-day readmission (4.8% vs 3.2%, P = .041), were more likely to have a surgical complication (odds ratio 1.84, 95% confidence interval 1.21-2.80), and had a higher rate of deep surgical site infection (SSI) (1.1% vs 0.2%, P = .007). Analysis of total hip arthroplasty only revealed that smokers had higher rates of deep SSI (1.3% vs 0.2%, P = .038) and higher readmission rate (4.3% vs 2.2%, P = .034). Analysis of total knee arthroplasty only revealed greater surgical complications (2.8% vs 1.2%, P = .048) and superficial SSI (1.8% vs 0.2%, P = .002) in smokers. Smoking in TJA is associated with higher rates of SSI, surgical complications, and readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

Chronic case management: Clinical governance with cost reductions.

PubMed

Costa, Élide Sbardellotto Mariano da; Hyeda, Adriano

2016-01-01

With increasing global impact of chronic degenerative non-communicable diseases (CDNCD), multidisciplinary chronic disease management care programs (CDMCP) come as a solution to improve the quality of patients care. We conducted a cross-sectional epidemiologic prospective cohort study with data comparing a group of patients monitored by a CDMCP with subjects without CDMCP care, from 2010 to 2012. The patients monitored in this program were selected because they presented CDNCD with frequent hospitalization and/or emergency care in the year prior to study selection. Also, the patients could be referred to the program by their physicians and/or other programs such as HomeCare or family medicine. All costs related to the program were included and compared with the costs of users with the same epidemiological profile who opted for not participating in the CDMCP. We analyzed data from 1,256 cases, including 639 (51%) men and 617 (49%) women. The mean age was 56.99 years and 73% were older than 50 years. There was a prevalence of 34% (428) cases with ischemic heart disease (myocardial infarction and stroke) and 17% (210) with neoplasms. The cases studied showed a reduction of 79% in the number of days of hospitalization compared with the cases without CDMCP monitoring. The average reduction of total costs (hospitalizations, emergency room visits and/or disease complications) was 31.94%, with average reduction of 8.36% in monthly costs. Multidisciplinary monitoring carried out by CDNCD patient management programs can reduce hospitalizations, emergency room visits and complications, positively impacting the costs with health care.

The Michigan Surgical Home and Optimization Program is a scalable model to improve care and reduce costs.

PubMed

Englesbe, Michael J; Grenda, Dane R; Sullivan, June A; Derstine, Brian A; Kenney, Brooke N; Sheetz, Kyle H; Palazzolo, William C; Wang, Nicholas C; Goulson, Rebecca L; Lee, Jay S; Wang, Stewart C

2017-06-01

The Michigan Surgical Home and Optimization Program is a structured, home-based, preoperative training program targeting physical, nutritional, and psychological guidance. The purpose of this study was to determine if participation in this program was associated with reduced hospital duration of stay and health care costs. We conducted a retrospective, single center, cohort study evaluating patients who participated in the Michigan Surgical Home and Optimization Program and subsequently underwent major elective general and thoracic operative care between June 2014 and December 2015. Propensity score matching was used to match program participants to a control group who underwent operative care prior to program implementation. Primary outcome measures were hospital duration of stay and payer costs. Multivariate regression was used to determine the covariate-adjusted effect of program participation. A total of 641 patients participated in the program; 82% were actively engaged in the program, recording physical activity at least 3 times per week for the majority of the program; 182 patients were propensity matched to patients who underwent operative care prior to program implementation. Multivariate analysis demonstrated that participation in the Michigan Surgical Home and Optimization Program was associated with a 31% reduction in hospital duration of stay (P < .001) and 28% lower total costs (P < .001) after adjusting for covariates. A home-based, preoperative training program decreased hospital duration of stay, lowered costs of care, and was well accepted by patients. Further efforts will focus on broader implementation and linking participation to postoperative complications and rigorous patient-reported outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

A CCTV system with SMS alert (CMDSA): An implementation of pixel processing algorithm for motion detection

NASA Astrophysics Data System (ADS)

Rahman, Nurul Hidayah Ab; Abdullah, Nurul Azma; Hamid, Isredza Rahmi A.; Wen, Chuah Chai; Jelani, Mohamad Shafiqur Rahman Mohd

2017-10-01

Closed-Circuit TV (CCTV) system is one of the technologies in surveillance field to solve the problem of detection and monitoring by providing extra features such as email alert or motion detection. However, detecting and alerting the admin on CCTV system may complicate due to the complexity to integrate the main program with an external Application Programming Interface (API). In this study, pixel processing algorithm is applied due to its efficiency and SMS alert is added as an alternative solution for users who opted out email alert system or have no Internet connection. A CCTV system with SMS alert (CMDSA) was developed using evolutionary prototyping methodology. The system interface was implemented using Microsoft Visual Studio while the backend components, which are database and coding, were implemented on SQLite database and C# programming language, respectively. The main modules of CMDSA are motion detection, capturing and saving video, image processing and Short Message Service (SMS) alert functions. Subsequently, the system is able to reduce the processing time making the detection process become faster, reduce the space and memory used to run the program and alerting the system admin instantly.

An Overview of the Automated Dispatch Controller Algorithms in the System Advisor Model (SAM)

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiOrio, Nicholas A

2017-11-22

Three automatic dispatch modes have been added to the battery model within the System Adviser Model. These controllers have been developed to perform peak shaving in an automated fashion, providing users with a way to see the benefit of reduced demand charges without manually programming a complicated dispatch control. A flexible input option allows more advanced interaction with the automated controller. This document will describe the algorithms in detail and present brief results on its use and limitations.

How to Manage and Control Healthcare Associated Infections

NASA Astrophysics Data System (ADS)

Wijaya, L.

2018-03-01

Healthcare associated infections (HAI) are the major complications of modern medical therapy. The most important HAIs are related to invasive devices including central line- associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP) and surgical-site infections (SSI). Excessive use of antibiotics has also led to the emergence and the global dissemination of antibiotic resistant bacteria over the last few decades. Reducing HAIs will involve a multi-modal approach to infection control practices as well as antibiotic stewardship program.

Hypercluster Parallel Processor

NASA Technical Reports Server (NTRS)

Blech, Richard A.; Cole, Gary L.; Milner, Edward J.; Quealy, Angela

1992-01-01

Hypercluster computer system includes multiple digital processors, operation of which coordinated through specialized software. Configurable according to various parallel-computing architectures of shared-memory or distributed-memory class, including scalar computer, vector computer, reduced-instruction-set computer, and complex-instruction-set computer. Designed as flexible, relatively inexpensive system that provides single programming and operating environment within which one can investigate effects of various parallel-computing architectures and combinations on performance in solution of complicated problems like those of three-dimensional flows in turbomachines. Hypercluster software and architectural concepts are in public domain.

Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Observational Study in a Referral Unit.

PubMed

Velázquez, Maite; Albarrán, Agustín; Hernández, Ignacio; López-Gude, M Jesús; Sarnago, Fernando; Martín, Roberto; Arribas, Fernando; Escribano, Pilar

2018-05-29

Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program. Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality. We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m 2 ; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%). Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Cardiovascular self-management support program for preventing cardiovascular complication behaviors and clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus in Indonesia: A pilot study.

PubMed

Hisni, Dayan; Rukmaini, Rukmaini; Saryono, Saryono; Chinnawong, Tippamas; Thaniwattananon, Ploenpit

2018-03-06

The aim of the study was to determine the feasibility, and to evaluate the effect of, a cardiovascular self-management support program by applying the 5A's self-management support program on preventing cardiovascular complication behaviors and to assess the clinical outcomes in the elderly with poorly controlled type 2 diabetes mellitus (DM). This pilot study used a quasi-experimental study design. Twelve elderly persons with poorly controlled type 2 DM were assigned into either a control or experimental group, with six participants in each group. The Preventing Cardiovascular Complication Behaviors (PCCB) was measured by the Preventing Cardiovascular Complication Behaviors Questionnaire, while the clinical outcomes were measured by clinical devices that were provided. These measurements were conducted and compared at baseline and 6 weeks after the completion of the program. The self-management support program was a 6 week program with several implementation methods, based on the 5A's self-management support program. The participants who received the cardiovascular self-management support program reported a significant improvement in their PCCB and clinical outcomes, compared to those receiving the usual care. This study revealed that a cardiovascular self-management support program that applies the 5A's self-management support program is feasible for implementation. © 2018 Japan Academy of Nursing Science.

A Novel Collaboration to Reduce the Travel-Related Cost of Residency Interviewing.

PubMed

Shappell, Eric; Fant, Abra; Schnapp, Benjamin; Craig, Jill P; Ahn, James; Babcock, Christine; Gisondi, Michael A

2017-04-01

Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois. Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season. We used a survey to assess applicant experiences interviewing in Chicago and attitudes regarding coordinated scheduling. Data on utilization of coordinated dates were obtained from interview scheduling software. The target group for this intervention consisted of applicants from medical schools outside Illinois who completed interviews at both programs. Of the 158 applicants invited to both programs, 84 (53%) responded to the survey. Scheduling data were available for all applicants. The total estimated cost savings for target applicants coordinating interview dates was $13,950. The majority of target applicants reported that this intervention increased the ease of scheduling (84%), made them less likely to cancel the interview (82%), and saved them money (71%). Coordinated scheduling of interview dates was associated with significant estimated cost savings and was reviewed favorably by applicants across all measures of experience. Expanding use of this practice geographically and across specialties may further reduce the cost of interviewing for applicants.

The learning curve associated with the introduction of the subcutaneous implantable defibrillator.

PubMed

Knops, Reinoud E; Brouwer, Tom F; Barr, Craig S; Theuns, Dominic A; Boersma, Lucas; Weiss, Raul; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D; Leon, Angel R; Hood, Margaret; Jones, Paul W; Wold, Nicholas; Grace, Andrew A; Olde Nordkamp, Louise R A; Burke, Martin C

2016-07-01

The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters with respect to implant-related complications, procedure time, and inappropriate shocks (IASs). In a pooled cohort from two clinical S-ICD databases, the IDE Trial and the EFFORTLESS Registry, complications, IASs at 180 days follow-up and implant procedure duration were assessed. Patients were grouped in quartiles based on experience of the implanter and Kaplan-Meier estimates of complication and IAS rates were calculated. A total of 882 patients implanted in 61 centres by 107 implanters with a median of 4 implants (IQR 1,8) were analysed. There were a total of 59 patients with complications and 48 patients with IAS. The complication rate decreased significantly from 9.8% in Quartile 1 (least experience) to 5.4% in Quartile 4 (most experience) (P = 0.02) and non-significantly for IAS from 7.9 to 4.8% (P = 0.10). Multivariable analysis demonstrated a hazard ratio of 0.78 (P = 0.045) for complications and 1.01 (P = 0.958) for IAS. Dual-zone programming increased with experience of the individual implanter (P < 0.001), which reduced IAS significantly in the multivariable model (HR 0.44, P = 0.01). Procedure time decreased from 75 to 65 min (P < 0.001). The complication rate and procedure time stabilized after Quartile 2 (>13 implants). There is a short and significant learning curve associated with physicians adopting the S-ICD. Performance stabilizes after 13 implants. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Effectiveness and safety of moderate-intensity aerobic water exercise during pregnancy for reducing use of epidural analgesia during labor: protocol for a randomized clinical trial.

PubMed

Navas, Araceli; Artigues, Catalina; Leiva, Alfonso; Portells, Elena; Soler, Aina; Cladera, Antonia; Ortas, Silvia; Alomar, Margarita; Gual, Marina; Manzanares, Concepción; Brunet, Marina; Julià, Magdalena; López, Lidia; Granda, Lorena; Bennasar-Veny, Miquel; Carrascosa, Mari Carmen

2018-04-11

Epidural analgesia during labor can provide effective pain relief, but can also lead to adverse effects. The practice of moderate exercise during pregnancy is associated with an increased level of endorphins in the blood, and this could also provide pain relief during labor. Aerobic water exercises, rather than other forms of exercise, do not negatively impact articulations, reduce edema, blood pressure, and back pain, and increase diuresis. We propose a randomized controlled trial (RCT) to evaluate the effectiveness and safety of a moderate water exercise program during pregnancy on the need for epidural analgesia during labor. A multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. We will randomised 320 pregnant women (14 to 20 weeks gestation) who have low risk of complications to a moderate water exercise program or usual care. The findings of this research will contribute toward understanding of the effects of a physical exercise program on pain and the need for analgesia during labor. ISRCTN Registry identifier: 14097513 register on 04 September 2017. Retrospectively registered.

Enhanced recovery care versus traditional care after laparoscopic liver resections: a randomized controlled trial.

PubMed

Liang, Xiao; Ying, Hanning; Wang, Hongwei; Xu, Hongxia; Liu, Minjun; Zhou, Haiyan; Ge, Huiqing; Jiang, Wenbin; Feng, Lijun; Liu, Hui; Zhang, Yingchun; Mao, Zhiying; Li, Jianhua; Shen, Bo; Liang, Yuelong; Cai, Xiujun

2018-06-01

Enhanced recovery after surgery (ERAS), with several evidence-based elements, has been shown to shorten length of hospital stay and reduce perioperative hospital costs in many operations. This randomized clinical trial was performed to compare complications and hospital stay of laparoscopic liver resection between ERAS and traditional care. A randomized controlled trial was performed for laparoscopic liver resection from August 2015 to August 2016. Patients were randomly divided into ERAS group and traditional care group. The primary outcome was length of hospital stay (LOS) after surgery. Second outcomes included postoperative complications, hospital cost, and 30-day readmissions. Elements used in ERAS group included more perioperative education, nurse navigators, nutrition support for liver diseases, respiratory therapy, oral carbohydrate 2 h before operation, early mobilization and oral intake, goal-directed fluid therapy, less drainages, postoperative nausea and vomiting (PONV) prophylaxis and multimodal analgesia. The study included 58 (two conversion to laparotomy) patients in ERAS group and 61 (three conversion to laparotomy) patients in the traditional care group. Postoperative LOS was significantly shorter in the ERAS group than traditional care group (5 vs. 8 days; p < 0.001). ERAS program significantly reduced the hospital costs (CNY 45413.1 vs. 55794.1; p = 0.006) and complications (36.2 vs. 55.7%; p = 0.033). Duration till first flatus and PONV were significantly reduced in ERAS group. Pain control was better in ERAS (Visual analogue scale (VAS) POD1 (≥ 4) 19.0 vs. 39.3%, p = 0.017; VAS POD1 2.5 vs. 3.1, p = 0.010). There was no difference in the rate of 30-day readmissions (6.9 vs. 8.2%; p = 1.000). ERAS protocol is feasible and safe for laparoscopic liver resection. Patients in ERAS group have less pain and complications.

[Perioperative management of laparoscopic cholecystectomy in children with homozygous sickle cell disease].

PubMed

Ndoye, M Diop; Bah, M Diao; Pape, I Ndiaye; Diouf, E; Kane, O; Bèye, M; Fall, B; Ka-Sall, B

2008-09-01

Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.

The PEREGRINETM program: using physics and computer simulation to improve radiation therapy for cancer

NASA Astrophysics Data System (ADS)

Hartmann Siantar, Christine L.; Moses, Edward I.

1998-11-01

When using radiation to treat cancer, doctors rely on physics and computer technology to predict where the radiation dose will be deposited in the patient. The accuracy of computerized treatment planning plays a critical role in the ultimate success or failure of the radiation treatment. Inaccurate dose calculations can result in either insufficient radiation for cure, or excessive radiation to nearby healthy tissue, which can reduce the patient's quality of life. This paper describes how advanced physics, computer, and engineering techniques originally developed for nuclear weapons and high-energy physics research are being used to predict radiation dose in cancer patients. Results for radiation therapy planning, achieved in the Lawrence Livermore National Laboratory (LLNL) 0143-0807/19/6/005/img2 program show that these tools can give doctors new insights into their patients' treatments by providing substantially more accurate dose distributions than have been available in the past. It is believed that greater accuracy in radiation therapy treatment planning will save lives by improving doctors' ability to target radiation to the tumour and reduce suffering by reducing the incidence of radiation-induced complications.

Culinary Grief Therapy: Cooking for One Series.

PubMed

Nickrand, Heather L; Brock, Cara M

2017-02-01

Although loss of loved ones is a universal experience, individuals who experience this loss grieve in different ways. Complicated grief involves the development of trauma symptoms, such as flashbacks, anxiety, and fear associated with daily activities after a death that disrupts the healthy grieving process. Daily activities such as eating, meal planning, grocery shopping, managing finances, and household maintenance can become painful and isolating for those experiencing complicated grief. Cognitive behavioral therapy is used to address irrational beliefs, feelings of depression or anger, and avoidance or numbing behaviors with a goal of leading the individual to adapting to a life, which no longer includes the lost loved one. As part of the bereavement counseling program in a hospice, a need was identified in individuals who had lost loved ones and were having difficulty with adjusting to meal planning, grocery shopping, and cooking for one. To address this need for grief counseling centered on meal planning, grocery shopping, meal preparations, and eating meals alone, "Culinary Grief Therapy: Cooking for One Series" was developed with a local Culinary Arts Program. Partnering with a local community college culinary arts program, the Cooking for One Series provides an interactive venue for cognitive behavioral therapy centered on meal planning and meal times. Along with demonstrations and hands-on experiences, participants are engaged in bereavement counseling with hospice staff. Initial reactions to Culinary Grief Therapy have been positive. Many attendees have participated in multiple workshops, and the number of participants grows for each offering. Culinary Grief Therapy is a novel approach to the needs of those experiencing the loss of a loved one and may reduce or prevent complicated grief associated with meal planning, grocery shopping, and cooking for one.

Pediatric Renal Transplantation in Oman: A Single-center Experience

PubMed Central

Al Riyami, Mohamed S.; Al Saidi, Sulaiman; Al Ghaithi, Badria; Al Maskari, Anisa; Lala, Sadiq; Mohsin, Nabil; Hirshikesan, Lekha; Al Kalbani, Naifain

2018-01-01

Objectives This study sought to report 22 years experience in pediatric kidney transplantation in Oman. Methods Electronic charts of all Omani children below 13 years of age who received a kidney transplant from January 1994 to December 2015 were reviewed. Data collected included patient demographics, etiology of end-stage kidney disease, modality and duration of dialysis, donor type, complication of kidney transplantation (including surgical complications, infections, graft rejection) graft and patient survival, and duration of follow-up. Results During the study period transplantation from 27 living related donors (LRDs), 42 living unrelated donors (LURDs), also referred to as commercial transplant, and one deceased donor were performed. The median age at transplantation was nine years for both groups. The most common primary diagnosis was congenital anomalies of the kidney and urinary tract in 32.8% of patients followed by familial nephrotic syndrome in 20.0% and polycystic kidney disease in 18.5%. Almost half the patients were on hemodialysis before transplantation, 35.7% were on peritoneal dialysis, and 14.2% received preemptive renal transplantation. Children who received LURD kidneys had high surgical complications (42.8%) compared to the LRDs group (17.8%). Five patients from LURDs group had early graft nephrectomy and four patients developed non-graft function or delayed graft function. In addition, patients in the LURDs group had a higher incidence of hypertension and acute rejection. Graft and patient survival were both better in the LRDs than the LURDs group. Conclusions Although our pediatric kidney transplant program is a young program it has had successful patient outcomes comparable to international programs. Our study provides evidence that in addition to legal and ethical issues with commercial transplant, it also carries significantly higher morbidity and reduced graft and patient survival. PMID:29467993

Optimisation of follow-up after metabolic surgery.

PubMed

Mingrone, Geltrude; Bornstein, Stefan; Le Roux, Carel W

2018-06-01

Bariatric surgery has many benefits beyond weight loss, including improved control of glycaemia, blood pressure, and dyslipidaemia; hence, such surgery has been rebranded as metabolic surgery. The operations are, unfortunately, also associated with major surgical and medical complications. The medical complications include gastro-oesophageal reflux disease, malnutrition, and metabolic complications deriving from vitamin and mineral malabsorption. The benefits of surgery can be optimised by implementing specific protocols before and after surgery. In this Review, we discuss the assessment of the risk of major cardiac complications and severe obstructive sleep apnoea before surgery, and the provision of adequate lifelong postsurgery nutritional, vitamin, and mineral supplementation to reduce complications. Additionally, we examine the best antidiabetic medications to reduce the risk of hypoglycaemia after gastric bypass and sleeve gastrectomy, and the strategies to improve weight loss or reduce weight regain. Although optimising clinical pathways is possible to maximise metabolic benefits and reduce the risks of complications and micronutrient deficiencies, evolution of these strategies can further improve the risk-to-benefit ratio of metabolic surgery. Copyright © 2018 Elsevier Ltd. All rights reserved.

Action plan to reduce perinatal mortality.

PubMed

Bhakoo, O N; Kumar, R

1990-01-01

The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

Implementation of Preoperative Screening Criteria Lowers Infection and Complication Rates Following Elective Total Hip Arthroplasty and Total Knee Arthroplasty in a Veteran Population.

PubMed

Nussenbaum, Fernando D; Rodriguez-Quintana, David; Fish, Sara M; Green, David M; Cahill, Catherine W

2018-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures with a risk of complications. Attempting to minimize complications, our institution implemented preoperative screening criteria for patients undergoing elective total joint replacement. Our study aimed to determine if screening criteria lowered total complications and/or surgical site infections (SSI). Two groups of consecutive patients undergoing TKA and THA at a single Veterans Affairs facility were evaluated prior to and after implementation of screening criteria, 520 and 475 respectively. Screening criteria included hemoglobin A1c ≤7, hemoglobin ≥11, body mass index ≤35, and albumin ≥3.5. Groups were analyzed for demographics, preoperative comorbidities, and postoperative complications. Rates of total complications and SSI were compared. Average follow-up was at least 2 years with minimum of 1 year. Demographics and comorbidities outside the screening criteria were similar. Total complication rate was reduced from 35.4% to 14.8% (P < .01) after implementation of screening criteria. For TKA, total complications were reduced from 33.1% to 15.0% (P < .01) and for THA they were reduced from 42.4% to 14.2% (P < .01). SSI rates for combined TKA and THA were reduced from 4.4% to 1.3% (P < .01). For knees, SSI was reduced from 4.6% to 1.3% (P = .01) and was statistically significant. For THA, SSI decreased from 3.8% to 1.2% (P < .05). Our institution saw a statistically significant decrease in both SSI and total complications following implementation of preoperative screening criteria for elective TKA and THA. Published by Elsevier Inc.

Combining landscape-level conservation planning and biodiversity offset programs: a case study.

PubMed

Underwood, Jared G

2011-01-01

Habitat loss is a major factor in the endangerment and extinction of species around the world. One promising strategy to balance continued habitat loss and biodiversity conservation is that of biodiversity offsets. However, a major concern with offset programs is their consistency with landscape-level conservation goals. While merging offset policies and landscape-level conservation planning is thought to provide advantages over a traditional disconnected approach, few such landscape-level conservation-offset plans have been designed and implemented, so the effectiveness of such a strategy remains uncertain. In this study, we quantitatively assess the conservation impact of combining landscape-level conservation planning and biodiversity offset programs by comparing regions of San Diego County, USA with the combined approach to regions with only an offset program. This comparison is generally very difficult due to a variety of complicating factors. We overcome these complications and quantify the benefits to rare and threatened species of implementing a combined approach by assessing the amount of each species' predicted distribution, and the number of documented locations, conserved in comparison to the same metric for areas with an offset policy alone. We found that adoption of the combined approach has increased conservation for many rare species, often 5-10 times more than in the comparison area, and that conservation has been focused in the areas most important for these species. The level of conservation achieved reduces uncertainty that these species will persist in the region into the future. This San Diego County example demonstrates the potential benefits of combining landscape-level conservation planning and biodiversity offset programs.

Sex and gender differences in therapy of type 2 diabetes.

PubMed

Kautzky-Willer, Alexandra; Harreiter, Jürgen

2017-09-01

Clinical guidelines for the management of type 2 diabetes recommend individual therapy considering age, duration of disease, presence of complication and risk of hypoglycaemia. However, at present, the patient's sex has no impact on clinical decisions. Yet, there is mounting data pointing at biological and psychosocial differences between men and women with great impact on progression of disease and complications. Moreover, choices and preferences of therapeutic strategies as well as adherence to lifestyle and pharmacological interventions differ in both sexes. In addition, drug therapy may have sex-specific side effects. Therefore, there is need of more research on biological differences and of evidence-based individualised targeted sex-sensitive therapeutic concepts. Clinical guidelines must consider relevant sex-differences. Development and implementation of sex-specific programs may help to improve adherence to therapy and to reduce progression of disease and development of complications. A more gender-sensitive clinical approach may improve quality of life and increase health and life expectancy in men and women with type 2 diabetes. Copyright © 2017 Elsevier B.V. All rights reserved.

Sirtuins-mediators of maternal obesity-induced complications in offspring?

PubMed

Nguyen, Long T; Chen, Hui; Pollock, Carol A; Saad, Sonia

2016-04-01

Obesity is a complex metabolic disease, attributed to diverse and interactive genetic and environmental factors. The associated health consequences of obesity are pleiotropic, with individuals being more susceptible to chronic diseases such as type 2 diabetes mellitus, hypertension, and lipotoxicity-related chronic diseases. The contribution of maternal obesity to the offspring's predisposition to both obesity and its complications is increasingly recognized. Understanding the mechanisms underlying these "transmissible" effects is critical to develop therapeutic interventions to reduce the risk for "programmed" obesity. Sirtuins (SIRTs), particularly SIRT1 and SIRT3, are NAD(+)-dependent deacetylases that regulate metabolic balance and stress responses in both central and peripheral tissues, of which dysregulation is a well-established mediator for the development and effects of obesity. Nevertheless, their implication in the transmissible effects of maternal obesity across generations remains largely elusive. In this review, we examine multiple pathways and systems that are likely to mediate such effects, with particular emphasis on the role of SIRTs.-Nguyen, L. T., Chen, H., Pollock, C. A., Saad, S. Sirtuins-mediators of maternal obesity-induced complications in offspring? © FASEB.

Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer: An Asian population study.

PubMed

Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

2016-12-01

Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD).This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated.The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group.Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD.

Acid-reducing vagotomy is associated with reduced risk of subsequent ischemic heart disease in complicated peptic ulcer

PubMed Central

Wu, Shih-Chi; Fang, Chu-Wen; Chen, William Tzu-Liang; Muo, Chih-Hsin

2016-01-01

Abstract Persistent exacerbation of a peptic ulcer may lead to a complicated peptic ulcer (perforation or/and bleeding). The management of complicated peptic ulcers has shifted from acid-reducing vagotomy, drainage, and gastrectomy to simple local suture or non-operative (endoscopic/angiographic) hemostasis. We were interested in the long-term effects of this trend change. In this study, complicated peptic ulcer patients who received acid-reducing vagotomy were compared with those who received simple suture/hemostasis to determine the risk of ischemic heart disease (IHD). This retrospective cohort study analyzed 335,680 peptic ulcer patients recorded from 2000 to 2006 versus 335,680 age-, sex-, comorbidity-, and index-year matched comparisons. Patients with Helicobacter pylori (HP) infection were excluded. In order to identify the effect of vagus nerve severance, patients who received gastrectomy or antrectomy were also excluded. The incidence of IHD in both cohorts, and in the complicated peptic ulcer patients who received acid-reducing vagotomy versus those who received simple suture or hemostasis was evaluated. The overall incidence of IHD was higher in patients with peptic ulcer than those without peptic ulcer (17.00 vs 12.06 per 1000 person-years), with an adjusted hazard ratio (aHR) of 1.46 based on multivariable Cox proportional hazards regression analysis controlling for age, sex, Charlson's comorbidity index, and death (competing risk). While comparing peptic ulcer patients with acid-reducing vagotomy to those with simple suture/hemostasis or those without surgical treatment, the aHR (0.58) was the lowest in the acid-reducing vagotomy group. Patients with peptic ulcer have an elevated risk of IHD. However, complicated peptic ulcer patients who received acid-reducing vagotomy were associated with reduced risk of developing IHD. PMID:27977613

Use of national surgical quality improvement program data as a catalyst for quality improvement.

PubMed

Rowell, Katherine S; Turrentine, Florence E; Hutter, Matthew M; Khuri, Shukri F; Henderson, William G

2007-06-01

Semiannually, the National Surgical Quality Improvement Program (NSQIP) provides its participating sites with observed-to-expected (O/E) ratios for 30-day postoperative mortality and morbidity. At each reporting period, there is typically a small group of hospitals with statistically significantly high O/E ratios, meaning that their patients have experienced more adverse events than would be expected on the basis of the population characteristics. An important issue is to determine which actions a surgical service should take in the presence of a high O/E ratio. This article reviews case studies of how some of the Department of Veterans Affairs and private-sector NSQIP participating sites used the clinically rich NSQIP database for local quality improvement efforts. Data on postoperative adverse events before and after these local quality improvement efforts are presented. After local quality improvement efforts, wound complication rates were reduced at the Salt Lake City Veterans Affairs medical center by 47%, surgical site infections in patients undergoing intraabdominal surgery were reduced at the University of Virginia by 36%, and urinary tract infections in vascular patients were reduced at the Massachusetts General Hospital by 74%. At some sites participating in the NSQIP, notably the Massachusetts General Hospital and the University of Virginia, the NSQIP has served as the basis for surgical service-wide outcomes research and quality improvement programs. The NSQIP not only provides participating sites with risk-adjusted surgical mortality and morbidity outcomes semiannually, but the clinically rich NSQIP database can also serve as a catalyst for local quality improvement programs to significantly reduce postoperative adverse event rates.

Costs of postoperative sepsis: the business case for quality improvement to reduce postoperative sepsis in veterans affairs hospitals.

PubMed

Vaughan-Sarrazin, Mary S; Bayman, Levent; Cullen, Joseph J

2011-08-01

To estimate the incremental costs associated with sepsis as a complication of general surgery, controlling for patient risk factors that may affect costs (eg, surgical complexity and comorbidity) and hospital-level variation in costs. Database analysis. One hundred eighteen Veterans Health Affairs hospitals. A total of 13 878 patients undergoing general surgery during fiscal year 2006 (October 1, 2005, through September 30, 2006). Incremental costs associated with sepsis as a complication of general surgery (controlling for patient risk factors and hospital-level variation of costs), as well as the increase in costs associated with complications that co-occur with sepsis. Costs were estimated using the Veterans Health Affairs Decision Support System, and patient risk factors and postoperative complications were identified in the Veterans Affairs Surgical Quality Improvement Program database. Overall, 564 of 13 878 patients undergoing general surgery developed postoperative sepsis, for a rate of 4.1%. The average unadjusted cost for patients with no sepsis was $24 923, whereas the average cost for patients with sepsis was 3.6 times higher at $88 747. In risk-adjusted analyses, the relative costs were 2.28 times greater for patients with sepsis relative to patients without sepsis (95% confidence interval, 2.19-2.38), with the difference in risk-adjusted costs estimated at $26 972 (ie, $21 045 vs $48 017). Sepsis often co-occurred with other types of complications, most frequently with failure to wean the patient from mechanical ventilation after 48 hours (36%), postoperative pneumonia (31%), and reintubation for respiratory or cardiac failure (29%). Costs were highest when sepsis occurred with pneumonia or failure to wean the patient from mechanical ventilation after 48 hours. Given the high cost of treating sepsis, a business case can be made for quality improvement initiatives that reduce the likelihood of postoperative sepsis.

Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes.

PubMed

Segal, Dale N; Wilson, Jacob M; Staley, Christopher; Yoon, Tim S

2018-06-11

Retrospective cohort study. To compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement surgery. Cervical total disc replacement (TDR) is a motion sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce healthcare costs are driving spine surgery to be performed in the outpatient setting. As cervical total disc replacement surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006-2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data was compared between the inpatient and outpatient cohort using univariate analysis. There were 531 (34.2%) patients treated as outpatients and 1,022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. There was no difference between 30-day complications, readmission and reoperation rates between inpatients and outpatients who underwent a single-level cervical total disc replacement. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. 3.

A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.

PubMed

Hall, Michael; Robertson, Jamie; Merkel, Matthias; Aziz, Michael; Hutchens, Michael

2017-08-01

Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. We hypothesized that a collaborative, comprehensive, structured handover of care from the intraoperative team to the ICU team would reduce a specific set of postoperative complications. We tested this hypothesis by developing and introducing a comprehensive multidisciplinary transfer of care process. We measured patient outcomes before and after the intervention using a linkage between 2 care databases: an Anesthesia Information Management System and a critical care complication registry database. There were 1127 total postoperative cardiac surgery admissions during the study period, 550 before and 577 after the intervention. There was no statistical difference between overall complications before and after the intervention (P = .154). However, there was a statistically significant reduction in preventable complications after the intervention (P = .023). The main finding of this investigation is that the introduction of a collaborative, comprehensive transfer of care process from the operating room to the ICU was associated with patients suffering fewer preventable complications.

Proton-pump inhibitors are associated with a reduced risk for bleeding and perforated gastroduodenal ulcers attributable to non-steroidal anti-inflammatory drugs: a nested case-control study

PubMed Central

Vonkeman, Harald E; Fernandes, Robert W; van der Palen, Job; van Roon, Eric N; van de Laar, Mart AFJ

2007-01-01

Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is hampered by gastrointestinal ulcer complications, such as ulcer bleeding and perforation. The efficacy of proton-pump inhibitors in the primary prevention of ulcer complications arising from the use of NSAIDs remains unproven. Selective cyclooxygenase-2 (COX-2) inhibitors reduce the risk for ulcer complications, but not completely in high-risk patients. This study determines which patients are especially at risk for NSAID ulcer complications and investigates the effectiveness of different preventive strategies in daily clinical practice. With the use of a nested case-control design, a large cohort of NSAID users was followed for 26 months. Cases were patients with NSAID ulcer complications necessitating hospitalisation; matched controls were selected from the remaining cohort of NSAID users who did not have NSAID ulcer complications. During the observational period, 104 incident cases were identified from a cohort of 51,903 NSAID users with 10,402 patient years of NSAID exposure (incidence 1% per year of NSAID use, age at diagnosis 70.4 ± 16.7 years (mean ± SD), 55.8% women), and 284 matched controls. Cases were characterised by serious, especially cardiovascular, co-morbidity. In-hospital mortality associated with NSAID ulcer complications was 10.6% (incidence 21.2 per 100,000 NSAID users). Concomitant proton-pump inhibitors (but not selective COX-2 inhibitors) were associated with a reduced risk for NSAID ulcer complications (the adjusted odds ratio 0.33; 95% confidence interval 0.17 to 0.67; p = 0.002). Especially at risk for NSAID ulcer complications are elderly patients with cardiovascular co-morbidity. Proton-pump inhibitors are associated with a reduced risk for NSAID ulcer complications. PMID:17521422

Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study.

PubMed

Yang, Kyeongra; Bernardo, Lisa M; Sereika, Susan M; Conroy, Molly B; Balk, Judy; Burke, Lora E

2011-01-01

Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.

Effect of Pre-Designed Instructions for Mothers of Children with Hypospadias on Reducing Postoperative Complications

ERIC Educational Resources Information Center

Mohamed, Sanaa A.

2015-01-01

Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of…

Feasibility [corrected] of regular physical exercise for patients with moderate to severe Alzheimer disease.

PubMed

Rolland, Y; Rival, L; Pillard, F; Lafont, C; Rivére, D; Albaréde, J; Vellas, B

2000-01-01

Physical activity delays loss of autonomy in the elderly. In patients with Alzheimer disease (AD), physical activity could be a useful strategy in therapeutic management by delaying loss of functional independence and the usual complications of the disease. To determine, using standardized tools, the effects on autonomy (ADL, IADL), cognitive function (MMS), nutritional status (MNA), behavioral problems (NPI) and risk of falls (Tinetti test) of a physical exercise program in patients with AD. Twenty-three subjects (13 men and 10 women, aged 71-92 years, mean 78 years) with AD (mean MMS 16, range 1-23) carried out for a mean of 7 weeks (5-12 weeks) a program of endurance exercise (walking, exercise bicycle) adapted to their individual capacities. Standardized gerontological evaluation was performed before and after the study. No significant change in autonomy (ADL, IADL) was observed. There was an improvement in the MNA (p<0.001) and the MMS (p<0.001). Risk of falls (p<0.01) and behavioral problems (p<0.05) decreased. These results were obtained without increasing family workload. We suggest that physical activity is a therapeutic option which can reduce nutritional and behavioral complications and risk of falls in subjects with AD.

Savoring every drop – Vampire or Mosquito?

PubMed Central

2014-01-01

Blood safety with respect to infectious complications has reached very high standards. Nevertheless, reports on transfusion-associated morbidity and mortality gain momentum. Multidisciplinary patient blood management programs can minimize unnecessary exposure to allogeneic blood products by strengthening and conserving patients’ own resources. This article outlines concepts designed to maintain hemoglobin concentration, to optimize hemostasis, and to minimize blood loss in ICUs. These measures prevent or at least alleviate hospital-acquired anemia, reduce the need for blood transfusions, and therefore have great potential to improve patient safety and medical outcome. PMID:25032998

Dimming LEDs with Phase-Cut Dimmers. The Specifier's Process for Maximizing Success

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, N. J.; Poplawski, M. E.

2013-10-01

DOE GATEWAY program report reviewing how phase-cut dimmers work, how LEDs differ from the incandescent lamps these dimmers were originally designed to control, and how those differences can lead to complications when attempting to dim LEDs. Providing both general guidance and step-by-step procedures for designing phase-controlled LED dimming on both new and existing projects—as well as real-world examples of how to use those procedures—the report aims to reduce the chance of experiencing compatibility-related problems and, if possible, ensure good dimming performance.

Who thinks that part d is too complicated? Survey results on the medicare prescription drug benefit.

PubMed

Cummings, Janet R; Rice, Thomas; Hanoch, Yaniv

2009-02-01

Evidence suggests that Medicare Part D plan ownership is "sticky"; beneficiaries are unlikely to change plans from year to year, even when it would be in their financial interest to do so. The complexity of the program may contribute to this problem. Using data from a national survey, the authors examine the characteristics of those who believe that Part D is too complicated as well as the characteristics of those who endorse one of two policies to simplify the program. The results indicate that a great majority of adults believe that the program is too complicated and most favor some form of simplification. In multivariate analyses, one of the most consistent predictors is political orientation. Republicans are significantly less likely to think that Part D is too complicated, and liberals and moderates are significantly more likely to favor allowing beneficiaries the option of purchasing a plan directly from the government.

Preventing infective complications relating to induced abortion.

PubMed

Mary, Nirmala; Mahmood, Tahir A

2010-08-01

Infective complications following induced abortions are still a common cause of morbidity and mortality. This review focusses on defining the strategies to improve care of women seeking an induced abortion and to reduce infective complications. We have considered the evidence for screening and cost-effectiveness for antibiotic prophylaxis. Current evidence suggests that treating all women with prophylactic antibiotics in preference to screening and treating is the most cost-effective way of reducing infective complications following induced abortions. The final strategy to prevent infective complications should be individualized for each region/area depending on the prevalence of organisms causing pelvic infections and the resources available. 2010 Elsevier Ltd. All rights reserved.

NASA's Space Launch System (SLS) Program: Mars Program Utilization

NASA Technical Reports Server (NTRS)

May, Todd A.; Creech, Stephen D.

2012-01-01

NASA's Space Launch System is being designed for safe, affordable, and sustainable human and scientific exploration missions beyond Earth's orbit (BEO), as directed by the NASA Authorization Act of 2010 and NASA's 2011 Strategic Plan. This paper describes how the SLS can dramatically change the Mars program's science and human exploration capabilities and objectives. Specifically, through its high-velocity change (delta V) and payload capabilities, SLS enables Mars science missions of unprecedented size and scope. By providing direct trajectories to Mars, SLS eliminates the need for complicated gravity-assist missions around other bodies in the solar system, reducing mission time, complexity, and cost. SLS's large payload capacity also allows for larger, more capable spacecraft or landers with more instruments, which can eliminate the need for complex packaging or "folding" mechanisms. By offering this capability, SLS can enable more science to be done more quickly than would be possible through other delivery mechanisms using longer mission times.

Research protections for diverted mentally ill individuals: should they be considered prisoners?

PubMed

Amory Carr, W; Amrhein, Charles; Dery, Ryna

2011-01-01

The number of diversion programs for the mentally ill has increased dramatically over the past decade. These programs serve the valuable goal of reducing the growing population of incarcerated mentally ill persons by providing supervised community treatment. Research within these programs, critical for improving outcomes for these vulnerable individuals, is complicated by the fact that participants may have legal statuses which carry significant coercive leverage. In this way their ability to freely consent to research may be limited. In this paper, the authors describe the practice of diversion and review relevant research on coercion, informed consent and decisional capacity among the mentally ill and imprisoned. Current legal protections for prisoners are then discussed in the light of a recent proposal to broaden the legal definition of "prisoner" for research purposes to include community corrections populations, thus including diverted individuals. Copyright © 2011 John Wiley & Sons, Ltd. 2011 John Wiley & Sons, Ltd.

Algorithms and software for nonlinear structural dynamics

NASA Technical Reports Server (NTRS)

Belytschko, Ted; Gilbertsen, Noreen D.; Neal, Mark O.

1989-01-01

The objective of this research is to develop efficient methods for explicit time integration in nonlinear structural dynamics for computers which utilize both concurrency and vectorization. As a framework for these studies, the program WHAMS, which is described in Explicit Algorithms for the Nonlinear Dynamics of Shells (T. Belytschko, J. I. Lin, and C.-S. Tsay, Computer Methods in Applied Mechanics and Engineering, Vol. 42, 1984, pp 225 to 251), is used. There are two factors which make the development of efficient concurrent explicit time integration programs a challenge in a structural dynamics program: (1) the need for a variety of element types, which complicates the scheduling-allocation problem; and (2) the need for different time steps in different parts of the mesh, which is here called mixed delta t integration, so that a few stiff elements do not reduce the time steps throughout the mesh.

40 CFR 721.72 - Hazard communication program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... irritation. (ii) Respiratory complications. (iii) Central nervous system effects. (iv) Internal organ effects... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E...

40 CFR 721.72 - Hazard communication program.

Code of Federal Regulations, 2010 CFR

2010-07-01

... irritation. (ii) Respiratory complications. (iii) Central nervous system effects. (iv) Internal organ effects... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E...

40 CFR 721.72 - Hazard communication program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... irritation. (ii) Respiratory complications. (iii) Central nervous system effects. (iv) Internal organ effects... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E...

40 CFR 721.72 - Hazard communication program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... irritation. (ii) Respiratory complications. (iii) Central nervous system effects. (iv) Internal organ effects... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E...

40 CFR 721.72 - Hazard communication program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... irritation. (ii) Respiratory complications. (iii) Central nervous system effects. (iv) Internal organ effects... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E... irritation (B) Respiratory complications (C) Central nervous system effects (D) Internal organ effects (E...

Prevention and Care Programs Addressing the Growing Prevalence of Diabetes in China.

PubMed

Yin, Junmei; Kong, Alice P S; Chan, Juliana C N

2016-12-01

According to a 2010 national survey, 11 % of adults in China have diabetes, affecting 109.6 million individuals. The high prevalence of diabetes has been attributed to the aging of the population, the rapid adoption of energy-dense foods, and a reduction in physical activity. Collectively, these secular changes have created an obesogenic environment that can unmask diabetes in subjects with a genetic predisposition. The growing prevalence of maternal obesity, gestational diabetes, childhood obesity, and early-onset disease can lead to premature morbidity and mortality. Rising to meet these public health challenges, researchers in China have conducted randomized studies to demonstrate the benefits of lifestyle modification in preventing diabetes (the Da Qing Study), as well as that of team-based integrated care, using multiple strategies including peer support and information technology, in order to reduce hospitalizations, cardiovascular-renal complications, and premature deaths. With growing evidence supporting the benefits of these diabetes prevention and management programs, the next challenge is to use policies and systems to scale up the implementation of these programs through raising awareness, building capacity, and providing resources to reduce the human and socioeconomic burden of diabetes.

Complication Reducing Effect of the Information Technology-Based Diabetes Management System on Subjects with Type 2 Diabetes

PubMed Central

Cho, Jae-Hyoung; Lee, Jin-Hee; Oh, Jeong-Ah; Kang, Mi-Ja; Choi, Yoon-Hee; Kwon, Hyuk-Sang; Chang, Sang-Ah; Cha, Bong-Yun; Son, Ho-Young; Yoon, Kun-Ho

2008-01-01

Objective We introduced a new information technology-based diabetes management system, called the Internet-based glucose monitoring system (IBGMS), and demonstrated its short-term and long-term favorable effects. However, there has been no report on clinical effects of such a new diabetes management system on the development of diabetic complications so far. This study was used to simulate the complication reducing effect of the IBGMS, given in addition to existing treatments in patients with type 2 diabetes. Research Design and Methods The CORE Diabetes Model, a peer-reviewed, published, validated computer simulation model, was used to project long-term clinical outcomes in type 2 diabetes patients receiving the IBGMS in addition to their existing treatment. The model combined standard Markov submodels to simulate the incidence and progression of diabetes-related complications. Results The addition of IBGMS was associated with improvements in reducing diabetic complications, mainly microangiopathic complications, including diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and diabetic foot ulcer. The IBGMS also delayed the development of all diabetic complications for more than 1 year. Conclusions This study demonstrated that the simulated IBGMS, compared to existing treatment, was associated with a reduction of diabetic complications. As a result, it provides valuable evidence for practical application to the public in the world. PMID:19885180

Introduction of an enhanced recovery protocol to reduce short-term complications following radical cystectomy and intestinal urinary diversion with vescica ileale Padovana neobladder.

PubMed

Cerruto, Maria Angela; De Marco, Vincenzo; D'Elia, Carolina; Bizzotto, Leonardo; Curti, Pierpaolo; Baldassarre, Roberto; Artibani, Walter

2014-01-01

To reduce short-term complications of radical cystectomy (RC) and intestinal urinary diversion with vescica ileale Padovana (VIP) neobladder, we described and assessed an enhanced recovery protocol (ERP) in a series of consecutive patients. An ERP was introduced focusing on reduced bowel preparation, standardized feeding and analgesic regimens. We analyzed the outcomes with all patients consecutively undergoing RC and VIP neobladder who met the following inclusion criteria: American Society of Anesthesiologists score <3; absence of malnutrition according to the Mini Nutritional Assessment-Short Form criteria; absence of inflammatory bowel diseases. Thirty-one consecutive patients were recruited to undergo our ERP. Mean age of patients was 62.16 years. No patients died due to surgical complications. Nine of 31 patients experienced complications (29.03%), none requiring surgical intervention. According to Clavien grading, all complications were grade <2. The application of our ERP to our patients undergoing RC and VIP neobladder contributed to reduce postoperative morbidity. Copyright © 2013 S. Karger AG, Basel.

A quality study of family-centered care coordination to improve care for children undergoing tracheostomy and the quality of life for their caregivers.

PubMed

Hartnick, Christopher; Diercks, Gillian; De Guzman, Vanessa; Hartnick, Elizabeth; Van Cleave, Jeanne; Callans, Kevin

2017-08-01

Approximately 4000 U.S. children undergo tracheostomy yearly [1], and these surgeries often result in hospital re-admissions that have definite cost and caregiver burdens due to complications that are avoidable with proper training and support. To assess the impact of a Family-Centered Care Coordination (FCCC) program on the quality of care received by children undergoing tracheostomy and their caregivers. Caregivers of children undergoing tracheostomies from January 2012 to January 2013 and then a different set of caregivers of children undergoing tracheostomies from January 2015 to January 2016 completed both the Pediatric Tracheostomy Health Status Instrument (PTHSI) 1 month after discharge and the Medical Complications Associated with Pediatric Tracheostomy (MCAT) questionnaire 6 months after initial tracheostomy. To assess complication rates, these same sets of caregivers were asked to complete the MCAT and only those who provided complete medical data for all 6 months were included for comparative analysis. The PTHSI and MCAT were administered at Massachusetts Eye and Ear in a hospital setting. Ten caregivers of children undergoing tracheostomies completed the PTHSI before FCCC program implementation and12 caregivers then completed the PTHSI after FCCC implementation. For each of the 2 groups, 5 caregivers provided complete data on the MCAT questionnaires. FCCC is a collection of programs, policies, and tools designed to ensure safe transition home for children undergoing tracheostomies, reduce re-admission rates, and minimize "caregiver burden". The PTHSI is a validated caregiver quality of life instrument that was supplemented by the MCAT which records post-discharge medical issues following tracheostomy that relate specifically to the tracheotomy placement. The time to first follow-up appointment decreased from 6.4 weeks (SD = 1.52) to 6 days (SD = 0.18) with FCCC implementation. The total MCAT scores decreased from 15.2 (SD = 1.1) to 1.3 (SD = 1.3) (Wilcoxon sum rank test: P < 0.016) whereas neither PTHSI scores (P = 0.32) nor the specific caregiver burden domain (P = 0.18) demonstrated a significant change. and Relevance: By reducing the time to first follow-up after tracheostomy and by optimizing caregiver tracheostomy tube care and teaching, children's quality of care and caregiver burden can be significantly improved. Copyright © 2017 Elsevier B.V. All rights reserved.

SGLT2 inhibitors with cardiovascular benefits: Transforming clinical care in Type 2 diabetes mellitus.

PubMed

d'Emden, Michael; Amerena, John; Deed, Gary; Pollock, Carol; Cooper, Mark E

2018-02-01

Cardiovascular risk reduction in individuals with Type 2 diabetes mellitus (T2DM) is a key part of clinical management. Sodium-glucose co-transporter (SGLT2) inhibitors improve glycaemic control, reduce body weight and decrease blood pressure. In addition, the SGLT2 inhibitors empagliflozin and canagliflozin reduced the risk of composite cardiovascular events in high-risk individuals with T2DM in the EMPA-REG OUTCOME trial and the CANVAS Program, respectively. Empagliflozin also reduced cardiovascular deaths and improved renal outcomes. This class of agents should be considered in people with established cardiovascular disease, usually in combination with other glucose lowering medications, when satisfactory glycaemic control has not been achieved. The dose of insulin or sulfonylureas may need to be lowered when used with SGLT2 inhibitors, to reduce the risk of hypoglycaemia. Genitourinary infections can occur with SGLT2 inhibitors in a small proportion of people. In people with osteoporosis or prior amputation, it may be prudent to use empagliflozin rather than canagliflozin, based on the increased risk for bone fractures and amputations observed with canagliflozin in the CANVAS Program. SGLT2 inhibitors have the potential to transform the clinical care of persons with T2DM by not only improving glycaemic control but also reducing blood pressure, body weight and diabetes-related end-organ complications. Copyright © 2017 Elsevier B.V. All rights reserved.

IMPORTANCE OF CONTEXTUAL DATA IN PRODUCING HEALTH TECHNOLOGY ASSESSMENT RECOMMENDATIONS: A CASE STUDY.

PubMed

Poder, Thomas G; Bellemare, Christian A

2018-01-01

Contextual data and local expertise are important sources of data that cannot be ignored in hospital-based health technology assessment (HTA) processes. Despite a lack of or unconvincing evidence in the scientific literature, technology can be recommended in a given context. We illustrate this using a case study regarding biplane angiography for vascular neurointervention. A systematic literature review was conducted, along with an analysis of the context in our setting. The outcomes of interest were radiation doses, clinical complications, procedure times, purchase cost, impact on teaching program, the confidence of clinicians in the technology, quality of care, accessibility, and the volume of activity. A committee comprising managers, clinical experts, physicians, physicists and HTA experts was created to produce a recommendation regarding biplane technology acquisition to replace a monoplane device. The systematic literature review yielded nine eligible articles for analysis. Despite a very low level of evidence in the literature, the biplane system appears to reduce ionizing radiation and medical complications, as well as shorten procedure time. Contextual data indicated that the biplane system could improve operator confidence, which could translate into reduced risk, particularly for complex procedures. In addition, the biplane system can support our institution in its advanced procedures teaching program. Given the advantages provided by the biplane technology in our setting, the committee has recommended its acquisition. Contextual data were of utmost importance in this recommendation. Moreover, this technology should be implemented alongside a responsibility to collect outcome data to optimize clinical protocol in the doses of ionizing delivered.

Malnutrition Increases With Obesity and Is a Stronger Independent Risk Factor for Postoperative Complications: A Propensity-Adjusted Analysis of Total Hip Arthroplasty Patients.

PubMed

Fu, Michael C; D'Ambrosia, Christopher; McLawhorn, Alexander S; Schairer, William W; Padgett, Douglas E; Cross, Michael B

2016-11-01

Obesity is frequently associated with complications after total hip arthroplasty (THA) and is often concomitant with malnutrition. The purpose of this study was to investigate the independent morbidity risk of malnutrition relative to obesity. The National Surgical Quality Improvement Program from 2005 to 2013 was queried for elective primary THA cases. Malnutrition was defined as albumin <3.5 g/dL. Propensity scores for having preoperative albumin data were determined from demographics, body mass index, and overall comorbidity burden. Patients were classified as nonobese (body mass index 18.5-29.9), obese I (30-34.9), obese II (35-39.9), or obese III (≥40). Complications were compared across nutritional and obesity classes. Multivariable propensity-adjusted logistic regressions were used to examine associations between obesity and malnutrition with 30-day outcomes. A total of 40,653 THA cases were identified, of which 20,210 (49.7%) had preoperative albumin measurements. Propensity score adjustment successfully reduced potential selection bias, with P > .05 for differences between those with and without albumin data. Malnutrition incidence increased from 2.8% in obese I to 5.7% in obese III patients. With multivariable propensity-adjusted logistic regression, malnutrition was a more robust predictor than any obesity class for any postoperative complication(s) (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.25-2.08), major complications (OR 1.63, 95% CI 1.21-2.19), respiratory complications (OR 2.35, 95% CI 1.27-4.37), blood transfusions (OR 1.71, 95% CI 1.44-2.03), and extended length of stay (OR 1.35, 95% CI 1.14-1.59). Malnutrition incidence increased significantly from obese I to obese III patients and was a stronger and more consistent predictor than obesity of complications after THA. Copyright © 2016 Elsevier Inc. All rights reserved.

The Auckland Cataract Study II: Reducing Complications by Preoperative Risk Stratification and Case Allocation in a Teaching Hospital.

PubMed

Kim, Bia Z; Patel, Dipika V; McKelvie, James; Sherwin, Trevor; McGhee, Charles N J

2017-09-01

To assess the effect of preoperative risk stratification for phacoemulsification surgery on intraoperative complications in a teaching hospital. Prospective cohort study. Prospective assessment of consecutive phacoemulsification cases (N = 500) enabled calculation of a risk score (M-score of 0-8) using a risk stratification system. M-scores of >3 were allocated to senior surgeons. All surgeries were performed in a public teaching hospital setting, Auckland, New Zealand, in early 2016. Postoperatively, data were reviewed for complications and corrected distance visual acuity (CDVA). Results were compared to a prospective study (N = 500, phase 1) performed prior to formal introduction of risk stratification. Intraoperative complications increased with increasing M-scores (P = .044). Median M-score for complicated cases was higher (P = .022). Odds ratio (OR) for a complication increased 1.269 per unit increase in M-score (95% confidence interval [CI] 1.007-1.599, P = .043). Overall rate of any intraoperative complication was 5.0%. Intraoperative complication rates decreased from 8.4% to 5.0% (OR = 0.576, P = .043) comparing phase 1 and phase 2 (formal introduction of risk stratification). The severity of complications also reduced. A significant decrease in complications for M = 0 (ie, minimal risk cases) was also identified comparing the current study (3.1%) to phase 1 (7.2%), P = .034. There was no change in postoperative complication risks (OR 0.812, P = .434) or in mean postoperative CDVA (20/30, P = .484) comparing current with phase 1 outcomes. A simple preoperative risk stratification system, based on standard patient information gathered at preoperative consultation, appears to reduce intraoperative complications and support safer surgical training by appropriate allocation of higher-risk cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Organ damage mitigation with the Baskent Sickle Cell Medical Care Development Program (BASCARE)

PubMed Central

Ozdogu, Hakan; Boga, Can; Asma, Suheyl; Kozanoglu, Ilknur; Gereklioglu, Cigdem; Yeral, Mahmut; Buyukkurt, Nurhilal Turgut; Solmaz, Soner; Korur, Aslı; Aytan, Pelin; Maytalman, Erkan; Kasar, Mutlu

2018-01-01

Abstract The Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2∗) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients. The sample was composed of 376 study subjects and 249 control subjects. The hospital's Data Management System and the central population operating system were used for data collection. BASCARE enabled better analysis and interpretation of complication and mortality data. Vaccination rates against influenza and pneumococcal disease improved (21.5% vs 50.8% and 21.5% vs 49.2%, respectively). Effective and safe ARCE with low citrate infusion were maintained in 352 subjects (1003 procedures). Maternal and fetal mortality was prevented in 35 consecutive pregnant patients with ARCE. Chelating therapy rates reduced from 6.7% to 5%. Successful outcomes could be obtained in all 13 adult patients who underwent allogeneic peripheral stem cell transplantation from a fully matched, related donor. No patients died by day 100 or after the first year. Cure could be achieved without graft loss, grades III to IV acute graft versus host disease, extensive chronic graft versus host disease, or other major complications. The BASCARE program significantly improved patient care and thereby prolonged the life span of SCD patients (42 ± 13 years vs 29 ± 7 years, P < .001). We may recommend using such individualized programs in centers that provide health care for patients with SCD, in accordance with holistic approach due to the benign nature but malignant course of the disease. PMID:29419693

Perinatal Complications and Aging Indicators by Midlife

PubMed Central

Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

2014-01-01

BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

Evaluation of preoperative risk factors and complication rates in cosmetic breast surgery.

PubMed

Hanemann, Michael S; Grotting, James C

2010-05-01

To assess the relationships between body mass index, smoking, and diabetes and postoperative complications after cosmetic breast surgery, based on patient claims made to CosmetAssure, a program which provides coverage for treatment of significant complications, which might not be reimbursed by patients' health insurance carriers. Complication rates of cosmetic breast operations were reviewed from 13,475 consecutive patients between April 1, 2008 and March 31, 2009. Correlations between complication rates and risk factors of body mass index > or =30, smoking, and diabetes were analyzed. Because this insurance program reimburses patients for costs associated with the treatment of postsurgical complications, physicians are incentivized to report significant complications. A "significant" complication is defined as a postsurgical problem, occurring within 30 days of the procedure that requires admission to a hospital, emergency room, or surgery center. Minor complications that were treated in the outpatient setting are not included, as their treatment did not generate an insurance claim. According to patient claims data between April 1, 2008 and March 31, 2009, the overall complication rate for cosmetic breast surgery was 1.8%. Obese patients (body mass index > or = 30) undergoing breast augmentation and augmentation mastopexy demonstrated higher complication rates than nonobese patients. Patients with diabetes undergoing augmentation mastopexy experienced higher complication rates than nondiabetics. Data collection is ongoing, and as the number of cases increases (approximately 1300 new cosmetic breast surgeries per month), multiple other trends in this study will likely achieve statistical significance. Analysis of CosmetAssure data can accurately and objectively track the rate of significant postoperative complications secondary to cosmetic surgical procedures. As the number of risk factors increase, the risk of complications increases. Cosmetic breast surgery is extremely safe, with low infection and overall complication rates. Plastic surgeons can further decrease complications through careful patient selection.

Minimally invasive surgery for pedal digital deformity: an audit of complications using national benchmark indicators.

PubMed

Gilheany, Mark; Baarini, Omar; Samaras, Dean

2015-01-01

There is increasing global interest and performance of minimally invasive foot surgery (MIS) however, limited evidence is available in relation to complications associated with MIS for digital deformity correction. The aim of this prospective audit is to report the surgical and medical complications following MIS for digital deformity against standardised clinical indicators. A prospective clinical audit of 179 patients who underwent MIS to reduce simple and complex digital deformities was conducted between June 2011 and June 2013. All patients were followed up to a minimum of 12 months post operatively. Data was collected according to a modified version of the Australian Council of Healthcare standards (ACHS) clinical indicator program. The audit was conducted in accordance with the National Research Ethics Service (NRES) guidelines on clinical audit. The surgical complications included 1 superficial infection (0.53%) and 2 under-corrected digits (0.67%), which required revision surgery. Two patients who underwent isolated complex digital corrections had pain due to delayed union (0.7%), which resolved by 6 months post-op. No neurovascular compromise and no medical complications were encountered. The results compare favourably to rates reported in the literature for open reduction of digital deformity. This audit has illustrated that performing MIS to address simple and complex digital deformity results in low complication rates compared to published standards. MIS procedures were safely performed in a range of clinical settings, on varying degrees of digital deformity and on a wide range of ages and health profiles. Further studies investigating the effectiveness of these techniques are warranted and should evaluate long term patient reported outcome measures, as well as developing treatment algorithms to guide clinical decision making.

Evaluation of normal lung tissue complication probability in gated and conventional radiotherapy using the 4D XCAT digital phantom.

PubMed

Shahzadeh, Sara; Gholami, Somayeh; Aghamiri, Seyed Mahmood Reza; Mahani, Hojjat; Nabavi, Mansoure; Kalantari, Faraz

2018-06-01

The present study was conducted to investigate normal lung tissue complication probability in gated and conventional radiotherapy (RT) as a function of diaphragm motion, lesion size, and its location using 4D-XCAT digital phantom in a simulation study. Different time series of 3D-CT images were generated using the 4D-XCAT digital phantom. The binary data obtained from this phantom were then converted to the digital imaging and communication in medicine (DICOM) format using an in-house MATLAB-based program to be compatible with our treatment planning system (TPS). The 3D-TPS with superposition computational algorithm was used to generate conventional and gated plans. Treatment plans were generated for 36 different XCAT phantom configurations. These included four diaphragm motions of 20, 25, 30 and 35 mm, three lesion sizes of 3, 4, and 5 cm in diameter and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe and left upper lobe). The complication of normal lung tissue was assessed in terms of mean lung dose (MLD), the lung volume receiving ≥20 Gy (V20), and normal tissue complication probability (NTCP). The results showed that the gated RT yields superior outcomes in terms of normal tissue complication compared to the conventional RT. For all cases, the gated radiation therapy technique reduced the mean dose, V20, and NTCP of lung tissue by up to 5.53 Gy, 13.38%, and 23.89%, respectively. The results of this study showed that the gated RT provides significant advantages in terms of the normal lung tissue complication, compared to the conventional RT, especially for the lesions near the diaphragm. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Bacterial drug resistance and etiology of non-complicated urinary tract infections].

PubMed

Chávez-Valencia, Venice; Gallegos-Nava, Selma; Arce-Salinas, C Alejandro

2010-01-01

Bacterial resistance to antibiotics is associated with morbidity, mortality, and an increase in cost. Our objective was to assess bacterial resistance from cultures of patients with non-complicated urinary tract infection (UTI). We analyzed antibiotic resistance using the VITEK-II system among patients attending the internal medicine unit with non-complicated UTI. 1,479 urine cultures were performed; we excluded: 98 due to contamination, 924 had no bacterial growth, and 57 had missing data. Among the 404 samples that were positive, 240 were found among out patients and 164 among hospitalized patients. E coli were the most frequent pathogen, followed by Enterococcus, and K pneumonia, in out patients; E coli, P aeruginosa, and fungal infections (23% of cases) in hospitalized patients. Samples with E coli among out patients displayed resistance of 50% to fluoroquinolones and 55% to sulfas. Among hospitalized patients, resistance was observed in 71 and 66% respectively. Resistance to P aeruginosa was 38% for amynoglucosides and carbapenems and 100% for piperacillin; Enterococcus had 50% for fluoroquinolones. E. coli is the most common pathogen among UTI patients. We must adapt guidelines to recommend antibiotics and design a comprehensive control program to reduce the high levels of bacterial antibiotic resistance among our population.

Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

PubMed Central

Bonner, Timethia; Foster, Margaret; Spears-Lanoix, Erica

2016-01-01

Introduction The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Results Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Conclusion Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations. PMID:26899439

Type 2 diabetes-related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature.

PubMed

Bonner, Timethia; Foster, Margaret; Spears-Lanoix, Erica

2016-01-01

The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9), survey design (n=13), cohort studies (n=4), cross-sectional studies (n=2), qualitative studies (n=2), and case series (n=1). Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.

Developing an automated database for monitoring ultrasound- and computed tomography-guided procedure complications and diagnostic yield.

PubMed

Itri, Jason N; Jones, Lisa P; Kim, Woojin; Boonn, William W; Kolansky, Ana S; Hilton, Susan; Zafar, Hanna M

2014-04-01

Monitoring complications and diagnostic yield for image-guided procedures is an important component of maintaining high quality patient care promoted by professional societies in radiology and accreditation organizations such as the American College of Radiology (ACR) and Joint Commission. These outcome metrics can be used as part of a comprehensive quality assurance/quality improvement program to reduce variation in clinical practice, provide opportunities to engage in practice quality improvement, and contribute to developing national benchmarks and standards. The purpose of this article is to describe the development and successful implementation of an automated web-based software application to monitor procedural outcomes for US- and CT-guided procedures in an academic radiology department. The open source tools PHP: Hypertext Preprocessor (PHP) and MySQL were used to extract relevant procedural information from the Radiology Information System (RIS), auto-populate the procedure log database, and develop a user interface that generates real-time reports of complication rates and diagnostic yield by site and by operator. Utilizing structured radiology report templates resulted in significantly improved accuracy of information auto-populated from radiology reports, as well as greater compliance with manual data entry. An automated web-based procedure log database is an effective tool to reliably track complication rates and diagnostic yield for US- and CT-guided procedures performed in a radiology department.

The traditional healer in obstetric care: A persistent wasted opportunity in maternal health.

PubMed

Aborigo, Raymond Akawire; Allotey, Pascale; Reidpath, Daniel D

2015-05-01

Traditional medical systems in low income countries remain the first line service of choice, particularly for rural communities. Although the role of traditional birth attendants (TBAs) is recognised in many primary health care systems in low income countries, other types of traditional practitioners have had less traction. We explored the role played by traditional healers in northern Ghana in managing pregnancy-related complications and examined their relevance to current initiatives to reduce maternal morbidity and mortality. A grounded theory qualitative approach was employed. Twenty focus group discussions were conducted with TBAs and 19 in-depth interviews with traditional healers with expertise in managing obstetric complications. Traditional healers are extensively consulted to manage obstetric complications within their communities. Their clientele includes families who for either reasons of access or traditional beliefs, will not use modern health care providers, or those who shop across multiple health systems. The traditional practitioners claim expertise in a range of complications that are related to witchcraft and other culturally defined syndromes; conditions for which modern health care providers are believed to lack expertise. Most healers expressed a willingness to work with the formal health services because they had unique knowledge, skills and the trust of the community. However this would require a stronger acknowledgement and integration within safe motherhood programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effects of health care-based violence intervention programs on injury recidivism and costs: A systematic review.

PubMed

Strong, Bethany L; Shipper, Andrea G; Downton, Katherine D; Lane, Wendy G

2016-11-01

Youth violence affects thousands annually, with homicide being the third leading cause of death for those aged 10 to 24 years. This systematic review aims to evaluate the published evidence for the effects of health care-based violence intervention programs (VIPs), which focus on reducing recurrent presentations for injury due to youth violence ("recidivism"). Health literature databases were searched. Studies were retained if peer reviewed and if programs were health care based, focused on intentional injury, addressed secondary or tertiary prevention (i.e., preventing recidivism and reducing complications), included participants aged 14 to 25 years, had greater than 1-month follow-up, and evaluated outcomes. Studies of child and sexual abuse and workplace, intimate partner, and self-inflicted violence were excluded. Extracted data subject to qualitative analysis included enrollment and retention, duration of follow-up, services provided, statistical analysis, and primary and intermediate outcomes. Of the 2,144 citations identified, 22 studies were included in the final sample. Twelve studies were randomized controlled trials representing eight VIPs. Injury recidivism was assessed in six (75%) of eight programs with a significant reduction in one (17%) of six programs. Of the randomized controlled trials showing no difference in recidivism, all were either underpowered or did not include a power analysis. Two observational studies also showed significant reduction in recidivism. Significant intermediate outcomes included increased service use, attitude change, and decreases in violence-related behavior. Reductions in injury recidivism led to reductions in health care and criminal justice system costs. Three studies showing reduced injury recidivism and several studies showing positive intermediate outcomes identify VIPs as a promising practice. Many studies were limited by poor methodological quality, including high losses to follow-up. Systematic review, level III.

Investigation of membranous ventricular septal defect complicated with tricuspid regurgitation in ventricular septal defect occlusion

PubMed Central

LIU, SHU-PING; LI, LI; YAO, KE-CHUN; WANG, NA; WANG, JIAN-CHANG

2013-01-01

This study aimed to explore the mechanism of membranous ventricular septal defect complicated with tricuspid regurgitation and the significance of ventricular septal defect occlusion by echocardiography. A total of 43 patients with membranous ventricular septal defect complicated with tricuspid regurgitation were observed by echocardiography and the changes in length, area and volume of tricuspid regurgitation prior to and following ventricular septal defect occlusion were measured. There were four different mechanisms of membranous ventricular septal defect complicated with tricuspid regurgitation. The various indices of tricuspid regurgitation volume were significantly reduced following occlusion. Ventricular septal defect occlusion significantly reduces tricuspid regurgitation volume complicated with membranous ventricular septal defect and echocardiography is an ideal method to detect these changes. PMID:23404058

Reduction of maternal mortality due to preeclampsia in Colombia-an interrupted time-series analysis

PubMed Central

Herrera-Medina, Rodolfo; Herrera-Escobar, Juan Pablo; Nieto-Díaz, Aníbal

2014-01-01

Introduction: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations. PMID:24970956

Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction.

PubMed

Hultman, Charles Scott; Kim, Sendia; Lee, Clara N; Wu, Cindy; Dodge, Becky; Hultman, Chloe Elizabeth; Roach, S Tanner; Halvorson, Eric G

2016-06-01

Perforator flaps have become a preferred method of breast reconstruction but can consume considerable resources. We examined the impact of a Six Sigma program on microsurgical breast reconstruction at an academic medical center. Using methods developed by Motorola and General Electric, we applied critical pathway planning, workflow analysis, lean manufacturing, continuous quality improvement, and defect reduction to microsurgical breast reconstruction. Primary goals were to decrease preoperative-to-cut time and total operative time, through reduced variability and improved efficiency. Secondary goals were to reduce length of stay, complications, and reoperation. The project was divided into 3 phases: (1) Pre-Six Sigma (24 months), (2) Six Sigma (10 months), (3) and Post-Six Sigma (24 months). These periods (baseline, intervention, control) were compared by Student t test and χ analysis. Over a 5-year period, 112 patients underwent 168 perforator flaps for breast reconstructions, by experienced microsurgeons. Total operative time decreased from 714 to 607 minutes (P < 0.01), across the study period, with the greatest drop occurring in unilateral cases, from 672 to 498 minutes (P < 0.01). Length of stay decreased from 6.3 to 5.2 days (P = 0.01). Overall complication rates (35.9% vs 30%, not significant) and take-back rates (20.5% vs 23.9%, not significant) remained similar over the 5-year period. Physician revenue/minute increased from US $6.28 to US $7.59, whereas hospital revenue/minute increased from US $21.84 to US $25.11. A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

Complications of Guillain-Barré syndrome.

PubMed

Wang, Ying; Zhang, Hong-Liang; Wu, Xiujuan; Zhu, Jie

2016-01-01

Guillain-Barré syndrome (GBS) is an immune-mediated disorder in the peripheral nervous system with a wide spectrum of complications. A good understanding of the complications of GBS assists clinicians to recognize and manage the complications properly thereby reducing the mortality and morbidity of GBS patients. Herein, we systemically review the literature on complications of GBS, including short-term complications and long-term complications. We summarize the frequency, severity, clinical manifestations, managements and possible mechanisms of different kinds of complications, and point out the flaws of current studies as well as demonstrate the further investigations needed.

Pregnant women: What do they need to know during pregnancy? A descriptive study.

PubMed

Almalik, Mona M A; Mosleh, Sultan M

2017-04-01

Antenatal education programs provide women with essential knowledge and skills in various aspects of maternal and fetal health. Antenatal education is based on improving women's health, reducing the risks of complications and enhancing couples' positive experience during childbirth. There is a lack of formal antenatal educational programs based on women's needs in Jordan. This study sought to identify and prioritize the learning needs for women during pregnancy. A descriptive cross-sectional design was employed. The study sample was recruited from three maternal and child health centers. Data were collected from a convenient sample of 150 pregnant women during their antenatal visits. One hundred and twenty three participants (response rate=82%) completed the self-reported antenatal learning needs questionnaire. Women identified their most important learning needs were related to managing major complications of pregnancy (mean=3.49, SD=0.78), investigations and physician follow-up visit during pregnancy (mean=3.42, SD=0.71), appropriate diet (mean=3.36, SD=0.84) and information about medication and supplements (mean=3.22, SD=0.97). Spearman correlation showed negative association between participants' age and physical (r=-0.536, p=0.015) and emotional concerns (r=-0.490, p=0.001). Women who had a diploma or higher degree reported greater concern regarding physical (median=4.00, IQR=3.00-4.00, p=0.047) and emotional changes (median=3.33, IQR=3.00-4.00, p=0.004). Finally, migrant participants showed greater significant concern regarding emotional changes and coping with minor complications. A large proportion of pregnant women in this study reported a high degree of importance of specific learning topics that were closely relevant to their current period of pregnancy. The lack of focusing on issues related to maternal emotional status and possible complications suggests a need for a national strategy to provide antenatal education based on women's perceptions of their needs. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Normal tissue complication probability modelling of tissue fibrosis following breast radiotherapy

NASA Astrophysics Data System (ADS)

Alexander, M. A. R.; Brooks, W. A.; Blake, S. W.

2007-04-01

Cosmetic late effects of radiotherapy such as tissue fibrosis are increasingly regarded as being of importance. It is generally considered that the complication probability of a radiotherapy plan is dependent on the dose uniformity, and can be reduced by using better compensation to remove dose hotspots. This work aimed to model the effects of improved dose homogeneity on complication probability. The Lyman and relative seriality NTCP models were fitted to clinical fibrosis data for the breast collated from the literature. Breast outlines were obtained from a commercially available Rando phantom using the Osiris system. Multislice breast treatment plans were produced using a variety of compensation methods. Dose-volume histograms (DVHs) obtained for each treatment plan were reduced to simple numerical parameters using the equivalent uniform dose and effective volume DVH reduction methods. These parameters were input into the models to obtain complication probability predictions. The fitted model parameters were consistent with a parallel tissue architecture. Conventional clinical plans generally showed reducing complication probabilities with increasing compensation sophistication. Extremely homogenous plans representing idealized IMRT treatments showed increased complication probabilities compared to conventional planning methods, as a result of increased dose to areas receiving sub-prescription doses using conventional techniques.

Prevention, identification, and management of post-operative penile implant complications of infection, hematoma, and device malfunction

PubMed Central

O’Rourke, Timothy K.; Erbella, Alexander; Zhang, Yu

2017-01-01

Penile prosthesis implant surgery is an effective management approach for a number of urological conditions, including medication refractory erectile dysfunction (ED). Complications encountered post-operatively include infection, bleeding/hematoma, and device malfunction. Since the 1970s, modifications to these devices have reduced complication rates through improvement in antisepsis and design using antibiotic coatings, kink-resistant tubing, lock-out valves to prevent autoinflation, and modified reservoir shapes. Device survival and complication rates have been investigated predominately by retrospective database-derived studies. This review article focuses on the identification and management of post-operative complications following penile prosthetic and implant surgery. Etiology for ED, surgical technique, and prosthesis type are variable among studies. The most common post-operative complications of infection, bleeding, and device malfunction may be minimized by adherence to consistent technique and standard protocol. Novel antibiotic coatings and standard antibiotic regimen may reduce infection rates. Meticulous hemostasis and intraoperative testing of devices may further reduce need for revision surgery. Additional prospective studies with consistent reporting of outcomes and comparison of surgical approach and prosthesis type in patients with variable ED etiology would be beneficial. PMID:29238663

Does minimal access tubular assisted spine surgery increase or decrease complications in spinal decompression or fusion?

PubMed

Fourney, Daryl R; Dettori, Joseph R; Norvell, Daniel C; Dekutoski, Mark B

2010-04-20

Systematic review. The purpose of this review was to attempt to answer the following 2 clinical questions: (1) Does minimal access tubular assisted spine surgery (MAS) decrease the rate of complications in posterior thoracolumbar decompression and/or fusion surgery compared with traditional open techniques? (2) What strategies to reduce the risk of complications in MAS have been shown to be effective? The objective of minimal access spine surgery is to reduce damage to surrounding tissues while accomplishing the same goals as conventional surgery. Patient demand and marketing for MAS is driven by the perception of better outcomes, although the purported advantages remain unproven. Whether the risk of complications is affected by minimal access techniques is unknown. A systematic review of the English language literature was undertaken for articles published between 1990 and July 2009. Electronic databases and reference lists of key articles were searched to identify published studies that compared the rate of complications after MAS to a control group that underwent open surgery. Single-arm studies were excluded. Two independent reviewers assessed the strength of literature using GRADE criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. From the 361 articles identified, 13 met a priori criteria and were included for review. All of the studies evaluated only lumbar spine surgery. The single large randomized study showed less favorable results for MAS discectomy, but no significant difference in complication rates. The quality of the other studies, particularly for fusion surgery, was low. Overall, the rates of reoperation, dural tear, cerebrospinal fluid leak, nerve injury, and infection occurred in similar proportions between MAS and open surgery. Blood loss was reduced in MAS fusion; however, the quality of those studies was very low. Operation time and hospital length of stay was variable across studies. There was no evidence to assess the effectiveness of strategies to reduce the risk of complications in MAS. Some data suggests that the rate of complications may decrease with experience. (1) Compared to open techniques, MAS does not decrease the rate of complications for posterior lumbar spinal decompression or fusion. (2) There is no evidence to assess the effectiveness of strategies to reduce the risk of MAS-related complications.

Review of sport-induced groin injuries.

PubMed

Sedaghati, Parisa; Alizadeh, Mohammad-Hossein; Shirzad, Elham; Ardjmand, Abolfazl

2013-12-01

Groin injuries are among the most common injuries co-existing with sports. The aim of this review was to outline the epidemiology and identify risk factors, as well as examine preventative and interventional measures for reducing the occurrence of this form of injury among athletes. An electronic, systematic search for relevant keywords, either separately or in combination was sought in the academic scientific databases. Groin injuries, acute or chronic, consist of a high percentage of injuries that manifest with pain. Despite the specific tendency for injury among some sports, such injuries make up 2-5% of sport-induced injuries. There are few available reports on lower limb injuries, especially groin injuries, in Iran. Numerous factors predispose to groin injuries. A lengthy list of preventive/ treatment measures, from preliminary to sophisticated, have been proposed. Although using a programmed strategy designed to decrease the risk of groin injuries by taking a strategic approach to exercise may alleviate complications, in some cases the chronic nature of the injury may threaten the professional life of the athlete. More research is required to plan suitable programs for reducing the risk of this type of injury in athletes.

Complications after surgery for lumbar stenosis in a veteran population.

PubMed

Deyo, Richard A; Hickam, David; Duckart, Jonathan P; Piedra, Mark

2013-09-01

Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Among 12,154 eligible patients, major medical complications occurred in 2.1%, wound complications in 3.2%, and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs. class 1 or 2: 2.97; 95% confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14-3.78; P < 0.0001). ASA class, age, type of surgery, insulin or corticosteroid use, and functional status were independent risk factors for major medical complications. These factors may help in selecting patients and planning procedures, improving patient safety.

Outpatient outcomes and satisfaction in pediatric population: data from the postoperative phone call.

PubMed

Brenn, B Randall; Choudhry, Dinesh K; Sacks, Karen

2016-02-01

Quality and patient/parent satisfaction are goals for pediatric perioperative services. As part of the implementation of our operating room electronic medical record (EMR), a postoperative phone call questionnaire was developed to assess patients discharged after outpatient surgery. The goal of this initiative was to determine the rate of common postoperative complications and understand reasons for patient/parent dissatisfaction. Institutional Review Board approval was obtained for chart review. The postoperative phone call survey was attempted by our postanesthesia care unit nursing staff on all pediatric outpatients. The call was attempted for 3 days. From 2009 to 2013, more than 37 000 phone records existed in our EMR, Epic Optime (Epic Systems, Verona, WI). These data were extracted to a business intelligence (BI) program, QlikView (Qliktech, Radnor, PA, USA). A BI dashboard was constructed to obtain phone call results for any given time frame from monthly to spanning several years. Complications were logged as 4-point severity rating scales (none, mild, moderate, severe) with descriptions for each level. The BI dashboard calculated the overall and rates by severity for the following: (i) nausea, (ii) vomiting, (iii) pain, (iv) bleeding, (v) hoarseness, and (vi) difficulty eating. Of 42 688 outpatient cases, 37 620 postoperative phone calls were completed for an overall response rate of 88%. Pain, at 11.1%, was the highest reported postoperative complication. The rate of dissatisfaction was reported to be 0.31%. Most patients reporting dissatisfaction (62%) did not report any complications. Contingency coefficient showed that there was little relationship between satisfaction and presence of complications. A postoperative phone survey is cost-effective and appreciated by patients. We found that satisfaction with our perioperative services was not related to the rates of reported complications. Although reducing complications is of utmost importance, improvements in wait times and other operational issues would yield greater improvements in satisfaction. © 2015 John Wiley & Sons Ltd.

Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa Government Hospital, Ghana: a descriptive study.

PubMed

Obirikorang, Yaa; Obirikorang, Christian; Anto, Enoch Odame; Acheampong, Emmanuel; Batu, Emmanuella Nsenbah; Stella, Agyemang Duah; Constance, Omerige; Brenya, Peter Kojo

2016-07-26

Diabetes mellitus (DM) appears to be a global epidemic and an increasingly major non-communicable disease threatening both affluent and non-affluent society. The study aimed to determine the knowledge of diabetic complications among diabetes mellitus clients visiting the Diabetic Clinical at Sampa Government Hospital, Ghana. This questionnaire-based descriptive study recruited a total 630 patients visiting the Diabetes Clinic at the Sampa Government Hospital. Structured questionnaire was used to obtain information such as socio-demographic and knowledge on complications of diabetes. Out of a total of 630 participants, 325 (51.5 %) knew diabetic foot as the most common complication followed by hypertension 223(35.4 %), neuropathy 184 (29.2 %), hypoactive sexual arousal 160(25.4 %), arousal disorder 135(21.5 %), eye diseases 112(17.7 %), heart disease 58(9.2 %), and renal disease 34(5.4 %). Comprehensive assessment of level of knowledge on the complications showed that majority 378(60.0 %) of T2D patients did not have knowledge on diabetes complications, 169(26.9 %) had inadequate knowledge on diabetics complication while 82(13.1 %) had adequate knowledge. The risk factors associated with the level of knowledge of diabetic complications were female gender adjusted odd ratio (AOR) =2.31 (1.56-3.41) married participants AOR = 3.37 (1.44-7.93), widowed AOR = 2.98 (1.10-8.08), basic level of education AOR =0.18 (0.082-0.50), Junior High School (JHS) and above of education level AOR = 0.035(0.017-0.75), 5-9 years of T2D duration AOR = 0.31(0.018-0.57), ≥10 years T2D duration AOR = 0.042 (0.02-0.10) and urban dwellers AOR = 0.36 (0.22-0.68) respectively. Participants knew the individual complication of diabetic mellitus but lack an in-depth knowledge on the complications. Further expansion of diabetic educative programs like using mass media and involving national curriculum of education can improve self-regulatory awareness of diabetic complications which may reduce the morbidity and mortality of diabetic patients.

Evaluation of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator for a gynecologic oncology service.

PubMed

Szender, J Brian; Frederick, Peter J; Eng, Kevin H; Akers, Stacey N; Lele, Shashikant B; Odunsi, Kunle

2015-03-01

The National Surgical Quality Improvement Program is aimed at preventing perioperative complications. An online calculator was recently published, but the primary studies used limited gynecologic surgery data. The purpose of this study was to evaluate the performance of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator (URC) on the patients of a gynecologic oncology service. We reviewed 628 consecutive surgeries performed by our gynecologic oncology service between July 2012 and June 2013. Demographic data including diagnosis and cancer stage, if applicable, were collected. Charts were reviewed to determine complication rates. Specific complications were as follows: death, pneumonia, cardiac complications, surgical site infection (SSI) or urinary tract infection, renal failure, or venous thromboembolic event. Data were compared with modeled outcomes using Brier scores and receiver operating characteristic curves. Significance was declared based on P < 0.05. The model accurately predicated death and venous thromboembolic event, with Brier scores of 0.004 and 0.003, respectively. Predicted risk was 50% greater than experienced for urinary tract infection; the experienced SSI and pneumonia rates were 43% and 36% greater than predicted. For any complication, the Brier score 0.023 indicates poor performance of the model. In this study of gynecologic surgeries, we could not verify the predictive value of the URC for cardiac complications, SSI, and pneumonia. One disadvantage of applying a URC to multiple subspecialties is that with some categories, complications are not accurately estimated. Our data demonstrate that some predicted risks reported by the calculator need to be interpreted with reservation.

Medical costs of war in 2035: long-term care challenges for veterans of Iraq and Afghanistan.

PubMed

Geiling, James; Rosen, Joseph M; Edwards, Ryan D

2012-11-01

War-related medical costs for U.S. veterans of Iraq and Afghanistan may be enormous because of differences between these wars and previous conflicts: (1) Many veterans survive injuries that would have killed them in past wars, and (2) improvised explosive device attacks have caused "polytraumatic" injuries (multiple amputations; brain injury; severe facial trauma or blindness) that require decades of costly rehabilitation. In 2035, today's veterans will be middle-aged, with health issues like those seen in aging Vietnam veterans, complicated by comorbidities of posttraumatic stress disorder, traumatic brain injury, and polytrauma. This article cites emerging knowledge about best practices that have demonstrated cost-effectiveness in mitigating the medical costs of war. We propose that clinicians employ early interventions (trauma care, physical therapy, early post-traumatic stress disorder diagnosis) and preventive health programs (smoking cessation, alcohol-abuse counseling, weight control, stress reduction) to treat primary medical conditions now so that we can avoid treating costly secondary and tertiary complications in 2035. (We should help an amputee reduce his cholesterol and maintain his weight at age 30, rather than treating his heart disease or diabetes at age 50.) Appropriate early interventions for primary illness should preserve veterans' functional status, ensure quality clinical care, and reduce the potentially enormous cost burden of their future health care.

Abortion and maternal mortality in the developing world.

PubMed

Okonofua, Friday

2006-11-01

Unsafe abortion is an important public health problem, accounting for 13% of maternal mortality in developing countries. Of an estimated annual 70,000 deaths from unsafe abortion worldwide, over 99% occur in the developing countries of sub-Saharan Africa, Central and Southeast Asia, and Latin America and the Caribbean. Factors associated with increased maternal mortality from unsafe abortion in developing countries include inadequate delivery systems for contraception needed to prevent unwanted pregnancies, restrictive abortion laws, pervading negative cultural and religious attitudes towards induced abortion, and poor health infrastructures for the management of abortion complications. The application of a public health approach based on primary, secondary, and tertiary prevention can reduce morbidity and mortality associated with unsafe abortion in developing countries. Primary prevention includes the promotion of increased use of contraception by women (and by men) at risk for unwanted pregnancy; secondary prevention involves the liberalization of abortion laws and the development of programs to increase access to safe abortion care in developing countries. In contrast, tertiary prevention includes the integration and institutionalization of post-abortion care for incomplete abortion and the early and appropriate treatment of more severe complications of abortion. Efforts to address these problems will contribute both to reducing maternal mortality associated with induced abortion and to achieving the Millennium Development Goals in developing countries.

Redo surgery after permanent pacemaker implantation: performance indicator of surgical techniques and pacing technology.

PubMed

Bharat, Vijaya

2004-01-01

The incidence of permanent pacemaker-related complications is reducing due to advancement of technology and increasing operator experience. There are only few series from India reporting the annual complication rates from a single center over the years. This is a series of 782 pacemakers implanted over 20 years in a secondary healthcare set-up. Eighty-two patients underwent redo surgery, either for a procedure-related complication (n=34) or for replacement of a malfunctioning/end-of-life pacemaker (n=48). Through critical analysis and corrective measures, all the procedural complications were reduced to less than 4% of the annual implantations. The introduction of a pacemaker follow-up clinic contributed to reducing the rate of elective replacement for battery depletion from 19.17% of the implanted VVI pacemakers to 0.63%. Despite being a low-volume center, with less than 100 pacemakers implanted annually, the performance of our pacing practice has shown continuous improvement.

Staged diabetes management: computerizing a disease state management program.

PubMed

Ginsberg, B H; Tan, M H; Mazze, R; Bergelson, A

1998-04-01

Recently, the Diabetes Control and Complication Trial (DCCT) and other similar studies have demonstrated that near-normalization of blood glucose in diabetes will reduce complications up to 75% but translation of these results into practice has been difficult. In an attempt to help provide the best possible control of patients with diabetes, we have produced an attempt to help provide the best possible control of patients with diabetes, we have produced a new disease state management system for diabetes, called "Staged Diabetes Management" (SDM), implemented it in over 100 sites worldwide, and developed a computer program to simplify its use. SDM, designed to change the way we deal with patients with diabetes, is based upon five principles: (1) community involvement in setting care guidelines; (2) negotiation of goals with patients; (3) appropriate timelines for therapeutic success; (4) use of flowcharts for medical decisions; and (5) evaluation of the program. SDM is designed to be altered by a community to meet its needs and resources. It encourages primary care physicians to deliver better diabetes care using a team approach and to refer patients with diabetes to specialists when appropriate. It has a complete set of materials for communities, individual health care providers and patients. SDM has been tested for changes in structure, process and outcomes. A meta-analysis of seven clinical trials with over 500 patients has shown a time-weighted average fall in hemoglobin A1c of 1.7 points (equivalent to a drop in mean blood glucose of about 3.5 mM or 60 mg/dL). Preliminary pharmacoeconomic analysis demonstrates a lifetime cost saving of over $27,000 per patient. A computer program has been developed for the Microsoft Windows environment that contains a client-server database, based upon DiabCare, for the data file structure.

Nutrition in peri-operative esophageal cancer management.

PubMed

Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

2017-07-01

Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

Preoperative weight loss program targeting women with overweight and hypertrophy of the breast - a pilot study.

PubMed

Geiker, N R W; Horn, J; Astrup, A

2017-04-01

Among women with hypertrophic breasts, the clear majority are overweight or obese. Owing to increased risk of complications, women with a body mass index (BMI) above 25 kg m -2 are precluded from reduction mammaplasty. The primary aim was to investigate if intensive weight loss could ready women with overweight for breast reduction surgery. Six women, all overweight [BMI 30.9 {28.5; 35.8} kg m -2 ] with symptomatic hypertrophy of the breast, were included a 12-week weight loss program. All women desired reduction mammaplasty and were motivated for preoperational weight loss. The first 8 weeks consisted of a formula-based diet supplying 800 kcal daily, in the subsequent 4 weeks regular foods were reintroduced increasing the intake to 1200 kcal daily. Five women completed the trial, and achieved a median (range) weight loss of 10.2 (6.5; 19) kg. Initial breast volume was 1100-2500 mL per breast, this was reduced by 300 (200; 500) mL after the intervention; equivalent to approximately 19%. Waist, hip, upper arm and thorax circumference were significantly reduced following weight loss. At end of study, all the women still suffered from symptomatic breast hypertrophy to substantiate reduction mammaplasty. Surgeries were performed 2 months thereafter. A 12-week intensive preoperative weight loss program enabled women with obesity for breast reduction surgery. Breast size was reduced proportionally more than total weight loss among women with hypertrophy. © 2017 World Obesity Federation.

Intensive exercise reduces the fear of additional falls in elderly people: findings from the Korea falls prevention study.

PubMed

Oh, Dong Hyun; Park, Ji Eun; Lee, Eon Sook; Oh, Sang Woo; Cho, Sung Il; Jang, Soong Nang; Baik, Hyun Wook

2012-12-01

Falls among older people are a major public health problem and may result in fracture, medical complications that require hospitalization, and fear of additional falls. Given the prevalence and impact of the fear of falling again, reducing the incidence of falls is important to prevent additional falls. This study analyzed whether exercise programs decrease the fear of future falls in elderly patients who have fallen previously. A randomized controlled study was performed that included 65 elderly community-dwelling subjects who had fallen in the previous year. Subjects were randomized into two groups: an exercise group (EG, n = 36) and a control group (CG, n = 29). The EG participated in three exercise sessions per week for 12 weeks. Muscle strength, balance, agility, flexibility, and muscular endurance were measured at baseline and after 12 weeks. After the 12-week exercise program, the subjects in the EG demonstrated remarkable improvement in their walking speed, balance (p = 0.003), back strength (p = 0.08), lower extremity strength (p = 0.004), and flexibility (p < 0.001). When asked whether they were afraid of falling, more participants in the EG than in the CG responded "not at all" or "a little." The 12-week exercise program described here reduced the fear of falling (p = 0.02). It also improved the balance, flexibility, and muscle strength of the participants and was associated with improved quality of life.

Pregnant Employee Protection Program in a Large Chemical Company.

PubMed

Frey, Gunild; Schuster, Michael; Oberlinner, Christoph; Queier-Wahrendorf, Annette; Lang, Stefan; Yong, Mei

2015-09-01

To assess whether a structured employee protection program for pregnant workers at a chemical company has an impact on pregnancy outcomes. Reported pregnancies (n = 1402) between 2003 and 2010 and their outcomes were documented using questionnaires at the time of pregnancy report, end of pregnancy, and 1 year later. Potential maternal exposures were assessed using job histories, workplace inspections, and questionnaires. Participation was 86% overall and was consistently high across subgroups.Pregnancy losses (10.9%), pregnancy complications, and preterm births (8.1%) were in agreement with rates in the general population and were independent of type of work and maternal exposure category. Pregnancy complication rates in this chemical company are not statistically elevated than that in the general population, as suggested in a previous study. The protection program may play a role in preventing complications that may have occurred.

Decreasing the complications of renal osteodystrophy secondary to high phosphorus levels by using an innovative self-monitoring educational program.

PubMed

Zagaroli, A M; Zimmer, S M; Bowes, J M; Hartley, K S

1995-01-01

We wanted continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients to become more cognitive of the complications of high-serum phosphorus levels (> 6.0 mg/dL). The phosphorus self-monitoring program was designed to encourage patients to be more responsible for preventing the complications of renal osteodystrophy. Patients' phosphorus levels were graphed monthly on a poster in the exam room. Additional posters discussed their responsibilities to control phosphorus and the complications associated with hyperphosphatemia. All patients received an informative letter regarding the inception of the program in March 1994 and also were assured total anonymity of their laboratory results. At monthly clinic appointments, they received additional written information on phosphorus and discussed their phosphorus levels. Our teaching method proved effective in our CAPD/CCPD population. In March 1994, 31% of our patients had a phosphorus level greater than 6.0 mg/dL versus 10% in September 1994. The ability of patients to see their monthly progress and the comparison with other patients encouraged much interest and questions regarding phosphorus control.

Decreasing NICU Costs in the managed care arena: the positive impact of collaborative high-risk OB and NICU disease management programs.

PubMed

Diehl-Svrjcek, Beth C; Richardson, Regina

2005-01-01

Costs for preterm and critically ill neonates in a neonatal intensive care unit (NICU) can be astronomical related to the number of inpatient day's accrued and professional ancillary fees. NICU births are often associated with maternal risk factors such as previous preterm or low birth weight delivery, maternal infections, chronic disease states, substance abuse and/or human immunodeficiency virus (HIV) infection. Accordingly, Johns Hopkins HealthCare provides a disease management approach for the prevention of NICU births through "Partners With Mom." This maternity disease management program identifies pregnant women that could potentially generate high-dollar claims. The mission of the program is to reduce hospital/NICU admissions related to pregnancy complications and improve maternal/neonatal outcomes. If an NICU birth does occur, multiple avenues are pursued to control costs. By working in concert with Partners With Mom, the NICU Disease Management Program utilizes a multifaceted approach by tracking maternal risk factors, optimizing levels of required inpatient neonatal care and pursuing other avenues of revenue enhancement.

Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve.

PubMed

Padin, Esther Mariño; Santos, Raquel Sánchez; Fernández, Sonia González; Jimenez, Antonia Brox; Fernández, Sergio Estevez; Dacosta, Ester Carrera; Duran, Agata Rial; Artime Rial, Maria; Dominguez Sanchez, Ivan

2017-10-01

3D laparoscopy allows the surgeon to regain the sense of depth and improve accuracy. The aim of the study was to assess the impact of 3D in bariatric surgery. A retrospective cohort study was conducted. All our patients who underwent bariatric surgery (sleeve gastrectomy (SG) or gastric bypass (GB)) between 2013 and 2016 were included. We compared 3D laparoscopy cohort and 2D laparoscopy cohort. Variables are as follows: age, sex, DM, hypertension, surgeon experience, and type of intervention. Comparisons of operative time, hospital stay, conversion, complications, reoperation, and exitus are completed. Three hundred twelve consecutive patients were included. 56.9% of patients underwent GB and 43.1% SG. Global complications were 3.2% (fistula 2.5%, hemoperitoneum 0.3%, others 0.4%). One hundred four procedures were performed in the 3D cohort and 208 in the 2D cohort. The 2D cohort and 3D cohort were similar regarding the following: percentage of GB vs SG, age, gender, learning curve, diabetes mellitus 2, hypertension, and sleep apnea. The operating time and hospital stay were significantly reduced in the 3D cohort (144.07 ± 58.07 vs 172.11 ± 76.11 min and 5.12 ± 9.6 vs 7.7 ± 13.2 days. It was the same when we stratified the sample by type of surgery or experience of the surgeon. Complications were reduced in the 3D cohort in the surgeries performed by novice surgeons (10.2 vs 1.8%, p = 0.034). The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.

Type 2 diabetes and disease management: exploring the connections.

PubMed

Segal, Karen R

2004-01-01

Type 2 diabetes is an enormous public health problem affecting an estimated 18.2 million Americans. The prevalence is increasing, particularly among youth and young adults, in parallel with the continuing rise in obesity. The cost of treating diabetes complications imposes a tremendous burden on healthcare resources, and there has been limited success in achieving the treatment targets which are clearly associated with reduced risks of complications and mortality. This paper reviews the relationship of obesity to the risk and health complications of diabetes, and the impact of weight loss in reducing the risk of developing diabetes and in reducing the severity of metabolic and cardiovascular consequences in individuals who have already developed diabetes.

Concomitant Liposuction Reduces Complications of Vertical Medial Thigh Lift in Massive Weight Loss Patients.

PubMed

Schmidt, Manfred; Pollhammer, Michael S; Januszyk, Michael; Duscher, Dominik; Huemer, Georg M

2016-06-01

Medial thigh lift procedures in the massive weight loss population have been associated with significant complication rates. Liposuction-assisted medial thighplasty has recently been introduced as a technical advancement to improve outcomes. To date, no study is available directly comparing the traditional approach and this new technique. Here, the authors evaluate outcomes and complications of both techniques in a retrospective cohort study. Outcomes of 59 patients undergoing vertical medial thighplasty at the authors' institution between 2008 and 2014 were assessed retrospectively. Evaluated parameters include age, sex, body mass indices, method of weight loss, comorbidities, and complications (e.g., seroma, infection, wound dehiscence, hematoma, and surgical revision). Appropriate statistical analysis was performed. There were 29 patients in the excision-only group and 30 patients in the liposuction-assisted group (all women; average age, 41.5 years). The overall complication rate was significantly reduced in the liposuction-assisted group (13 percent versus 59 percent; p < 0.001). The incidence of individual complications such as seroma formation (zero patients versus 10 patients; p < 0.001) and wound infection (one patient versus eight patients; p = 0.01) was significantly less in the liposuction-assisted group. In addition, we observed a significantly shorter hospital stay (6.0 days versus 7.8 days), reduced number of follow-up visits (2.0 versus 4.4), and reduced time to drain removal (1.8 days versus 4.1 days; p < 0.001) in the liposuction-assisted group. Liposuction-assisted medial thighplasty led to a significant reduction of complications and faster recovery in the massive weight loss patient population. As a consequence, the excision-only vertical thigh lift has been completely abandoned in the authors' clinical practice. Therapeutic, III.

Visualized Evaluation of Blood Flow to the Gastric Conduit and Complications in Esophageal Reconstruction.

PubMed

Noma, Kazuhiro; Shirakawa, Yasuhiro; Kanaya, Nobuhiko; Okada, Tsuyoshi; Maeda, Naoaki; Ninomiya, Takayuki; Tanabe, Shunsuke; Sakurama, Kazufumi; Fujiwara, Toshiyoshi

2018-03-01

Evaluation of the blood supply to gastric conduits is critically important to avoid complications after esophagectomy. We began visual evaluation of blood flow using indocyanine green (ICG) fluorescent imaging in July 2015, to reduce reconstructive complications. In this study, we aimed to statistically verify the efficacy of blood flow evaluation using our simplified ICG method. A total of 285 consecutive patients who underwent esophagectomy and gastric conduit reconstruction were reviewed and divided into 2 groups: before and after introduction of ICG evaluation. The entire cohort and 68 patient pairs after propensity score matching (PS-M) were evaluated for clinical outcomes and the effect of visualized evaluation on reducing the risk of complication. The leakage rate in the ICG group was significantly lower than in the non-ICG group for each severity grade, both in the entire cohort (285 subjects) and after PS-M; the rates of other major complications, including recurrent laryngeal nerve palsy and pneumonia, were not different. The duration of postoperative ICU stay was approximately 1 day shorter in the ICG group than in the non-ICG group in the entire cohort, and approximately 2 days shorter after PS-M. Visualized evaluation of blood flow with ICG methods significantly reduced the rate of anastomotic complications of all Clavien-Dindo (CD) grades. Odds ratios for ICG evaluation decreased with CD grade (0.3419 for CD ≥ 1; 0.241 for CD ≥ 2; and 0.2153 for CD ≥ 3). Objective evaluation of blood supply to the reconstructed conduit using ICG fluorescent imaging reduces the risk and degree of anastomotic complication. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience.

PubMed

Cavarocchi, N C; Wallace, S; Hong, E Y; Tropea, A; Byrne, J; Pitcher, H T; Hirose, H

2015-03-01

The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes. A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared. During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events. We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes. © The Author(s) 2014.

Projected Outcomes of Nurse-Family Partnership Home Visitation During 1996-2013, USA.

PubMed

Miller, Ted R

2015-08-01

Nurse-Family Partnership (NFP) targets intensive prenatal and postnatal home visitation by registered nurses to low-income first-time mothers. Through 2013, 177,517 pregnant women enrolled in NFP programs. This article projects how NFP will affect their lives and the lives of their babies. NFP has been evaluated in six randomized trials and several more limited analyses of operational programs. We systematically reviewed evaluation findings on 21 outcomes and calculated effects on three more. We added outcome data from the NFP national data system and personal communications that filled outcome data gaps on some trials. We assumed effectiveness in replication declined by 21.8 %, proportionally with the decline in mean visits per family from trials to operational programs. By 2031, NFP program enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 preterm births, 13,000 dangerous closely spaced second births, 4700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse. They will reduce smoking during pregnancy, pregnancy complications, childhood injuries, and use of subsidized child care; improve language development; increase breast-feeding; and raise compliance with immunization schedules. They will eliminate the need for 4.8 million person-months of child Medicaid spending and reduce estimated spending on Medicaid, TANF, and food stamps by $3.0 billion (present values in 2010 dollars). By comparison, NFP cost roughly $1.6 billion. Thus, NFP appears to be a sound investment. It saves money while enriching the lives of participating low-income mothers and their offspring and benefiting society more broadly by reducing crime and safety net demand.

Impact of modality choice on rates of hospitalization in patients eligible for both peritoneal dialysis and hemodialysis.

PubMed

Quinn, Robert R; Ravani, Pietro; Zhang, Xin; Garg, Amit X; Blake, Peter G; Austin, Peter C; Zacharias, James M; Johnson, John F; Pandeya, Sanjay; Verrelli, Mauro; Oliver, Matthew J

2014-01-01

Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♢ We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization. ♢ The study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease. ♢ Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications.

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

PubMed Central

2018-01-01

PURPOSE: To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. DESIGN: A cross-sectional study. SUBJECTS AND SETTING: A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. METHODS: The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. RESULTS: Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being readmitted and visiting the ER due to ostomy complications after the first month of hospital discharge and up to 18 months postdischarge (odds ratio [OR] = 0.45; 95% confidence interval [CI], 0.27-0.73; and OR = 0.37; 95% CI, 0.22-0.64, respectively). CONCLUSIONS: Findings suggest that enrolling patients in the postdischarge ostomy support program provides an effective approach to reducing preventable healthcare utilization. PMID:29189646

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization.

PubMed

Rojanasarot, Sirikan

To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. A cross-sectional study. A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being readmitted and visiting the ER due to ostomy complications after the first month of hospital discharge and up to 18 months postdischarge (odds ratio [OR] = 0.45; 95% confidence interval [CI], 0.27-0.73; and OR = 0.37; 95% CI, 0.22-0.64, respectively). Findings suggest that enrolling patients in the postdischarge ostomy support program provides an effective approach to reducing preventable healthcare utilization.

Malnutrition: a marker for increased complications, mortality, and length of stay after total shoulder arthroplasty.

PubMed

Garcia, Grant H; Fu, Michael C; Dines, David M; Craig, Edward V; Gulotta, Lawrence V

2016-02-01

Malnutrition is an established risk factor for postoperative complications. The purpose of this investigation was to determine the overall prevalence of malnutrition in total shoulder arthroplasty (TSA) patients, the differences in prevalence across obesity subgroups, and the overall complication risk of malnourished patients compared with normal patients. The American College of Surgeons National Surgical Quality Improvement Program database was queried for TSA cases from 2005 to 2013 for this retrospective cohort study. Malnutrition was defined as preoperative albumin concentration of <3.5 g/dL. Rates of postoperative complications were compared between normal and malnourished patients. We identified 4,655 TSA cases, with preoperative albumin measurements available for 1681 patients (36.1%). Propensity score adjustment successfully reduced selection bias, with adjusted P values of >.05 for demographics, body mass index, and modified Charlson Comorbidity Index. Of the cohort with albumin measurements, 7.6% of patients were malnourished according to our criteria. Bivariate analysis showed malnourished patients had higher rates of pulmonary complications, anemia requiring transfusion, extended length of stay (LOS), and death (all P < .05). Propensity-adjusted multivariable logistic regression demonstrated that malnutrition was significantly associated (all P < .05) with postoperative transfusion (odds ratio, 2.49), extended LOS (odds ratio, 1.69), and death (odds ratio, 18.09). The overall prevalence of malnutrition was 7.6%. Malnourished patients were at a significantly increased risk for blood transfusion, longer hospital LOS, and death within 30 days of surgery. Multivariable analysis showed TSA patients with preoperative albumin levels of <3.5 g/dL are at much higher risk for morbidity and death after surgery than patients with albumin levels within normal reference ranges. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The control of H5 or H7 mildly pathogenic avian influenza: a role for inactivated vaccine.

PubMed

Halvorson, David A

2002-02-01

Biosecurity is the first line of defence in the prevention and control of mildly pathogenic avian influenza (MPAI). Its use has been highly successful in keeping avian influenza (AI) out of commercial poultry worldwide. However, sometimes AI becomes introduced into poultry populations and, when that occurs, biosecurity again is the primary means of controlling the disease. There is agreement that routine serological monitoring, disease reporting, isolation or quarantine of affected flocks, application of strict measures to prevent the contamination of and movement of people and equipment, and changing flock schedules are necessities for controlling AI. There is disagreement as to the disposition of MPAI-infected flocks: some advocate their destruction and others advocate controlled marketing. Sometimes biosecurity is not enough to stop the spread of MPAI. In general, influenza virus requires a dense population of susceptible hosts to maintain itself. When there is a large population of susceptible poultry in an area, use of an inactivated AI vaccine can contribute to AI control by reducing the susceptibility of the population. Does use of inactivated vaccine assist, complicate or interfere with AI control and eradication? Yes, it assists MPAI control (which may reduce the risk of highly pathogenic AI (HPAI)) but, unless steps are taken to prevent it, vaccination may interfere with sero-epidemiology in the case of an HPAI outbreak. Does lack of vaccine assist, complicate or interfere with AI control and eradication? Yes, it assists in identification of sero-positive (convalescent) flocks in a HPAI eradication program, but it interferes with MPAI control (which in turn may increase the risk of emergence of HPAI).A number of hypothetical concerns have been raised about the use of inactivated AI vaccines. Infection of vaccinated flocks, serology complications and spreading of virus by vaccine crews are some of the hypothetical concerns. The discussion of these concerns should take place in a scientific framework and should recognize that control of MPAI reduces the risk of HPAI. That inactivated vaccines have reduced a flock's susceptibility to AI infection, have reduced the quantity of virus shed post-challenge, have reduced transmission and have markedly reduced disease losses, are scientific facts. The current regulations preventing vaccination against H5 or H7 MPAI have had the effect of promoting circulation of MPAI virus in commercial poultry and live poultry markets. In the absence of highly pathogenic avian influenza, there is no justification for forbidding the use of inactivated vaccine.

Problems in the evaluation of day hospitals.

PubMed

Guy, W; Gross, G M

1967-06-01

The day hospital has been utilized as a means both to maintain and improve remission status of previously hospitalized patients and, more recently, as an alternative to inpatient treatment. Although uniformly encouraging, the reports of treatment success are ambiguous and complicated by the recency and diversity of the programs. Proposals to reduce confusion in the areas of identification of population, definition of treatment, treatment effects, and assessment procedures are discussed. The concept of therapeutic community with its emphasis on socialization processes makes symptom reduction alone an insufficient criterion of treatment success. More comprehensive measures of the permanency of remission and quality of social adjustment are advocated.

Pulmonary resections performed at hospitals with thoracic surgery residency programs have superior outcomes.

PubMed

Bhamidipati, Castigliano M; Stukenborg, George J; Ailawadi, Gorav; Lau, Christine L; Kozower, Benjamin D; Jones, David R

2013-01-01

Pulmonary resections are performed at thoracic residency (TR), general surgery residency (GSR), no surgery residency, and no residency hospitals. We hypothesize that morbidity and mortality for these procedures are different between hospitals and that operations performed at TR teaching hospitals have superior results. Records of adults who underwent pneumonectomy, lobar, segmentectomy, and nonanatomic wedge resections (N = 498,099) were evaluated in an all-payer inpatient database between 2003 and 2009. Hospital teaching status was determined by linkage to Association of American Medical College's Graduate Medical Education Tracking System. Multiple hierarchical regression models examined the in-hospital mortality, occurrence of any complication, and failure to rescue. The mean annual pulmonary resection volume among hospitals was TR (16%), GSR (17%), no surgery residency (28%), and no residency (39%). Unadjusted mortality for all procedures was lowest at TR hospitals (P < .001). Likewise, any complication was least likely to occur at TR hospitals (P < .001). After case-mix adjustment, the risk of any complication after segmentectomy or nonanatomic wedge resection was lower at TR hospitals than in GSR hospitals (P < .001). Among pneumonectomy recipients, TR hospitals reduced the adjusted odds ratio of failure to rescue by more than 25% compared with no surgery residency (P < .001). Likewise, in patients who underwent pneumonectomy, TR centers were associated with reducing the odds ratio of death by more than 30% compared with GSR hospitals (P < .001). In comparison with other hospitals, including GSR hospitals, TR hospitals have lower morbidity and mortality. These results support using hospitals with a TR as an independent prognostic indicator of outcomes in pulmonary resections. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Comparison of Complications Rates in Endoscopic Surgery Performed by a Clinical Assistant vs. An Experienced Endoscopic Surgeon

PubMed Central

Singhi, Aditi

2009-01-01

Study Objectives: (a) To find out the actual incidence of complications during endoscopic surgeries. (b) Comparison of complication rate between an experienced laparoscopic surgeon (> 10 years of experience in endoscopic surgery) and a clinical assistant (> 3 years of experience in endoscopic surgery). (c) How to manage complications in endoscopic surgery. (d) Concrete suggestions to reduce the complication rate. Design: Retrospective study (Canadian Task Force classification ii-2). Setting: Tertiary gynecologic endoscopic unit. Patients: A total of 3204 cases of gynecologic endoscopic surgery out of which 2001 were laparoscopic and 1203 were hysteroscopic surgeries. Interventions: Laparoscopic and hysteroscopic gynecologic surgeries in indicated cases. Measurements and Main Results: The study was carried out between April 2003 and October 2007 at a referral center for endoscopic surgery. A total of 3204 cases of gynecologic endoscopic surgery were studied. There were five significant complications in laparoscopic surgeries and four significant complications in hysteroscopic surgeries seen in four years and six months. All the complications could be managed with no mortality. Conversion to laparotomy was needed in eight cases of laparoscopic surgeries and none in hysteroscopic surgeries. Conclusion: The risk of complication reduces with the experience in endoscopic surgery. However, the proper grooming of a novice in experienced hands, for a sufficient period of time, can minimize the complication rate in the initial learning phase. The complication may be utilized as a stepping-stone to overcome any given situation without panic, but with adequate safety. PMID:22442510

Description of an Audio-Based Paced Respiration Intervention for Vasomotor Symptoms

PubMed Central

Burns, Debra S.; Drews, Michael R.; Carpenter, Janet S.

2013-01-01

Millions of women experience menopause-related hot flashes or flushes that may have a negative effect on their quality of life. Hormone therapy is an effective treatment, however, it may be contraindicated or unacceptable for some women based on previous health complications or an undesirable risk–benefit ratio. Side effects and the unacceptability of hormone therapy have created a need for behavioral interventions to reduce hot flashes. A variety of complex, multimodal behavioral, relaxation-based interventions have been studied with women (n = 88) and showed generally favorable results. However, currently extensive resource commitments reduce the translation of these interventions into standard care. Slow, deep breathing is a common component in most interventions and may be the active ingredient leading to reduced hot flashes. This article describes the content of an audio-based program designed to teach paced breathing to reduce hot flashes. Intervention content was based on skills training theory and music entrainment. The audio intervention provides an efficient way to deliver a breathing intervention that may be beneficial to other clinical populations. PMID:23914283

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

PubMed

Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who delivered at home, the risk of perinatal mortality among women with intrapartum complications was 43.0% lower for women who delivered in a public health facility (OR = 0.57; 95% CI = 0.42-0.78) and 58.0% lower when delivered in a private health facility (OR = 0.42; 95% CI = 0.28-0.63). Maternal health programs need to promote timely recognition of intrapartum complications and delivery in health facilities to improve perinatal outcomes, particularly in populations where overall facility delivery rates are low. The differential risk between public and private health facilities may be due to differences in quality of care. Efforts should be made to improve the quality of care in all health facilities.

Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program.

PubMed

Shaffer, Virginia O; Owi, Tari; Kumarusamy, Mathu A; Sullivan, Patrick S; Srinivasan, Jahnavi K; Maithel, Shishir K; Staley, Charles A; Sweeney, John F; Esper, Greg

2017-04-01

Nearly 30% of patients with newly formed ileostomies require hospital readmission from severe dehydration or associated complications. This contributes to significant morbidity and rising healthcare costs associated with this procedure. Our aim was to design and pilot a novel program to decrease readmissions in this patient population. An agreement was established with Visiting Nurse Health System (VNHS) in March 2015 that incorporated regular home visits with clinical triggers to institute surgeon-supervised corrective measures aimed at preventing patient decompensation associated with hospital readmissions. Thirty-day readmission data for patients managed with and without VNHS support for 10.5 months before and after implementation of this new program were collected. Of 833 patients with small bowel procedures, 162 were ileostomies with 47 in the VNHS and 115 in the non-VNHS group. Before program implementation, VNHS (n = 24) and non-VNHS patients (n = 54) had similar readmission rates (20.8% vs 16.7%). After implementation, VNHS patients (n = 23) had a 58% reduction in hospital readmission (8.7%) and non-VNHS patient hospital readmissions (n = 61) increased slightly (24.5%). Total cost of readmissions per patient in the cohort decreased by >80% in the pilot VNHS group. Implementation of a novel program reduced the 30-day readmission rate by 58% and cost of readmissions per patient by >80% in a high risk for readmission patient population with newly created ileostomies. Future efforts will expand this program to a greater number of patients, both institutionally and systemically, to reduce the readmission-rate and healthcare costs for this high-risk patient population. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

[Contra: Is Postoperative Epidural Analgesia the Gold Standard?

PubMed

Gerbershagen, Hans Jürgen

2018-04-01

As strategy for postoperative pain therapy, epidural analgesia (EDA) is superior to systemic opiate analgesia after abdominal and thoracic surgery. In addition, EDA may significantly reduce the incidence of complications in some large operations, such as, e.g. cardiac (myocardial infarction, atrial fibrillation) and pulmonary complications (pneumonia, atelectasis), and even reduce mortality. Intestinal motility can also be improved. However, these positive effects do not appear in all interventions and not to the same degree. Therefore, for benefit-risk assessment, it is important to know both the operation-specific benefits and disadvantages of EDA. In the meantime, the distinctly different complication rates of epidural bleeding and abscesses after EDA are also known for different surgical interventions. In large open abdominal interventions, open thorax operations, and especially open abdominal aortic surgeries, EDA reduces pain and complications. It should be noted that the positive effects of EDA have so far hardly been directly compared with those of intraoperative lidocaine administration. Georg Thieme Verlag KG Stuttgart · New York.

Outcomes of group-based treatment program with parental involvement for the management of childhood and adolescent obesity.

PubMed

Santiprabhob, Jeerunda; Leewanun, Chanin; Limprayoon, Kawewan; Kiattisakthavee, Pornpimol; Wongarn, Renu; Aanpreung, Prapun; Likitmaskul, Supawadee

2014-10-01

An uncontrolled study was conducted to evaluate the effects of a group-based program on weight control, metabolic profiles, and obesity-related complications in obese youth. The program consisted of an initial in-patient session and five group sessions, one, two, three, six, and nine months into the study, providing participants and their parents with information about the consequences of obesity and lifestyle modifications. The severity of obesity and obesity-related complications were evaluated at baseline and 12 months after the intervention. The participants' and their parents' perceptions of the program were assessed. Of the obese youth recruited (n=126), 115 completed the study. Their percentage weight for height and percentage body fat decreased significantly (both p<0.001), and their insulin resistance, lipid profiles, and transaminases levels improved (all p<0.01). The prevalence of prediabetes, dyslipidemia, and elevated transaminases decreased significantly (all p<0.05). The participants and their parents perceived the program as valuable. A group-based program is effective in managing childhood obesity, improving metabolic profiles, and alleviating certain obesity-related complications. A group-based program that provides education and raises the awareness of obese children and their parents about the consequences of obesity is an effective model for treating childhood obesity. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

[Dynamics of tooth decay prevalence in children receiving long-term preventive program in school dental facilities].

PubMed

Avraamova, O G; Kulazhenko, T V; Gabitova, K F

2016-01-01

The paper presents the assessment of tooth decay prevalence in clinically homogenous groups of children receiving long-term preventive program (PP) in school dental facilities. Five-years PP were introduced in clinical practice in 2 Moscow schools. Preventive treatment was performed by dental hygienist. The results show that systematic preventive treatment in school dental offices starting from elementary school allows reducing dental caries incidence 46-53% and stabilize the incidence of caries complications. It should be mentioned though that analysis of individualized outcomes proves heterogeneity of study results despite of equal conditions of PP. Potentially significant hence is early diagnostics and treatment of initial caries forms as demineralization foci, especially in children with intensive tooth decay. Optimization of pediatric dentist and dental hygienist activity in school dental facilities is the main factor of caries prevention efficiency.

Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics.

PubMed

Ball, Samuel A; Martino, Steve; Nich, Charla; Frankforter, Tami L; Van Horn, Deborah; Crits-Christoph, Paul; Woody, George E; Obert, Jeanne L; Farentinos, Christiane; Carroll, Kathleen M

2007-08-01

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites.

An Education Program to Increase Teacher Knowledge about Sickle Cell Disease.

ERIC Educational Resources Information Center

King, Allison A.; Tang, Sujie; Ferguson, Kim L.; DeBaun, Michael R.

2005-01-01

This program evaluated the effectiveness of a sickle cell disease (SCD) education program for teachers of students with SCD in their classroom. Teachers with students in a remediation program for students participated in an educational program consisting of four domains: Inheritance and Prevalence, Common Complications, Strokes, and Individual…

Impact of enhanced recovery after surgery programs on pancreatic surgery: A meta-analysis.

PubMed

Ji, Hai-Bin; Zhu, Wen-Tao; Wei, Qiang; Wang, Xiao-Xiao; Wang, Hai-Bin; Chen, Qiang-Pu

2018-04-21

To evaluate the impact of enhanced recovery after surgery (ERAS) programs on postoperative complications of pancreatic surgery. Computer searches were performed in databases (including PubMed, Cochrane Library and Embase) for randomized controlled trials or case-control studies describing ERAS programs in patients undergoing pancreatic surgery published between January 1995 and August 2017. Two researchers independently evaluated the quality of the studies' extracted data that met the inclusion criteria and performed a meta-analysis using RevMan5.3.5 software. Forest plots, demonstrating the outcomes of the ERAS group vs the control group after pancreatic surgery, and funnel plots were used to evaluate potential publication bias. Twenty case-control studies including 3694 patients, published between January 1995 and August 2017, were selected for the meta-analysis. This study included the ERAS group ( n = 1886) and the control group ( n = 1808), which adopted the traditional perioperative management. Compared to the control group, the ERAS group had lower delayed gastric emptying rates [odds ratio (OR) = 0.58, 95% confidence interval (CI): 0.48-0.72, P < 0.00001], lower postoperative complication rates (OR = 0.57, 95%CI: 0.45-0.72, P < 0.00001), particularly for the mild postoperative complications (Clavien-Dindo I-II) (OR = 0.71, 95%CI: 0.58-0.88, P = 0.002), lower abdominal infection rates (OR = 0.70, 95%CI: 0.54-0.90, P = 0.006), and shorter postoperative length of hospital stay (PLOS) (WMD = -4.45, 95%CI: -5.99 to -2.91, P < 0.00001). However, there were no significant differences in complications, such as, postoperative pancreatic fistulas, moderate to severe complications (Clavien-Dindo III- V), mortality, readmission and unintended reoperation, in both groups. The perioperative implementation of ERAS programs in pancreatic surgery is safe and effective, can decrease postoperative complication rates, and can promote recovery for patients.

Use of the WHO surgical safety checklist in trauma and orthopaedic patients.

PubMed

Sewell, Mathew; Adebibe, Miriam; Jayakumar, Prakash; Jowett, Charlie; Kong, Kin; Vemulapalli, Krishna; Levack, Brian

2011-06-01

The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0-16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58-1.37) and 1.6% (RR 0.88; 95% CI 0.34-2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation.

Understanding Quality Issues in Your Surgical Department: Comparing the ACS NSQIP With Traditional Morbidity and Mortality Conferences in a Canadian Academic Hospital.

PubMed

Auspitz, Mark; Cleghorn, Michelle C; Tse, Alvina; Sockalingam, Sanjeev; Quereshy, Fayez A; Okrainec, Allan; Jackson, Timothy D

2015-01-01

Review of surgical complications in traditional morbidity and mortality (M&M) rounds remains an important mechanism to identify and discuss quality-of-care issues. This process relies on case selection by providers; therefore, complications identified for review may differ from those captured in comprehensive quality programs such as the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). Additionally, although the ACS NSQIP captures robust data on complications in surgical wards, without strategies to disseminate this information to staff and improve practice, minimal change may result. The objective of this study was to compare complications identified by the ACS NSQIP with those captured in M&M conferences at a large Canadian academic hospital. Retrospective medical record reviews of all patients admitted to the general surgery unit from March 2012 to March 2013 were reviewed. Number and types of complications were recorded for cases that were both submitted and reviewed in M&M rounds and those cases that were submitted but not reviewed. These complications were compared with those extracted from our local ACS NSQIP database. A total of 1348 general surgical procedures were performed. The ACS NSQIP captured complications in 143 patients compared with 58 patients identified for review in M&M rounds. Both the methods identified similar proportions of major and minor complications (ACS NSQIP 52% major, 48% minor; M&M 58% major, 42% minor). More postoperative deaths were entered into the ACS NSQIP (12) than in M&M conferences (8 reviewed and 2 submitted). The ACS NSQIP identified higher proportions of surgical site infections and readmissions. However, M&M conferences captured additional complications in patients who did not undergo surgery and identified potential quality issues in patients who did not ultimately experience an adverse outcome. M&M rounds and the ACS NSQIP provide important and potentially complementary data on surgical quality. Incorporating the ACS NSQIP outcomes data into traditional M&M conferences may help to optimize quality improvement efforts. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Trends of 30-day mortality and morbidities in endovascular repair of intact abdominal aortic aneurysm during the last decade.

PubMed

Yin, Kanhua; Locham, Satinderjit S; Schermerhorn, Marc L; Malas, Mahmoud B

2018-06-15

Significant research efforts have been made to improve the safety and efficacy of endovascular aneurysm repair (EVAR) in treating abdominal aortic aneurysm. This study aimed to examine the trends of perioperative outcomes of EVAR in the recent decade using a national validated database. Patients who underwent EVAR for intact abdominal aortic aneurysm between 2006 and 2015 were identified from the National Surgical Quality Improvement Program and divided into early (2006-2010) and late (2011-2015) periods. The primary outcome of the study was 30-day mortality. Secondary outcomes included operative time, length of hospital stay, and 30-day major complications (renal, cardiopulmonary, and wound infection). A total of 30,076 patients were identified, with 11,539 in the early period and 18,537 in the late period. The 30-day mortality was kept at a low level in both periods (1.2% vs 1.2%; P = .98), whereas both the mean operation time (155.5 ± 72.6 minutes vs 141.9 ± 73.7 minutes; P < .001) and length of hospital stay (3.24 ± 5.32 days vs 2.81 ± 4.30 days; P < .001) were decreased in the late period. The 30-day major complication rate was reduced by 19.6% (5.1% vs 4.1%; P < .0001), with decreased renal failure (1.4% vs 1.0%; P = .003), cardiopulmonary complications (2.2% vs 1.7%; P = .006), and wound complications (2.5% vs 1.8%; P < .001). All the decreasing trends of mortality, any 30-day complication, and each type of major complication were statistically significant. Being treated in the late period was independently associated with decreased 30-day major complications (odds ratio, 0.75; 95% confidence interval, 0.65-0.87; P < .001), and this effect was confirmed in the propensity score-matched cohort (odds ratio, 0.76; 95% confidence interval, 0.66-0.90; P < .001). Although the 30-day mortality remains similar, postoperative complications in EVAR have decreased significantly during the recent decade. The continuous improvement in endograft technology and surgical skills has resulted in decreased operative time, marked reduction in surgical complications, and shorter hospital length of stay after endovascular repair. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

[Perioperative management of the pancreaticoduoden-ectomy: fluid administration and nutritional support based on complication prevention and treatment].

PubMed

Peng, Jun-sheng; Chen, Shi

2013-11-01

Pancreaticoduodenectomy(PD) has been widely accepted as one of the most complicated operation in abdominal surgery. The patients who receive PD operation always have other concurrent conditions, such as jaundice, diabetes, liver dysfunction, and malnutrition. Pancreatic fistula, biliary fistula and gastrointestinal dysfunction are common complications after PD. Proper perioperative management and fluid administration can reduce postoperative complications and the mortality.

Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

PubMed Central

Willoughby, Deborah; Aybar-Damali, Begum; Grady, Carmelita; Oran, Rebecca; Knudson, Alana

2018-01-01

The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care. PMID:29614803

C-Reactive Protein and Procalcitonin as Early Markers of Septic Complications after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients Within an Enhanced Recovery After Surgery Program.

PubMed

Muñoz, José Luis; Ruiz-Tovar, Jaime; Miranda, Elena; Berrio, Diana Lorena; Moya, Pedro; Gutiérrez, Manuel; Flores, Raquel; Picó, Carlos; Pérez, Ana

2016-05-01

The performance of most bariatric procedures within an Enhanced Recovery After Surgery (ERAS) programs has resulted in considerable advantages, including a reduction in the length of hospital stay to 2 to 3 days. However, some postoperative complications can appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 and 48 hours after laparoscopic sleeve gastrectomy (LSG) as bariatric procedure, for predicting septic complications, such a surgical site infection (SSI), in the postoperative course. A prospective study of 115 morbidly obese patients who underwent LSG within an ERAS program between 2012 and 2015 was conducted. Blood analysis was performed 24 and 48 hours after surgery. Acute-phase parameters (C-reactive protein [CRP], procalcitonin, and fibrinogen) and WBC count were investigated. Septic complications were observed in 13 patients (11.3%). Using receiver operating characteristic analysis at 24 hours postoperatively, a cutoff level of CRP at 70 mg/L achieved 85% sensitivity and 90% specificity for predicting SSI, and a cutoff level of procalcitonin at 0.2 ng/mL achieved 70% sensitivity and 90% specificity. At 48 hours postoperatively, a cutoff level of CRP at 150 mg/L and procalcitonin at 0.95 ng/mL achieved 100% sensitivity and 100% specificity for predicting SSI. The use of CRP and procalcitonin in the first day and especially in the second day postoperative can predict septic complications after LSG. This is most useful for patients within an ERAS program who will be discharged early. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Supportive care after curative treatment for breast cancer (survivorship care): resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.

PubMed

Ganz, Patricia A; Yip, Cheng Har; Gralow, Julie R; Distelhorst, Sandra R; Albain, Kathy S; Andersen, Barbara L; Bevilacqua, Jose Luiz B; de Azambuja, Evandro; El Saghir, Nagi S; Kaur, Ranjit; McTiernan, Anne; Partridge, Ann H; Rowland, Julia H; Singh-Carlson, Savitri; Vargo, Mary M; Thompson, Beti; Anderson, Benjamin O

2013-10-01

Breast cancer survivors may experience long-term treatment complications, must live with the risk of cancer recurrence, and often experience psychosocial complications that require supportive care services. In low- and middle-income settings, supportive care services are frequently limited, and program development for survivorship care and long-term follow-up has not been well addressed. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert panel identified nine key resources recommended for appropriate survivorship care, and developed resource-stratified recommendations to illustrate how health systems can provide supportive care services for breast cancer survivors after curative treatment, using available resources. Key recommendations include health professional education that focuses on the management of physical and psychosocial long-term treatment complications. Patient education can help survivors transition from a provider-intense cancer treatment program to a post-treatment provider partnership and self-management program, and should include: education on recognizing disease recurrence or metastases; management of treatment-related sequelae, and psychosocial complications; and the importance of maintaining a healthy lifestyle. Increasing community awareness of survivorship issues was also identified as an important part of supportive care programs. Other recommendations include screening and management of psychosocial distress; management of long-term treatment-related complications including lymphedema, fatigue, insomnia, pain, and women's health issues; and monitoring survivors for recurrences or development of second primary malignancies. Where possible, breast cancer survivors should implement healthy lifestyle modifications, including physical activity, and maintain a healthy weight. Health professionals should provide well-documented patient care records that can follow a patient as they transition from active treatment to follow-up care. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Challenges and Consequences of Reduced Skilled Nursing Facility Lengths of Stay.

PubMed

Tyler, Denise A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Gadbois, Emily A; Mor, Vincent

2018-06-05

To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014. Challenges reported regardless of reductions in LOS included frequent and more complicated re-authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients. © Health Research and Educational Trust.

Wound Complications in Preoperatively Irradiated Soft-Tissue Sarcomas of the Extremities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rosenberg, Lewis A.; Esther, Robert J.; Erfanian, Kamil

2013-02-01

Purpose: To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities. Methods and Materials: This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing. Results: Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closedmore » 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P=.093), but the frequency of major wound complications was not different (28% vs 38%; P=.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%. Conclusions: The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes.« less

Preventing microvascular complications in type 1 diabetes mellitus

PubMed Central

Viswanathan, Vijay

2015-01-01

Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c <7.5% across all ages replaces previous guidelines that had called for different targets by age. Evidence shows that prevalence of microvascular complications is greater in patients with age >20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour. PMID:25941647

Wound Complications in Preoperatively Irradiated Soft-Tissue Sarcomas of the Extremities

PubMed Central

Rosenberg, Lewis A.; Esther, Robert J.; Erfanian, Kamil; Green, Rebecca; Kim, Hong Jin; Sweeting, Raeshell; Tepper, Joel E.

2014-01-01

Purpose To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities. Methods and Materials This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing. Results Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closed 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P =.093), but the frequency of major wound complications was not different (28% vs 38%; P =.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%. Conclusions The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes. PMID:22677371

High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study.

PubMed

Walton, Robert B; Shnaekel, Kelsey L; Ounpraseuth, Songthip T; Napolitano, Peter G; Magann, Everett F

2017-11-01

Women having cesarean section have a high risk of wound complications. Our objective was to determine whether high transverse skin incisions are associated with a reduced risk of cesarean wound complications in women with BMI greater than 40. A retrospective cohort study was undertaken of parturients ages 18-45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Temporally matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence, or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included rates of endometritis, number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Analysis of outcomes was performed using two-sample t-test or Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. Thirty-two women had high transverse incisions and were temporally matched with 96 controls (low transverse incisions). The mean BMI was 49 for both groups. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (15.63% versus 27.08%, p = .2379). Those having high transverse skin incisions had lower five minute median Apgar scores (8.0 versus 9.0, p = .0021), but no difference in umbilical artery pH values. The high transverse group also had increased NICU admissions (28.13% versus 5.21%, p = .0011), and early gestational age at delivery (36.8 versus 38.0, p = .0272). High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.

Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?

PubMed

Ho, David M; Huo, Michael H

2007-07-01

Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs. Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups. Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs. Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.

Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer.

PubMed

Steffens, Daniel; Beckenkamp, Paula R; Hancock, Mark; Solomon, Michael; Young, Jane

2018-03-01

To investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life. Intervention systematic review with meta-analysis. MEDLINE, Embase and PEDro. Trials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models. Seventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD -2.86 days, 95% CI -5.40 to -0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI -2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases. Preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low. PROSPEROREGISTRATION NUMBER. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A Framework for Identifying Implementation Issues Affecting Extension Human Sciences Programming

ERIC Educational Resources Information Center

Abell, Ellen; Cummings, Rebekah; Duke, Adrienne M.; Marshall, Jennifer Wells

2015-01-01

Extension programs based on identified needs, relevant theory, and solid research too often fail to realize their objectives. Program implementation is acknowledged to contribute to program effectiveness, yet systematic attention has not been paid to the array of implementation issues that can complicate achieving program goals. We developed the…

Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins.

PubMed

Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Hirata, Yoshihiro

2012-09-01

The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P < 0.05] and BMI (OR 0.86; P < 0.01) were risk factors for bleeding complications; and sheath size (OR 5.2; P < 0.05) and the lack of statin pretreatment (OR 0.50; P < 0.05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures.

Journal of Special Operations Medicine. Volume 7, Edition 1, Winter 2007. Training Supplement: USSOCOM Medic Certification Program

DTIC Science & Technology

2007-01-01

Complicated intra-abdominal infections Complicated skin infections Pneumonia Complicated UTI , including pyelonephritis Acute pelvic infections Drug of...nitroimidazole derivatives. Pregnancy (first trimester in patients with Trichomoniasis). Administer with caution to patients with CNS diseases. Use with caution...under 12 years Dehydration Use with caution in pregnancy . Dosage: Patient in shock, bleeding not controlled: hold fluid and control bleeding. Patient

Estimation of prediagnostic duration of type 2 diabetes mellitus by lens autofluorometry

NASA Astrophysics Data System (ADS)

Kessel, Line; Glumer, Charlotte; Larsen, Michael

2003-10-01

Type 2 diabetes mellitus is a global epidemic with the number of affected subjects exceeding 4% of the adult population world-wide. Undiagnosed and untreated, the disease results in long-term complications such as myocardial infarction, stroke, and blindness. Treatment reduces the number and severity of long-term complications but treatment is often delayed by a time-lag of 10 years or more from the onset of disease to diagnosis. Earlier diagnosis can be achieved by systematic screening programs but the potential time won is unknown. The aim of the present study was to develop a mathematical model estimating the prediagnostic duration of type 2 diabetes mellitus using lens autofluorescence as an indicator of lifetime glycemic load. Fluorometry of the human is lens a quantitative measurement which is attractive because of the ease by which it can be performed. It is our hope that lens fluorometry will prove useful in estimating the prediagnostic duration of type 2 diabetes mellitus in population studies, a property of profound clinical relevance that is difficult to estimate by any other currently available method.

Targeted antioxidant therapies in hyperglycemia-mediated endothelial dysfunction.

PubMed

de Haan, Judy B; Cooper, Mark E

2011-01-01

Although intensive glycaemic and blood pressure control have reduced the risks of micro- and macrovascular complications, diabetes remains a major cause of cardiovascular events, end-stage renal failure, blindness and neuropathy. It is therefore imperative to understand the underlying mechanisms and to establish effective treatments to prevent, retard or reverse diabetic complications. One area of increased focus is the diabetic vascular endothelium. Hyperglycaemia triggers a cascade of events, not least an increase in reactive oxygen species (ROS) leading to enhanced oxidative stress, with its negative impact on endothelial function. In this review, we explore a unifying hypothesis that increased glucose-mediated ROS leads to endothelial dysfunction as the underpinning causative event triggering accelerated micro- and macrovascular complications. In particular, the consequences of deficiencies in the antioxidant enzyme, glutathione peroxidase, on endothelial dysfunction as a trigger of diabetic micro- and macrovascular complications, will be reviewed. Furthermore, novel antioxidant therapies will be highlighted. Specifically, use of Gpx1-mimetics holds promise as a targeted antioxidant approach and an alternative adjunct therapy to reduce diabetic complications.

Effect of natural products on diabetes associated neurological disorders.

PubMed

Patel, Sita Sharan; Udayabanu, Malairaman

2017-04-01

Diabetes mellitus, a metabolic disorder, is associated with neurological complications such as depression, anxiety, hypolocomotion, cognitive dysfunction, phobias, anorexia, stroke, pain, etc. Traditional system of medicine is long known for its efficient management of diabetes. The current review discusses the scope of some common medicinal herbs as well as secondary metabolites with a special focus on diabetes-mediated central nervous system complications. Literatures suggest that natural products reduce diabetes-mediated neurological complications partly by reducing oxidative stress and/or inflammation or apoptosis in certain brain regions. Natural products are known to modulate diabetes-mediated alterations in the level of acetylcholinesterase, choline acetyltransferase, monoamine oxidase, serotonin receptors, muscarinic receptors, insulin receptor, nerve growth factor, brain-derived neurotrophic factor, and neuropeptide in brain. Further, there are several natural products reported to manage diabetic complications with unknown mechanism. In conclusion, medicinal plants or their secondary metabolites have a wide scope and possess therapeutic potential to effectively manage neurological complications associated with chronic diabetes.

Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model.

PubMed

Hoffman, George M; Nowakowski, Rhonda; Troshynski, Todd J; Berens, Richard J; Weisman, Steven J

2002-02-01

Guidelines for risk reduction during procedural sedation from the American Academy of Pediatrics (AAP) and the American Society of Anesthesiologists (ASA) rely on expert opinion and consensus. In this article, we tested the hypothesis that application of an AAP/ASA-structured model would reduce the risk of sedation-related adverse events. Prospectively coded sedation records were abstracted by a hospital quality improvement specialist with practical and administrative experience in pediatric sedation. Process variables included notation of nulla per os (NPO) status, performance of a guided risk assessment, assignment of ASA physical status score, obtaining informed consent, generation of a sedation plan, and assessment of sedation level using a quantitative scoring system. Content variables included adherence to AAP NPO guidelines, ASA class, target sedation level, actual sedation level, age, procedure, and drugs used. Complication risk was assessed by logistic regression and Mantel-Haenszel odds ratios (OR). Complications were identified in 40 of 960 records (4.2%). The complication rate was 34 of 895 (3.8%) with planned conscious sedation and 6 of 65 (9.2%) with planned deep sedation ([DS]; OR: 2.6). Complications were reduced by performance of structured risk assessment (OR: 0.10), adherence to all process guidelines (OR: 0), and avoiding actual DS (OR: 0.4). The only drug associated with higher risk was chloral hydrate (OR: 2.1). Failure to adhere to NPO guidelines did not increase risk in this assessment; however, the adverse event rate was 0 if all process guidelines were followed. Presedation assessment reduces complications of DS. Repeated assessment of sedation score reduces the risk of inadvertent DS. The data provide direct evidence that AAP/ASA guidelines can reduce the risk of pediatric procedural sedation.

A review of falconry as a bird control technique with recommendations for use at the Shuttle Landing Facility, John F. Kennedy Space Center, Florida, USA

NASA Technical Reports Server (NTRS)

Larson, Vickie L.; Rowe, Sean P.; Breininger, David R.; Yosef, Reuven

1994-01-01

Falconry has been proposed as a method of reducing the bird/aircraftstrike hazard, in addition to current bird control techniques, at the Shuttle Landing Facility (SLF), John F. Kennedy Space Center (KSC), Florida, U.S. Bird control programs using falconry have been employed at a number of military and commercial airfields in the U.S., Canada, and Europe. Most falconry programs have been discontinued. In most situations, falconry did not prove cost effective when compared to alternative bird control techniques. Available literature and documents, as well as several raptor specialists and military personnel, suggest that falconry may be useful only against certain problem species and when other bird control methods have been proven inadequate. Because many of the most commonly used falcons are protected species, acquisition of falcons will complicate their use in bird control programs. Many avian species found at the SLF are federally and state protected or of conservation concern, therefore, environmental impacts may also result from the use of falcons.

Options for streamlining the site assessment process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Myers, R.

The current site assessment process consists of entry into the CERCLA Information System (CERCLIS) database; completion of the Preliminary Assessment (PA), Site Inspection (SI), and Hazard Ranking System (HRS) documents; and placement on the National Priorities List (NPL). The purpose behind site assessment has been to identify sites for the NPL, not identify the most appropriate means for clearup. Several developments have led EPA to consider redesigning the process, including; the need to encourage brownfields redevelopment; the unintended stigma associated with being on CERCLIS; and the increased expertise of State and some Tribal programs. (For purposes of this paper, brownfieldsmore » are considered abandoned, idled, or under-used industrial and commercial facilities where expansion or redevelopment is complicated by real or perceived environmental contamination.) EPA has begun various site assessment pilots to aid in developing a more efficient and effective Superfund site assessment program. Key goals are to give States increased responsibility, encourage early/more efficient cleanups, reduce costs, and promote environmental recovery and economic revitalization. Possible components of a revised site assessment program are presented.« less

Numerical optimization methods for controlled systems with parameters

NASA Astrophysics Data System (ADS)

Tyatyushkin, A. I.

2017-10-01

First- and second-order numerical methods for optimizing controlled dynamical systems with parameters are discussed. In unconstrained-parameter problems, the control parameters are optimized by applying the conjugate gradient method. A more accurate numerical solution in these problems is produced by Newton's method based on a second-order functional increment formula. Next, a general optimal control problem with state constraints and parameters involved on the righthand sides of the controlled system and in the initial conditions is considered. This complicated problem is reduced to a mathematical programming one, followed by the search for optimal parameter values and control functions by applying a multimethod algorithm. The performance of the proposed technique is demonstrated by solving application problems.

Surgical mesh for ventral incisional hernia repairs: Understanding mesh design

PubMed Central

Rastegarpour, Ali; Cheung, Michael; Vardhan, Madhurima; Ibrahim, Mohamed M; Butler, Charles E; Levinson, Howard

2016-01-01

Surgical mesh has become an indispensable tool in hernia repair to improve outcomes and reduce costs; however, efforts are constantly being undertaken in mesh development to overcome postoperative complications. Common complications include infection, pain, adhesions, mesh extrusion and hernia recurrence. Reducing the complications of mesh implantation is of utmost importance given that hernias occur in hundreds of thousands of patients per year in the United States. In the present review, the authors present the different types of hernia meshes, discuss the key properties of mesh design, and demonstrate how each design element affects performance and complications. The present article will provide a basis for surgeons to understand which mesh to choose for patient care and why, and will explain the important technological aspects that will continue to evolve over the ensuing years. PMID:27054138

Benefits of early specialized nutritional support in malnourished patients.

PubMed

Morán López, Jesús Manuel; Beneítez Moralejo, Belén; Piedra León, María; Enciso Izquierdo, Fidel Jesús; Luengo Pérez, Luis Miguel; Amado Señaris, José Antonio

2017-04-07

Disease related malnutrition (DRM) is highly prevalent in Spain, affecting 23% of in-hospital patients, and is associated with clinical complications. Specialized nutritional support (SNS) can reduce these complications. Prospective study carried out in standard clinical practice conditions to test if SNS during the first 5 days of hospitalization, or subsequently, was associated to a lower length of stay or reduced complications in patients with a NRS-2002 score≥3 points. In the group of patients who initiated early SNS, the length of stay was 8.83 days shorter than in the group with a later introduction (95% CI 3.55-14.10); nevertheless, the higher prevalence of male and oncological patients in this group could have impacted the results. A tendency towards a statistically significant lower mortality rate and a reduced amount of total complications was described. The early introduction of SNS (within the first 5 days of hospitalization) in patients with DRM was associated with a 32.4% reduction in the length of stay. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Central venous access in children: indications, devices, and risks.

PubMed

Ares, Guillermo; Hunter, Catherine J

2017-06-01

Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation. Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs. Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study.

PubMed

Li, Zhen; Zhou, Xinmei; Cao, Jing; Li, Zheng; Wan, Xia; Li, Jiaqian; Jiao, Jing; Liu, Ge; Liu, Ying; Li, Fangfang; Song, Baoyun; Jin, Jingfen; Liu, Yilan; Wen, Xianxiu; Cheng, Shouzhen; Wu, Xinjuan

2018-05-01

To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications. Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking. Cross-sectional study. A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models. Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia. Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications. Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients. © 2018 John Wiley & Sons Ltd.

Impact of Modality Choice on Rates of Hospitalization in Patients Eligible for Both Peritoneal Dialysis and Hemodialysis

PubMed Central

Quinn, Robert R.; Ravani, Pietro; Zhang, Xin; Garg, Amit X.; Blake, Peter G.; Austin, Peter C.; Zacharias, James M.; Johnson, John F.; Pandeya, Sanjay; Verrelli, Mauro; Oliver, Matthew J.

2014-01-01

♦ Background: Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality. Previous comparisons of peritoneal dialysis (PD) and hemodialysis (HD) have not been restricted to individuals who were eligible for both therapies. ♦ Methods: We conducted a multicenter prospective cohort study of people 18 years of age and older who were eligible for both PD and HD, and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs. Zero-inflated negative binomial models, adjusted for baseline patient characteristics, were used to examine the association between modality choice and rates of hospitalization. ♦ Results: The study enrolled 314 patients. A trend in the HD group toward higher rates of hospitalization, observed in the primary analysis, became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care. Cardiovascular disease, infectious complications, and elective surgery were the most common reasons for hospital admission; only 23% of hospital stays were directly related to complications of dialysis or kidney disease. ♦ Conclusions: Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization, and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications. PMID:24525596

Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients.

PubMed

Berend, Keith R; Lombardi, Adolph V; Mallory, Thomas H

2004-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are among the most successful procedures performed in terms of quality-of-life years gained. The long-term goals of arthroplasty, to relieve pain, increase function, provide stability, and obtain durability, are accomplished in the vast majority of cases. The short-term goals, however, have become the target of aggressive peri-operative programs that aim to speed recovery, reduce morbidity and complications, and create a program of efficiency while maintaining the highest level of patient care. The concept of rapid recovery is built upon the burgeoning interest in less-invasive and small-incision surgeries for (THA and TKA). However, the incision size does not appear to be the most critical aspect of the program. This article outlines the specific elements of the rapid-recovery program for lower-extremity arthroplasty patients, including pre-operative patient education, peri-operative nutrition, vitamin and herbal medication supplementation, preemptive analgesia, and post-operative rehabilitation. A holistic peri-operative, rapid-recovery program has lead to a significantly decreased hospital length of stay and significantly lower hospital readmission rates in patients who undergo primary THAs and TKAs. Combining these results with minimally invasive techniques and instrumentation should make recovery even faster.

Risk Factors for 30-Day Complications After Thumb CMC Joint Arthroplasty: An American College of Surgeons National Surgery Quality Improvement Program Study.

PubMed

Shah, Kalpit N; Defroda, Steven F; Wang, Bo; Weiss, Arnold-Peter C

2017-12-01

The first carpometacarpal (CMC) joint is a common site of osteoarthritis, with arthroplasty being a common procedure to provide pain relief and improve function with low complications. However, little is known about risk factors that may predispose a patient for postoperative complications. All CMC joint arthroplasty from 2005 to 2015 in the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database were identified. Bivariate testing and multiple logistic regressions were performed to determine which patient demographics, surgical variables and medical comorbidities were significant predictors for complications. These included wound related, cardiopulmonary, neurological and renal complications, return to the operating room (OR) and readmission. A total of 3344 patients were identified from the database. Of those, 45 patients (1.3%) experienced a complication including wound issues (0.66%), return to the OR (0.15%) and readmission (0.27%) amongst others. When performing bivariate analysis, age over 65, American Society of Anesthesiologists (ASA) Class, diabetes and renal dialysis were significant risk factors. Multiple logistic regression after adjusting for confounding factors demonstrated that insulin-dependent diabetes and ASA Class 4 had a strong trend while renal dialysis was a significant risk factor. CMC arthroplasty has a very low overall complication rate of 1.3% and wound complication rate of 0.66%. Diabetes requiring insulin and ASA Class 4 trended towards significance while renal dialysis was found to be a significant risk factors in logistic regression. This information may be useful for preoperative counseling and discussion with patients who have these risk factors.

Menu-Driven Solver Of Linear-Programming Problems

NASA Technical Reports Server (NTRS)

Viterna, L. A.; Ferencz, D.

1992-01-01

Program assists inexperienced user in formulating linear-programming problems. A Linear Program Solver (ALPS) computer program is full-featured LP analysis program. Solves plain linear-programming problems as well as more-complicated mixed-integer and pure-integer programs. Also contains efficient technique for solution of purely binary linear-programming problems. Written entirely in IBM's APL2/PC software, Version 1.01. Packed program contains licensed material, property of IBM (copyright 1988, all rights reserved).

Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial.

PubMed

Eisma, Maarten C; Boelen, Paul A; van den Bout, Jan; Stroebe, Wolfgang; Schut, Henk A W; Lancee, Jaap; Stroebe, Margaret S

2015-11-01

This study examined the effectiveness and feasibility of therapist-guided Internet-delivered exposure (EX) and behavioral activation (BA) for complicated grief and rumination. Forty-seven bereaved individuals with elevated levels of complicated grief and grief rumination were randomly assigned to three conditions: EX (N=18), BA (N=17), or a waiting-list (N=12). Treatment groups received 6 homework assignments over 6 to 8weeks. Intention-to-treat analyses showed that EX reduced complicated grief, posttraumatic stress, depression, grief rumination, and brooding levels relative to the control group at posttreatment (d=0.7-1.2). BA lowered complicated grief, posttraumatic stress, and grief rumination levels at posttreatment (d=0.8-0.9). At 3-month follow-up, effects of EX were maintained on complicated grief and grief rumination (d=0.6-1.2), and for BA on complicated grief, posttraumatic stress, and grief rumination (d=0.8-0.9). EX reduced depression more strongly than BA (d=0.6). Completers analyses corroborated results for EX, and partially those for BA, but no group differences were detected. BA suffered from high dropout (59%), relative to EX (33%) and the waiting-list (17%). Feasibility appeared higher for EX than BA. Results supported potential applicability of online exposure but not behavioral activation to decrease complicated grief and rumination. Copyright © 2015. Published by Elsevier Ltd.

Sustained Reduction of Ventilator-Associated Pneumonia Rates Using Real-Time Course Correction With a Ventilator Bundle Compliance Dashboard.

PubMed

Talbot, Thomas R; Carr, Devin; Parmley, C Lee; Martin, Barbara J; Gray, Barbara; Ambrose, Anna; Starmer, Jack

2015-11-01

The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned. To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications. DESIGN Before-and-after quasi-experimental study with interrupted time-series analysis. SETTING Academic medical center. In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients. The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64-3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14-0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, -0.32). A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.

Effects of psychoeducation on helpful support for complicated grief: a preliminary randomized controlled single-blind study.

PubMed

Nam, I S

2016-01-01

Complicated grief is a distinct psychological response of individuals facing the loss of a loved one and can lead to many types of adverse health outcomes. Although social support may be beneficial, few studies have examined the beneficial effects of helpful support on complicated grief following bereavement. A randomized controlled trial was conducted. Bereaved participants and supporters were randomized to psychoeducation on complicated grief and helpful social support or psychoeducation on complicated grief. The primary outcome was the Inventory of Complicated Grief. The results showed that psychoeducation of supporters of bereaved individuals has significant beneficial effects. Particularly, symptoms of complicated grief were decreased in bereaved individuals with supporters that received psychoeducation. The results highlight the potential of psychoeducation to facilitate helpful social support and reduce complicated grief.

Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support.

PubMed

Bozzetti, Federico; Gianotti, Luca; Braga, Mario; Di Carlo, Valerio; Mariani, Luigi

2007-12-01

This study investigated the effects of nutritional support on postoperative complications, in relation with demographic and nutritional factors, intraoperative factors, type and routes of nutritional regimens. A series of 1410 subjects underwent major abdominal surgery for gastrointestinal cancer and received various types of nutritional support: standard intravenous fluids (SIF; n=149), total parenteral nutrition (TPN; n=368), enteral nutrition (EN; n=393), and immune-enhancing enteral nutrition (IEEN; n=500). Postoperative complications, considered as major (if lethal or requiring re-operation, or transfer to intensive care unit), or otherwise minor, were recorded. Major and minor complications occurred in 101 (7.2%) and 446 (31.6%) patients, respectively. Factors correlated with postoperative complications at multivariate analysis were pancreatic surgery, (p<0.001), advanced age (p=0.002), weight loss (p=0.019), low serum albumin (p=0.019) and nutritional support (p=0.001). Nutritional support reduced morbidity versus SIF with an increasing protective effect of TPN, EN, and IEEN. This effect remained valid regardless the severity of risk factors identified at the multivariate analysis and it was more evident by considering infectious complications only. Pancreatic surgery, advanced age, weight loss and low serum albumin are independent risk factors for the onset of postoperative complications. Nutritional support, particularly IEEN, significantly reduced postoperative morbidity.

Botulinum Toxin A for Oral Cavity Cancer Patients: In Microsurgical Patients BTX Injections in Major Salivary Glands Temporarily Reduce Salivary Production and the Risk of Local Complications Related to Saliva Stagnation

PubMed Central

Bartolo, Corradino; Sara, Di Lorenzo; Francesco, Moschella

2012-01-01

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients. PMID:23202301

Botulinum toxin A for oral cavity cancer patients: in microsurgical patients BTX injections in major salivary glands temporarily reduce salivary production and the risk of local complications related to saliva stagnation.

PubMed

Corradino, Bartolo; Di Lorenzo, Sara; Moschella, Francesco

2012-10-24

In patients suffering from oral cavity cancer surgical treatment is complex because it is necessary to remove carcinoma and lymph node metastasis (through a radical unilateral or bilateral neck dissection) and to reconstruct the affected area by means of free flaps. The saliva stagnation in the post-operative period is a risk factor with regard to local complications. Minor complications related to saliva stagnation (such as tissue maceration and wound dehiscence) could become major complications compromising the surgery or the reconstructive outcome. In fact the formation of oro-cutaneous fistula may cause infection, failure of the free flap, or the patient’s death with carotid blow-out syndrome. Botulinum injections in the major salivary glands, four days before surgery, temporarily reduces salivation during the healing stage and thus could reduce the incidence of saliva-related complications. Forty three patients with oral cancer were treated with botulinum toxin A. The saliva quantitative measurement and the sialoscintigraphy were performed before and after infiltrations of botulinum toxin in the major salivary glands. In all cases there was a considerable, but temporary, reduction of salivary secretion. A lower rate of local complications was observed in the post-operative period. The salivary production returned to normal within two months, with minimal side effects and discomfort for the patients. The temporary inhibition of salivary secretion in the post-operative period could enable a reduction in saliva-related local complications, in the incidence of oro-cutaneous fistulas, and improve the outcome of the surgery as well as the quality of residual life in these patients.

Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty.

PubMed

Kallio, Peter J; Nolan, Jenea; Olsen, Amy C; Breakwell, Susan; Topp, Richard; Pagel, Paul S

2015-06-01

Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery. We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA). Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (> 5 days) were recorded. Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c < 10%, but not those with HbA1c < 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P < 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P < 0.001 and P = 0.0404, respectively). APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA.

Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program.

PubMed

Cohen, Mark E; Bilimoria, Karl Y; Ko, Clifford Y; Richards, Karen; Hall, Bruce L

2009-12-01

Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. Patients were identified who underwent colorectal surgery at 182 hospitals participating in the American College of Surgeon's National Surgical Quality Improvement Program (ACS NSQIP) from 2006 to 2007. Regression models for extended LOS (greater than the 75th percentile) were developed to identify hospitals whose ratios of observed to expected events (O/E) were significantly better (low outlier) or worse (high outlier) than expected after adjustment for case mix. To evaluate strategies for evaluating LOS that would be minimally influenced by the occurrence of complications, separate models were developed for patients categorized either by (1) the nonoccurrence or occurrence of any postoperative complication or (2) tercile of preoperative morbidity risk. The 23,098 patients selected for this study were partitioned into groups without complications (0% complications), with complications (100%) or into terciles of preoperative morbidity risk (with 22.4%, 38.7%, and 60.0% of patients having complications, respectively). In general, the greater the complication rate the longer the LOS and the fewer the number of statistical outliers that were identified. ACS NSQIP data can provide individual hospitals with riskadjusted LOS measures that can be used to identify outlying performance and motivate quality improvement efforts.

Impact of Health Programs on Instructional Expenditures in Higher Education. Working Paper Series.

ERIC Educational Resources Information Center

Smith, John D.

The reporting of financial statistics for the Higher Education General Information Survey by health professional programs (medical, veterinary, osteopathic, dental, and related programs) was investigated. Attention was directed to how HEGIS data can be used to compare institutions when the mix of programs within the institutions complicates the…

Racial Disparity in Surgical Complications in New York State

PubMed Central

Fiscella, Kevin; Franks, Peter; Meldrum, Sean; Barnett, Steven

2005-01-01

Objective: To examine the relationship between race and surgical complications. Summary Background Data: Blacks have been reported to experience higher rates of surgical complications than whites, but the reasons are not known. Methods: The effect of the black race on risk of any surgical complication (from the Agency for Healthcare Research and Quality's patient safety indicators) was examined using New York State (NYS) hospital discharge data from 1998 to 2000. Sequential, hierarchical analyses controlled for: 1) patient age and gender, 2) morbidity length of stay, 3) individual social factors, 4) hospital characteristics, and 5) ecologic factors (region of state, percent black and Medicaid annual discharges, and mean income of admitted patients). Results: Following adjustment for patient age and gender, blacks had 65% higher odds for a surgical complication. Further adjustment for comorbidity and length of stay (LOS) reduced the odds substantially to 1.18. Additional adjustment for American Hospital Association hospital characteristics essentially eliminated the risk. Final adjustment for hospital ecologic variables reduced the odds to 1.0. Conclusions: Higher rates of surgical complications among blacks than whites in NYS are primarily explained by differences in comorbidity LOS and the hospital where the surgery occurred. PMID:16041203

Resection of olfactory groove meningioma - a review of complications and prognostic factors.

PubMed

Mukherjee, Soumya; Thakur, Bhaskar; Corns, Robert; Connor, Steve; Bhangoo, Ranjeev; Ashkan, Keyoumars; Gullan, Richard

2015-01-01

High complication rates have been cited following olfactory groove meningioma (OGM) resection but data are lacking on attendant risk factors. We aimed to review the complications following OGM resection and identify prognostic factors. A retrospective review was performed on 34 consecutive patients who underwent primary OGM resection at a single London institution between March 2008 and February 2013. Collected data included patient comorbidities, pre-operative corticosteroid use, tumour characteristics, imaging features, operative details, extent of resection, histology, use of elective post-operative ventilation, complications, recurrence and mortality. Complication rate was 39%. 58% of complications required intensive care or re-operation. Higher complication rates occurred with OGM > 40 mm diameter versus ≤ 40 mm (53 vs. 28%; p = 0.16); OGM with versus without severe perilesional oedema (59 vs. 19%; p = 0.26), more evident when corrected for tumour size; and patients receiving 1-2 days versus 3-5 days of pre-operative dexamethasone (75 vs. 19%; p = 0.016). Patients who were electively ventilated post-operatively versus those who were not had higher risk tumours but a lower complication rate (17 vs. 44%; p = 0.36) and a higher proportion making a good recovery (83 vs. 55%; p = 0.20). Complete versus incomplete resection had a higher complication rate (50 vs. 23%; p = 0.16) but no recurrence (0 vs. 25%; p = 0.07). Risk of morbidity with OGM resection is high. Higher complication risk is associated with larger tumours and greater perilesional oedema. Pre-operative dexamethasone for 3-5 days versus shorter periods may reduce the risk of complications. We describe a characteristic pattern of perilesional oedema termed 'sabre-tooth' sign, whose presence is associated with a higher complication rate and may represent an important radiological prognostic sign. Elective post-operative ventilation for patients with high-risk tumours may reduce the risk of complications.

Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis.

PubMed

Gu, Yu; Dennis, Sarah M

2017-02-01

Diabetic peripheral neuropathy (DPN) is a common complication of type-2 diabetes mellitus (T2DM) that predisposes the elderly to a higher falls risk. Falls prevention programs with a component of weight-bearing exercises are effective in decreasing future falls in the elderly. However, weight-bearing exercise was only recently recommended in guidelines for exercise for people with T2DM and DPN. Since then, there have been an increasing number of studies to evaluate the effectiveness of falls prevention programs on this targeted population. A systematic literature review was undertaken to determine the effectiveness of falls prevention programs for people with T2DM and DPN. Nine published studies that investigated the effect of exercise training on falls risk among people with T2DM and DPN were included in the review. Interventions included lower limb strengthening, balance practice, aerobic exercise, walking programs, and Tai Chi. The preliminary evidence presented in this review suggests that people with T2DM and DPN can improve their balance and walking after a targeted multicomponent program without risk of serious adverse events. There is insufficient long-term follow-up data to determine whether the improvements in balance or strength resulted in a decrease falls risk in the community setting. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of antiviral treatment on influenza-related complications over four influenza seasons: 2006-2010.

PubMed

Spagnuolo, Philip J; Zhang, Mengxi; Xu, Yaping; Han, Jian; Liu, Shuqian; Liu, Jinan; Lichtveld, Maureen; Shi, Lizheng

2016-08-01

The objective of the study is to evaluate the effect of antiviral treatment, pre-existing diseases, and sociodemographic factors on the risk of influenza-related complications and healthcare utilization. Case data was obtained from U.S. MarketScan Research Databases. Cases had a clinical diagnosis of influenza between 2006 and 2010 and continuous healthcare insurance from 90 days before to 30 days after diagnosis. Logistic regression models were applied to explore the impact of antiviral treatment on complications and healthcare utilization. Modified generalized estimating equation regression models in propensity score matched samples were used to address the robustness of the study. Analyses included 1,557,437 cases from four influenza seasons. In each season, 34.82%-43.42% of patients received antiviral treatment, mostly oseltamivir. On average, 1.86% of patients were hospitalized, 9.56% visited the emergency room and 41.14% made ≥2 outpatient visits. The incidence of complications ranged from 17.62 to 19.67 per 100 patient-months. The relative risk of complications was increased in patients aged 0-4 years and those with pre-existing diseases, including asthma, Parkinson's disease, and cystic fibrosis. Overall, patients receiving antiviral treatment had an 11% reduction in the risk of complications. Among oseltamivir-treated patients, the risk of complications was significantly reduced by 81% in those treated ≤2 days after diagnosis compared with later. Antiviral treatment significantly reduced the risk of hospitalization, emergency room visits and need for ≥2 outpatient visits by 29%, 24% and 11%, respectively. The propensity score matching method improved the strength of the study. Early treatment with antivirals, and specifically oseltamivir, significantly reduced the risk of influenza-related complications and healthcare utilization. However, lacking information about disease severity and the time from onset of symptoms to fulfillment of a prescription may bias the outcomes.

Limb lengthening over a nail can safely reduce the duration of external fixation

PubMed Central

Chaudhary, Milind

2008-01-01

Background: Limb lengthening using Ilizarov external fixation is safe, but the consolidation phase tends to take too long. A method that can safely reduce the time spent in external fixation would help increase patient tolerance and comfort. We report our results of lengthening over nails (LON) method in which an interlocking nail was used along with an Ilizarov external fixator to reduce external fixation duration in limb lengthening. This is a retrospective study. Materials and Methods: Twenty-seven lengthening surgeries were done with the LON method in 23 patients with 22 tibiae and five femora during the last 12 years. Length gain ranged from 1.5 cm to a maximum of 9.8 cm with a mean of 4.6 cm. The mean modified Paley difficulty score was 7.6 points. Fourteen associated procedures were performed in these patients, including equinus contracture releases, supracondylar osteotomies, ilizarov hip reonstruction and ankle fusion. We had a 29% rate of complications which included one problem, three obstacles and four complications with no serious deep intramedullary infections. Our rate of complications compares favorably with series reported in the literature. External fixation duration was reduced significantly to a mean of 17.8 days per cm. Conclusions: A combination of intramedullary nailing along with external fixation significantly reduces external fixation time while maintaining low rate of complications. Great care needs to be taken to prevent pin track infection and deep intramedullary sepsis. PMID:19753160

Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures

PubMed Central

Yaligod, Vishwanath; Rudrappa, Girish H.; Nagendra, Srinivas; Shivanna, Umesh M.

2013-01-01

Background The complications of intramedullary nailing of distal third tibial shaft and metaphyseal fractures have a direct impact on ankle and hind foot function. Methods We retrospectively evaluated 28 patients. Unreamed nail was negotiated across the well reduced fracture till subchondral bone and fixed with 2 to 3 distal locking screws in different planes. Results Fracture union rate was 85%. Three out of 28 patients had malalignment. Mean ankle, hindfoot functional score was 85. Conclusion Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes. PMID:24719527

Opening a window of opportunity through technology and coordination: a multisite case study.

PubMed

Cherry, Julie Cheitlin; Dryden, Kirsten; Kobb, Rita; Hilsen, Patricia; Nedd, Nicole

2003-01-01

The Community Care Coordination Service (CCCS) program was implemented in April, 2000, at the Veterans Integrated Service Network (VISN 8). The goals of the CCCS were to improve the coordination of care for clinically complex patients, referred to as veterans, and to increase their access to care while reducing complications, hospital admissions, and emergency room (ER) visits. This program used a coordinated care approach, a process whereby veterans were followed throughout the continuum of care. The information presented in this case study is specific to three medical centers that implemented the CCCS: Ft. Myers, Lake City, and Miami. Analysis of utilization and clinical impact were conducted after 18 months. Inpatient admissions were reduced by 46% at Ft. Myers, 68% at Lake City, and 13% at Miami. ER encounters were reduced by 19% at Ft. Myers, 70% at Lake City, and 15% at Miami. Reductions in bed days were demonstrated at Ft. Myers (29%) and Lake City (71%). In Miami, there was a 13% increase in the number of bed days of care for the patients after 1 year in the program. In addition to these changes in health-care utilization, quality of life was significantly improved as evidenced by increases in the four of the eight components scores of the Medical Outcomes Study 36-item Short Form health survey for veterans (SF36V) at Lake City and Ft. Myers. In the CCCS model of care using home telehealth technology, the Care Coordinators bridged the gap between office visits by providing a daily connection between the coordinators and the patients. This daily communication made it possible for problems to be identified early and interventions implemented before problems escalated.

Postoperative hyperglycaemia control reduces postoperative complications in patients subject to total knee arthroplasty.

PubMed

Reátegui, Diego; Tornero, Eduard; Popescu, Dragos; Sastre, Sergi; Camafort, Miquel; Gines, Gracia; Combalía, Andrés; Lozano, Luis

2017-01-01

The aim of our study was the early detection and treatment of patients with unknown alterations of the hydrocarbon metabolism subject to total knee arthroplasty in order to reduce the incidence of postoperative complications. Patients were classified as non-diabetic patients (group 1), diabetic patients (group 2) and patients with stress hyperglycaemia (group 3). The last two groups were recommended assessment by a primary care physician (PCP). After one year follow-up the groups were compared with respect to incidence of postoperative complications. The groups were also compared regarding the decrease or increase of HbA1c levels with the incidence of complications. Of the 228 patients, 116 (50%) were included in group 1, 40 (17.5%) in group 2 and 72 (31.6%) in group 3. Patients that consulted their PCP presented lower medical complication rates than those who did not (9.2% vs. 26.4%, P=0.020). Not being attended by a PCP was an independent predictive factor of medical complication (odds ratio (OR): 21.3; 95% confidence interval (95% CI): 4.6-98.5), surgical site infection (OR: 4.1; 95% CI: 1.1-15.0) and mechanical complication (OR: 5.0; 95% CI: 1.3-18.8). A decrease of HbA1c value was related to less medical systemic complications (7.3% vs. 24.2%, P=0.035). Patients with hyperglycaemia during the postoperative total knee arthroplasty period, who are controlled by the PCP present lower incidence of complications. Decrease of HbA1c value during postoperative total knee arthroplasty period leads to a lower rate of medical complications. Copyright © 2016 Elsevier B.V. All rights reserved.

Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total hip arthroplasty: comparison of 10. 00 Gy vs 20. 00 Gy schedules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anthony, P.; Keys, H.; Evarts, C.M.

1987-03-01

Prior studies have demonstrated the effectiveness of postoperative radiation therapy (RT) to the hip area following total hip replacement (THR) surgery in preventing the development of heterotopic bone formation in patients considered to be at high risk for development of this complication. Previously, patients received 20.00 Gy in 10 fractions (fx) over 2 weeks, beginning as soon postop as medically feasible (usually post-op day 2). In an effort to reduce hospital stay and risk of secondary malignancy, a prospective treatment program was initiated April 1982 using a reduced dose of 10.00 Gy in 5 fx over 5-7 days. As ofmore » February 1984, 46 consecutive hips determined to be at high risk were treated with this reduced dose. Prior studies have demonstrated that heterotopic bone is always radiographically evident by 8 weeks. Of the 46 hips, 41 had been evaluated with the minimum required 8 week follow-up X ray. Twenty-five of these hips, 61%, had a mean long term follow-up of 12 months. It historical control group, consisting of 54 consecutive high risk post-THR's, was shown to have a 68.5% incidence of heterotopic bone. The 20.00 Gy group, when RT was started by post-op day 5, demonstrated a 3.2% incidence, compared to 4.9% in the 10.00 Gy group. Complication rates were also comparable in the two RT groups, 19.4% and 7.3% respectively; 10.00 Gy is apparently as effective as 20.00 Gy in preventing heterotopic bone formation in high risk post-THR patients.« less

C-reactive protein as early predictor of complications after minimally invasive colorectal resection.

PubMed

Pedrazzani, Corrado; Moro, Margherita; Mantovani, Guido; Lazzarini, Enrico; Conci, Simone; Ruzzenente, Andrea; Lippi, Giuseppe; Guglielmi, Alfredo

2017-04-01

Minimally invasive surgery (MIS) and enhanced recovery programs have been increasingly adopted in colorectal surgery. The aim of this prospective observational study was to evaluate the usefulness of the C-reactive protein (CRP) concentration measured on postoperative day 3 (POD-3) as an early predictor of severe complications after minimally invasive colorectal resection. From January 2014 to December 2015, 160 patients underwent resection of colorectal disease by MIS at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Among these, CRP measurement was available on POD-3 in 143 patients. Conversion from laparoscopic to open surgery was necessary in 18 patients (12.6%). The mean POD-3 CRP concentration was significantly higher in patients who did than did not require conversions (205.6 ± 89.6 mg/L versus 104.6 ± 85.8 mg/L, respectively; P < 0.001), even in the absence of postoperative complications, and these patients were therefore excluded from the subsequent analysis. No deaths occurred during the study period, but complications occurred in 39 patients (31.2%). Among these, 24 patients (61.5%) developed surgery-related complications. A POD-3 CRP concentration of 120 mg/L was highly reliable for excluding the occurrence of surgery-related and severe complications. The negative predictive values for excluding surgery-related and severe complications was 86.8% and 97.7%, respectively. Assessment of the POD-3 CRP concentration after colorectal MIS is clinically significant for excluding the occurrence of surgery-related and severe complications. This measurement is a largely available, inexpensive, and easy-to-use tool that allows early and safe discharge in the setting of colorectal MIS and enhanced recovery programs. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of risk factors for central venous catheter-related complications: a prospective observational study in pediatric patients with bone sarcomas.

PubMed

Abate, Massimo Eraldo; Sánchez, Olga Escobosa; Boschi, Rita; Raspanti, Cinzia; Loro, Loretta; Affinito, Domenico; Cesari, Marilena; Paioli, Anna; Palmerini, Emanuela; Ferrari, Stefano

2014-01-01

The incidence of central venous catheter (CVC)-related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications. The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor. During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed. Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed. The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria. As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented.

Complication Rates in Altitude Restricted Patients Following Aeromedical Evacuation

DTIC Science & Technology

2016-04-01

humidity and temperature , reduced barometric pressure and oxygen levels, increased vibration, trapped gas expansion, and serious n oise, not to...correlated to PFC and PFC-100 rates. This finding suggests that aggressive prescribing of CARs may have a salutary effect on postflight complication...suggests that aggressive prescribing of CARs may have a salutary effect on postflight complication rates and bears further investigation. KEYWORDS: cabin

Grief interventions for people bereaved by suicide: A systematic review.

PubMed

Linde, Katja; Treml, Julia; Steinig, Jana; Nagl, Michaela; Kersting, Anette

2017-01-01

Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals.

Initial experience with laparoscopic sleeve gastrectomy by a novice bariatric team in an established bariatric center--a review of literature and initial results.

PubMed

Dey, Ashish; Mittal, Tarun; Malik, Vinod K

2013-04-01

Laparoscopic sleeve gastrectomy (LSG) is a highly successful approach to morbid obesity with low incidence of complications. The literature suggests a learning curve of 50-100 cases for attaining proficiency and reducing the complication rates for laparoscopic bariatric surgery. The aims of this paper were to review the literature of initial cases by bariatric surgeons worldwide and to report the experience of initial 50 cases of LSG by a novice bariatric team in a single center. The objective was to evaluate the outcomes for laparoscopic bariatric surgery in the first 50 patients by a novice team of bariatric surgeons in an already established bariatric surgery program with short-term follow-up. All surgeries were done by a new bariatric team who underwent laparoscopic fellowship training under a bariatric team with an experience of over 600 bariatric procedures. Fifty consecutive patients from March 2010 to January 2012 were offered LSG and followed up for a minimum of 6 months. Weight loss and comorbidity resolution were tabulated and assessed. Mean preoperative and postoperative BMIs were 46.6 and 35.7 kg/m2, respectively. There were no life threatening postoperative complications or mortality. The median percent excess weight loss was 50.3% at the end of 6 months. Comorbidity resolution values were 96% for obstructive sleep apnea, 89% for diabetes mellitus, and 87% for joint pains, among the most common comorbidities. LSG is effective in achieving weight loss and in improving comorbidities with minimal complications even at the hands of novice bariatric surgeons with good laparoscopic skills and adequate bariatric training.

Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes.

PubMed

Prahalad, P; Tanenbaum, M; Hood, K; Maahs, D M

2018-04-01

With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life. © 2018 Diabetes UK.

Development of visual 3D virtual environment for control software

NASA Technical Reports Server (NTRS)

Hirose, Michitaka; Myoi, Takeshi; Amari, Haruo; Inamura, Kohei; Stark, Lawrence

1991-01-01

Virtual environments for software visualization may enable complex programs to be created and maintained. A typical application might be for control of regional electric power systems. As these encompass broader computer networks than ever, construction of such systems becomes very difficult. Conventional text-oriented environments are useful in programming individual processors. However, they are obviously insufficient to program a large and complicated system, that includes large numbers of computers connected to each other; such programming is called 'programming in the large.' As a solution for this problem, the authors are developing a graphic programming environment wherein one can visualize complicated software in virtual 3D world. One of the major features of the environment is the 3D representation of concurrent process. 3D representation is used to supply both network-wide interprocess programming capability (capability for 'programming in the large') and real-time programming capability. The authors' idea is to fuse both the block diagram (which is useful to check relationship among large number of processes or processors) and the time chart (which is useful to check precise timing for synchronization) into a single 3D space. The 3D representation gives us a capability for direct and intuitive planning or understanding of complicated relationship among many concurrent processes. To realize the 3D representation, a technology to enable easy handling of virtual 3D object is a definite necessity. Using a stereo display system and a gesture input device (VPL DataGlove), our prototype of the virtual workstation has been implemented. The workstation can supply the 'sensation' of the virtual 3D space to a programmer. Software for the 3D programming environment is implemented on the workstation. According to preliminary assessments, a 50 percent reduction of programming effort is achieved by using the virtual 3D environment. The authors expect that the 3D environment has considerable potential in the field of software engineering.

Introduction of a second dose of measles in national immunization program in India: a major step towards eradication.

PubMed

Verma, Ramesh; Khanna, Pardeep; Bairwa, Mohan; Chawla, Suraj; Prinja, Shankar; Rajput, Meena

2011-10-01

Measles is a highly infectious, acute respiratory illness that is caused by a virus of the genus Morbillivirus. The disease infects nearly 30 million children each year, and deaths usually occur from complications related to pneumonia, diarrhea and malnutrition. A systematic review of published Indian literature depicts the median case fatality ratio (CFR) of measles to be 1.6%. Through immunization, measles deaths dropped a remarkable 78% from 733,000 in 2000 to 164,000 in 2008. As of 2008, 192 of 193 Member States of WHO use 2 doses of measles vaccine in their national immunization programs, India being the only exception. The Millennium Development Goal (MDG) 4 aims to reduce by two-thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the world. Per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010–17) for immunization of India, the country aims to reduce measles-related mortality by 90% by 2013 when compared to 2000. As recommended by the National Technical Advisory Group on Immunization (NTAGI), the implementation strategy of the second dose of measles vaccine at the state level is determined by the underlying performance of the routine immunization program. The second dose in the national immunization schedule gives extra immunity against measles infection that renders children more susceptible to secondary pneumonia and diarrheal diseases, which are the primary causes of under-5 child mortality in India.

The Stop Smoking Before Surgery Program

PubMed Central

Bottorff, Joan L.; Seaton, Cherisse L.; Viney, Nancy; Stolp, Sean; Krueckl, Sandra; Holm, Nikolai

2015-01-01

Objective: This study aimed to examine the impact of a Stop Smoking Before Surgery (SSBS) program in a health authority where responsibility for surgical services is shared by health professionals in regional centers and outlying communities. Methods: A between-subjects, pre-post mixed method program evaluation was conducted. Elective surgery patients at 2 Northern Canadian hospitals were recruited and surveyed at 2 time points: pre-SSBS implementation (n = 150) and 1 year post-SSBS implementation (n = 90). In addition, semistructured interviews were conducted with a purposeful sample of participants (n = 18). Results: Participants who received information about stopping smoking before surgery post-SSBS implementation were more likely than expected to have reduced their smoking, χ2(1, 89) = 10.62, P = .001, and had a significantly higher Awareness of Smoking-Related Perioperative Complications score than those that were advised to quit smoking prior to SSBS implementation (U = 1288.0, P < .001). Being advised by a health care professional was the second strongest predictor of whether or not participants reduced their smoking before surgery post-SSBS implementation. However, there was no significant change in the number of participants who reported being advised to quit smoking before surgery between groups. Conclusion: Providing surgery-specific resources to increase awareness of and support for surgery-specific smoking cessation had limited success in this rural context. Additional strategies are needed to ensure that every surgical patient who smokes receives information about the benefits of quitting for surgery and is aware of available cessation resources. PMID:26385995

[Improving home auto-control in diabetic children: reducing atherogenic risk].

PubMed

Bayes García, R; Campoy Folgoso, C; Pérez Bonilla, E; Molina Font, J

1991-03-01

Insulin-dependent Diabetes (IDDM) is a major endocrine abnormality in children and the greatest morbi-mortality problems for diabetic patients are those related to cardiovascular complications (macro-microangiopaties), where kept hyperlipidemia and hyperglucemia play a fundamental patogenic role. The programs for optimization of home autocontrol have reduced frequent metabolic derangements. The aim of this study was to analyze the metabolic control state and its relationships with plasma lipids and atherogenic ratios in diabetic patients that were submitted to a program for optimization of home autocontrol of this illness. Blood samples were taken fom 49 IDDM, aged 10.53 +/- 0.51 (+/- SEM) years old, with a mean evolution period of 4.34 +/- 0.38 years, at the begining of the program (Stage I) and 6 months later (Stage II). Biochemical Analysis: Total Cholesterol (TC), cholesterol joined to high density lipoprotein (HDLc), Triglycerides (TG) and Phospholipids (Ph) were measured by microspectrphotometric methods. Cholesterol joined to very low and low density lipoproteins (VLDLc and LDLc, respectively) were calculated by Friedwald's formula. Apoproteins A and B (Apo A and Apo B) were measured using Mancini's method, Glycemia levels (Gly) by peroxidase's method, Glycosilated Serum Protein (GSP) by colormetric's method and Glycosilated haemoglobine (HbA1c) by chromatographic separation using cationic interchange microcolumns. 65% of the patients showed a significant decrease in plasma levels of Gly, GSP and HbA1c percentage between Stages I and II (Favourable Metabolic Control).(ABSTRACT TRUNCATED AT 250 WORDS)

Illiteracy and diabetic foot complications.

PubMed

Al-Kaabi, Juma M; Al Maskari, Fatma; Cragg, Paul; Afandi, Bachar; Souid, Abdul-Kader

2015-12-01

Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes. Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist. Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care. Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Short- and long-term outcomes of surgical management of peptic ulcer complications in the era of proton pump inhibitors.

PubMed

Hasadia, Rabea; Kopelman, Yael; Olsha, Oded; Alfici, Ricardo; Ashkenazi, Itamar

2018-01-22

We evaluated the short-term and long-term outcomes of emergency operations for peptic ulcer (PUD) complications in a period of time in which the need for surgery is infrequent. Retrospective review of operated patients (2007-2015) in one medical center. 81 patients were included (8.9 patients/year): 70 (86.4%) male; 11 (13.6%) female. Indications for operation were hemorrhage in 18 (22.2%), perforation in 62 (76.5%) and gastric-outlet obstruction in one (1.2%). Only 16 (19.8%) operations included a procedure to reduce gastric acid secretion. Six (7.4%) patients had a second operation for recurrent or persistent complication. Of these, two had a procedure to reduce gastric acid secretion in their first operation. 16 (19.8%) patients died during the index hospitalization. Three (3.7%) patients were rehospitalized for a PUD complication following 3-24 months. One patient, who had surgery for a second perforation 3 months following the first operation, was treated empirically for Helicobacter Pylori (HP) between the two operations. In comparison to perforation, patients with hemorrhage were older (69.9 ± 20.3 vs. 52.1 ± 19.9 years; p = 0.0015), more commonly had a history of PUD or treatment by nonsteroidal anti-inflammotry drugs (55.6 vs. 19.4%; p = 0.0054), more commonly had a procedure to reduce gastric acid secretion during their index operation (61.1 vs. 6.5%; p < 0.0001), and had a higher mortality (38.9 vs. 14.5%; p = 0.0406). Mortality is high following surgery for the complications of PUD, moreso in patients undergoing surgery for hemorrhage. Reoperations and repeated hospitalizations for complications are not uncommon, even in patients who have had procedures to reduce gastric acid secretion and HP eradication.

Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.

PubMed

Menezes, Kênia Kp; Nascimento, Lucas R; Ada, Louise; Polese, Janaine C; Avelino, Patrick R; Teixeira-Salmela, Luci F

2016-07-01

After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications? Systematic review of randomised or quasi-randomised trials. Adults with respiratory muscle weakness following stroke. Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength. Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications. Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14) and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25); it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96) compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain. This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation. PROSPERO (CRD42015020683). [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.Journal of Physiotherapy62: 138-144]. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

A study of the complications of small bore 'Seldinger' intercostal chest drains.

PubMed

Davies, Helen E; Merchant, Shairoz; McGown, Anne

2008-06-01

Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. A retrospective case note audit was performed of consecutive patients requiring pleural drainage over a 12-month period. One hundred consecutive small bore Seldinger (12F) chest drain insertions were evaluated. Few serious complications occurred. However, 21% of the chest drains were displaced ('fell out') and 9% of the drains became blocked. This contributed to high morbidity rates, with 13% of patients requiring repeat pleural procedures. The frequency of drain blockage in pleural effusion was reduced by administration of regular normal saline drain flushes (odds ratio for blockage in flushed drains compared with non-flushed drains 0.04, 95% CI: 0.01-0.37, P < 0.001). Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

Evaluation of common vaginal tunic ligation during field castration in draught colts.

PubMed

Carmalt, J L; Shoemaker, R W; Wilson, D G

2008-09-01

The objective of this study was to determine if ligation of the common vaginal tunic could prevent or reduce the incidence of omental herniation and eventration in draught colts undergoing routine field castration. It was found that common vaginal tunic ligation, while not completely preventing omental herniation and evisceration, significantly reduced the incidence of these complications and should be considered in those males deemed at increased risk of significant post castration complications.

Infection Reduces Return-to-duty Rates for Soldiers with Type III Open Tibia Fractures

DTIC Science & Technology

2014-09-01

Infection reduces return-to-duty rates for soldiers with Type III open tibia fractures Matthew A. Napierala, MD, Jessica C. Rivera, MD, Travis C... Type III open tibia fracture and tabulated the prevalence of infectious complications.We searched the Physical Evaluation Board database to determine...were not infected ( p 0.1407). Soldiers who experienced any type of infectious complication ( p 0.0470) and having osteomyelitis ( p 0.0335) had a lower

A Look Inside Corporate Employee Volunteer Programs.

ERIC Educational Resources Information Center

Benjamin, Ellen J.

2001-01-01

A survey of 15 corporate volunteer program managers found that administration was complicated by limited staff time and lack of clear policies; employee preferences and incentives/rewards had a higher priority than impact on customers and community; feedback on program results was mostly informal; and 73% reported no measurement process. (Contains…

Reducing abortion-related mortality in South Asia: a review of constraints and a road map for change.

PubMed

Ganatra, Bela; Johnston, Heidi Bart

2002-01-01

South Asia (Bangladesh, India, Nepal, Pakistan, and Sri Lanka) is home to 28% of the world's people and accounts for about a third (30%) of the world's maternal deaths. Thirteen percent of all maternal deaths in South Asia are attributed to complications of unsafe abortion and are almost entirely preventable. This article reviews the legal, health system, and sociocultural barriers to safe abortion and suggests strategies to reduce abortion-related morbidity and mortality. Restrictive laws hamper safe abortion in most of the region, but even where laws are more liberal, limited awareness of the law has been a barrier to access. Such health system barriers as an insufficient number of trained providers, inequitable distribution of services, and excessive costs have contributed to death from unsafe abortion. Sociocultural attitudes, including the right of male relatives to make reproductive decisions, the emphasis on male heirs, and the strong social stigma against extramarital pregnancy also put women at risk. Government and other institutions must strive to prevent abortion-related death and disability by making safe abortion services accessible to the fullest extent of the law. Health systems need to provide emergency care for complications and postabortion contraceptive counseling, use appropriate technology, and allow nonphysician providers to deliver care. Safe abortion care programs need to address the needs of the local community, particularly the needs of socially and economically vulnerable subgroups, such as the unmarried and adolescents.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

The ineffectiveness and unintended consequences of the public health war on obesity.

PubMed

Ramos Salas, Ximena

2015-02-03

The public health war on obesity has had little impact on obesity prevalence and has resulted in unintended consequences. Its ineffectiveness has been attributed to: 1) heavy focus on individual-based approaches and lack of scaled-up socio-environmental policies and programs, 2) modest effects of interventions in reducing and preventing obesity at the population level, and 3) inappropriate focus on weight rather than health. An unintended consequence of these policies and programs is excessive weight preoccupation among the population, which can lead to stigma, body dissatisfaction, dieting, disordered eating, and even death from effects of extreme dieting, anorexia, and obesity surgery complications, or from suicide that results from weight-based bullying. Future public health approaches should: a) avoid simplistic obesity messages that focus solely on individuals' responsibility for weight and health, b) focus on health outcomes rather than weight control, and c) address the complexity of obesity and target both individual-level and system-level determinants of health.

[Epidemiology of invasive group A streptococcal infections in developed countries : the Canadian experience with necrotizing fasciitis].

PubMed

Ovetchkine, Ph; Bidet, Ph; Minodier, Ph; Frère, J; Bingen, E

2014-11-01

In industrialized countries, group A streptococcal infections were a source of concern, mainly due to the occurrence of rheumatic fever and its cardiac complications. At present, the incidence of rheumatic fever is decreasing in these countries, giving way to an increasing occurrence of invasive streptococcal group A infections with high level of morbidity and mortality. Streptococcal necrotizing fasciitis, a specific entity, emerged these last decades, often in association with chickenpox. The introduction of the varicella vaccine in the province of Quebec routine immunization program, was followed by a significant decrease in the number of necrotizing fasciitis or other skin and soft-tissues infections in our pediatric population. However, in our experience at the CHU Sainte-Justine, this immunization program has not been helpful to reduce the overall incidence of invasive group A streptococcal infections. Conversely, an increase in the number of pleuro-pulmonary and osteo-articular infections was observed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Site Matters: Multisite Randomized Trial of Motivational Enhancement Therapy in Community Drug Abuse Clinics

PubMed Central

Ball, Samuel A.; Martino, Steve; Nich, Charla; Frankforter, Tami L.; Van Horn, Deborah; Crits-Christoph, Paul; Woody, George E.; Obert, Jeanne L.; Farentinos, Christiane; Carroll, Kathleen M.

2007-01-01

The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. PMID:17663610

Developmental Programming in Response to Intrauterine Growth Restriction Impairs Myoblast Function and Skeletal Muscle Metabolism

PubMed Central

Yates, D. T.; Macko, A. R.; Nearing, M.; Chen, X.; Rhoads, R. P.; Limesand, S. W.

2012-01-01

Fetal adaptations to placental insufficiency alter postnatal metabolic homeostasis in skeletal muscle by reducing glucose oxidation rates, impairing insulin action, and lowering the proportion of oxidative fibers. In animal models of intrauterine growth restriction (IUGR), skeletal muscle fibers have less myonuclei at birth. This means that myoblasts, the sole source for myonuclei accumulation in fibers, are compromised. Fetal hypoglycemia and hypoxemia are complications that result from placental insufficiency. Hypoxemia elevates circulating catecholamines, and chronic hypercatecholaminemia has been shown to reduce fetal muscle development and growth. We have found evidence for adaptations in adrenergic receptor expression profiles in myoblasts and skeletal muscle of IUGR sheep fetuses with placental insufficiency. The relationship of β-adrenergic receptors shifts in IUGR fetuses because Adrβ2 expression levels decline and Adrβ1 expression levels are unaffected in myofibers and increased in myoblasts. This adaptive response would suppress insulin signaling, myoblast incorporation, fiber hypertrophy, and glucose oxidation. Furthermore, this β-adrenergic receptor expression profile persists for at least the first month in IUGR lambs and lowers their fatty acid mobilization. Developmental programming of skeletal muscle adrenergic receptors partially explains metabolic and endocrine differences in IUGR offspring, and the impact on metabolism may result in differential nutrient utilization. PMID:22900186

Effectiveness of self-management promotion educational program among diabetic patients based on health belief model

PubMed Central

Jalilian, Farzad; Motlagh, Fazel Zinat; Solhi, Mahnaz; Gharibnavaz, Hasan

2014-01-01

Introduction: Diabetes is a chronic disease; it can cause serious complications. Diabetes self-management is essential for prevention of disease complications. This study was conducted to evaluate self-management promotion educational program intervention efficiency among diabetic patients in Iran and health belief model (HBM) was applied as a theoretical framework. Materials and Methods: Overall, 120 Type 2 diabetic patients referred to rural health centers in Gachsaran, Iran participated in this study as randomly divided into intervention and control group. This was a longitudinal randomized pre- and post-test series control group design panel study to implement a behavior modification based intervention to promotion self-management among diabetic patients. Cross-tabulation and t-test by using SPSS statistical package, version 16 was used for the statistical analysis. Results: Mean age was 55.07 years (SD = 9.94, range: 30-70). Our result shows significant improvements in average response for susceptibility, severity, benefit and self-management among intervention group. Additionally, after intervention, average response of the barrier to self-management was decreased among intervention group. Conclusion: Our result showed education program based on HBM was improve of self-management and seems implementing these programs can be effective in the and prevention of diabetes complications. PMID:24741654

Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake.

PubMed

Li, Yongqiang; Reinhardt, Jan D; Gosney, James E; Zhang, Xia; Hu, Xiaorong; Chen, Sijing; Ding, Mingpu; Li, Jianan

2012-06-01

To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

Cost-effectiveness of screening and treatment for bacterial vaginosis in early pregnancy among women at low risk for preterm birth.

PubMed

Kekki, Minnamaija; Kurki, Tapio; Kotomäki, Teija; Sintonen, Harri; Paavonen, Jorma

2004-01-01

Bacterial vaginosis (BV) is an important risk factor for preterm birth. BV is detected in 10-30% of pregnant women and is often asymptomatic. Treatment of BV during pregnancy seems to reduce the risk of preterm delivery among high-risk women. We performed a cost-effectiveness analysis of screening and treatment for BV in early pregnancy among asymptomatic women at low risk for preterm delivery. A decision tree was built with two arms. For the screening (and treatment) arm the probabilities were derived from our earlier randomized trial on screening and treatment for BV, consisting of BV-positive women treated with intravaginal clindamycin cream or placebo and also of BV-negative pregnant women. The probabilities of outcomes among these women were collected from antenatal clinic records and hospital records, and for the no-screening arm mainly from the Finnish Perinatal Statistics. The outcomes considered were preterm delivery, mode of delivery, peripartum infections and postpartum complications. The unit costs associated with these outcomes were mainly based on disease-related groups (DRGs). No-screening was compared with two screening programs (one with clindamycin, the other with metronidazole treatment) and subjected to sensitivity analyses. There was no significant difference between screening and no-screening strategies in the costs and in the rate of preterm deliveries but the screening strategy produced significantly fewer peripartum infections and postpartum complications. Sensitivity analyses suggested that the screening strategy may become cost-saving if the rate of preterm deliveries exceeds 3%. Screening and treatment for BV in early pregnancy may not reduce costs compared to no-screening in a population at low risk for preterm birth but would produce, at the same cost, more health benefits in terms of fewer peripartum infections and postpartum complications. However, it may be cost-saving if the rate of preterm deliveries is higher than 3%.

Hepatic Tract Plug-Embolisation After Biliary Stenting. Is It Worthwhile?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dale, Adam P., E-mail: adamdale@doctors.org.uk; Khan, Rafeh, E-mail: rafeh.khan@yahoo.com; Mathew, Anup, E-mail: anup.mathew@sth.nhs.uk

PurposePTC and stenting procedures are associated with significant risks including life-threatening haemorrhage, sepsis, renal failure and high mortality rates. PTC tract closure methods are utilised to reduce haemorrhagic complications despite little evidence to support their use. The current study assesses the incidence of haemorrhagic complications following PTC and stenting procedures, both prior to and following the introduction of a dedicated expanding gelatin foam-targeted embolisation liver tract closure technique.Materials and MethodsHaemorrhagic complications were retrospectively identified in patients undergoing PTC procedures both prior to (subgroup 1) and following (subgroup 2) the introduction of a dedicated targeted liver tract closure method between 9/11/2010more » and 10/08/2012 in a single tertiary referral centre. Mean blood Hb decrease following PTC was established in subgroups 1 and 2. Kaplan–Meier life-table analysis was performed to compare survival outcomes between subgroups using the log-rank test.ResultsHaemorrhagic complications were significantly reduced following the introduction of the targeted PTC tract closure method [(12 vs. 3 % of subgroups 1 (n = 101) and 2 (n = 92), respectively (p = 0.027)]. Mean blood Hb decrease following PTC was 1.40 versus 0.68 g/dL in subgroups 1 and 2, respectively (p = 0.069). 30-day mortality was 14 and 12 % in subgroups 1 and 2, respectively. 50 % of the entire cohort had died by 174 days post-PTC.ConclusionIntroduction of liver tract embolisation significantly reduced haemorrhagic complications in our patient cohort. Utilisation of this method has the potential to reduce the morbidity and mortality burden associated with post-PTC haemorrhage by preventing bleeding from the liver access tract.« less

Short and long-term outcomes from a multisession diabetes education program targeting low-income minority patients: a six-month follow up.

PubMed

Ryan, John G; Jennings, Terri; Vittoria, Isabel; Fedders, Mark

2013-01-01

A diabetes self-management education (DSME) program was offered to patients at a primary care clinic serving low-income people. The purpose of the analyses presented here was to understand the feasibility of the program and effectiveness of the intervention. The program was facilitated by a nurse and licensed dietician. Data were collected at baseline, after each class, and after 6 months. Patients were interviewed to identify diabetes self-care behaviors before the first class, after the fourth class, and at 6 months. Knowledge related to content areas was measured before and after each class. Glycosylated hemoglobin (HbA(1c)), blood pressure, weight, and body mass index (BMI) were collected at baseline and after 6 months. Medical records were reviewed for LDL levels, co-morbidity, and diabetes management. Frequencies, χ(2) and t tests, and repeated measures t tests were used to analyze data. Patients were mostly non-Hispanic black or Hispanic (93.1%); mean BMI was 34.89 kg/m(2). About one-half (41.95%) completed the program. Significant improvements were observed for knowledge related to each of the 4 content areas: diet (P < 0.001), diabetes management (P = 0.003), monitoring blood glucose (P < 0.001), and preventing complications (P = 0.001). Among long-term outcomes, mean HbA(1c) was significantly reduced (0.82%), from 8.60% to 7.78% (P = 0.007), with 26.67% of patients reducing HbA(1c) from ≥7.0% at baseline to <7% at follow up (P < 0.001). Patients demonstrated a significant improvement in readiness to improve dietary behaviors (P = 0.016). Outcomes suggested that minority patients with a high risk for poor diabetes outcomes might be retained in a multisession DSME program and benefit from increasing knowledge of diabetes content. Further evaluation is necessary to determine the cost-effectiveness of this intervention. Copyright © 2013 Elsevier HS Journals, Inc. All rights reserved.

The relationship between hand hygiene and health care-associated infection: it’s complicated

PubMed Central

McLaws, Mary-Louise

2015-01-01

The reasoning that improved hand hygiene compliance contributes to the prevention of health care-associated infections is widely accepted. It is also accepted that high hand hygiene alone cannot impact formidable risk factors, such as older age, immunosuppression, admission to the intensive care unit, longer length of stay, and indwelling devices. When hand hygiene interventions are concurrently undertaken with other routine or special preventive strategies, there is a potential for these concurrent strategies to confound the effect of the hand hygiene program. The result may be an overestimation of the hand hygiene intervention unless the design of the intervention or analysis controls the effect of the potential confounders. Other epidemiologic principles that may also impact the result of a hand hygiene program include failure to consider measurement error of the content of the hand hygiene program and the measurement error of compliance. Some epidemiological errors in hand hygiene programs aimed at reducing health care-associated infections are inherent and not easily controlled. Nevertheless, the inadvertent omission by authors to report these common epidemiological errors, including concurrent infection prevention strategies, suggests to readers that the effect of hand hygiene is greater than the sum of all infection prevention strategies. Worse still, this omission does not assist evidence-based practice. PMID:25678805

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

PubMed

Leahy, Michael F; Hofmann, Axel; Towler, Simon; Trentino, Kevin M; Burrows, Sally A; Swain, Stuart G; Hamdorf, Jeffrey; Gallagher, Trudi; Koay, Audrey; Geelhoed, Gary C; Farmer, Shannon L

2017-06-01

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes. This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications. Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001). Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Optimal diabetes care--can we afford it?: evidence-based diabetes care could be highly cost effective.

PubMed

Chowdhury, T A; Bennett-Richards, P

2013-11-01

Management of diabetes is expensive and set to get costlier. Managing the condition and it's devastating complications imposing a huge societal and economic toll on healthcare systems worldwide. While many interventions to reduce complications are available, a number of interventions do not have a strong basis in evidence, and lack cost effectiveness. In a time of economic austerity, and unprecedented pressure to reduce costs of health care in the UK, are there ways improving care, without driving up cost?

Prioritizing quality improvement in general surgery.

PubMed

Schilling, Peter L; Dimick, Justin B; Birkmeyer, John D

2008-11-01

Despite growing interest in quality improvement, uncertainty remains about which procedures offer the most room for improvement in general surgery. In this context, we sought to describe the relative contribution of different procedures to overall morbidity, mortality, and excess length of stay in general surgery. Using data from the American College of Surgeons' National Surgery Quality Improvement Program (ACS-NSQIP), we identified all patients undergoing a general surgery procedure in 2005 and 2006 (n=129,233). Patients were placed in 36 distinct procedure groups based on Current Procedural Terminology codes. We first examined procedure groups according to their relative contribution to overall morbidity and mortality. We then assessed procedure groups according to their contribution to overall excess length of stay. Ten procedure groups alone accounted for 62% of complications and 54% of excess hospital days. Colectomy accounted for the greatest share of adverse events, followed by small intestine resection, inpatient cholecystectomy, and ventral hernia repair. In contrast, several common procedures contributed little to overall morbidity and mortality. For example, outpatient cholecystectomy, breast procedures, thyroidectomy, parathyroidectomy, and outpatient inguinal hernia repair together accounted for 34% of procedures, but only 6% of complications (and only 4% of major complications). These same procedures accounted for < 1% of excess hospital days. A relatively small number of procedures account for a disproportionate share of the morbidity, mortality, and excess hospital days in general surgery. Focusing quality improvement efforts on these procedures may be an effective strategy for improving patient care and reducing cost.

Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal.

PubMed

Rapone, B; Nardi, G M; DI Venere, D; Pettini, F; Grassi, F R; Corsalini, M

2016-01-01

This study was aimed at assessing the effectiveness and the importance of an oral hygiene (OH) protocol in patients undergoing radiation therapy and chemotherapy after prosthesis rehabilitation, in order to reduce or minimize oral complications. This study was carried out at the Department of Dental Science, at the University of Bari-Italy from December 2012 to December 2015 on 34 selected patients with primary oral cancer undergoing chemotherapy and radiotherapy after prosthesis rehabilitation. They were divided into 2 groups according to their age, sex and cancer therapy. Seventeen patients were assigned to the control group and seventeen in the experimental one. In the experimental group (Table 1), patients underwent an oral hygiene protocol whereas in the control group (Table 2) patients received the usual care provided within the clinical setting. All the patients gave written informed consent. It has been asked and obtained the authorisation from the Ethics Committee of the Dental Science and Surgery Department. Results show that in patients undergoing the oral hygiene protocol, the complications and the risks of infection and permanent dental problems have been minimized. Indeed, of the seventeen patients undergoing the OH protocol, 70% obtained positive results and were satisfied with the program outcome. The role of the health care providers is essential to educate patients to adhere to the prescribed treatments and reinforce their motivation in oral hygiene. The oral hygiene procedures prevent and ameliorate oral complications due to the radiation therapy and chemotherapy.

Bronchoscopy with endobronchial ultrasound guided transbronchial needle aspiration vs. transthoracic needle aspiration in lung cancer diagnosis and staging.

PubMed

Munoz, Mark L; Lechtzin, Noah; Li, Qing Kay; Wang, KoPen; Yarmus, Lonny B; Lee, Hans J; Feller-Kopman, David J

2017-07-01

In evaluating patients with suspected lung cancer, it is important to not only obtain a tissue diagnosis, but also to obtain enough tissue for both histologic and molecular analysis in order to appropriately stage the patient with a safe and efficient strategy. The diagnostic approach may often be dependent on local resources and practice patterns rather than current guidelines. We Describe lung cancer staging at two large academic medical centers to identify the impact different procedural approaches have on patient outcomes. We conducted a retrospective cohort study of all patients undergoing a lung cancer diagnostic evaluation at two multidisciplinary centers during a 1-year period. Identifying complication rates and the need for multiple biopsies as our primary outcomes, we developed a multivariate regression model to determine features associated with complications and need for multiple biopsies. Of 830 patients, 285 patients were diagnosed with lung cancers during the study period. Those staged at the institution without an endobronchial ultrasound (EBUS) program were more likely to require multiple biopsies (OR 3.62, 95% CI: 1.71-7.67, P=0.001) and suffer complications associated with the diagnostic procedure (OR 10.2, 95% CI: 3.08-33.58, P<0.001). Initial staging with transthoracic needle aspiration (TTNA) and conventional bronchoscopy were associated with greater need for subsequent biopsies (OR 8.05 and 14.00, 95% CI: 3.43-18.87 and 5.17-37.86, respectively) and higher complication rates (OR 37.75 and 7.20, 95% CI: 10.33-137.96 and 1.36-37.98, respectively). Lung cancer evaluation at centers with a dedicated EBUS program results in fewer biopsies and complications than at multidisciplinary counterparts without an EBUS program.

Effects of Volatile Anesthetics on Mortality and Postoperative Pulmonary and Other Complications in Patients Undergoing Surgery: A Systematic Review and Meta-analysis.

PubMed

Uhlig, Christopher; Bluth, Thomas; Schwarz, Kristin; Deckert, Stefanie; Heinrich, Luise; De Hert, Stefan; Landoni, Giovanni; Serpa Neto, Ary; Schultz, Marcus J; Pelosi, Paolo; Schmitt, Jochen; Gama de Abreu, Marcelo

2016-06-01

It is not known whether modern volatile anesthetics are associated with less mortality and postoperative pulmonary or other complications in patients undergoing general anesthesia for surgery. A systematic literature review was conducted for randomized controlled trials fulfilling following criteria: (1) population: adult patients undergoing general anesthesia for surgery; (2) intervention: patients receiving sevoflurane, desflurane, or isoflurane; (3) comparison: volatile anesthetics versus total IV anesthesia or volatile anesthetics; (4) reporting on: (a) mortality (primary outcome) and (b) postoperative pulmonary or other complications; (5) study design: randomized controlled trials. The authors pooled treatment effects following Peto odds ratio (OR) meta-analysis and network meta-analysis methods. Sixty-eight randomized controlled trials with 7,104 patients were retained for analysis. In cardiac surgery, volatile anesthetics were associated with reduced mortality (OR = 0.55; 95% CI, 0.35 to 0.85; P = 0.007), less pulmonary (OR = 0.71; 95% CI, 0.52 to 0.98; P = 0.038), and other complications (OR = 0.74; 95% CI, 0.58 to 0.95; P = 0.020). In noncardiac surgery, volatile anesthetics were not associated with reduced mortality (OR = 1.31; 95% CI, 0.83 to 2.05, P = 0.242) or lower incidences of pulmonary (OR = 0.67; 95% CI, 0.42 to 1.05; P = 0.081) and other complications (OR = 0.70; 95% CI, 0.46 to 1.05; P = 0.092). In cardiac, but not in noncardiac, surgery, when compared to total IV anesthesia, general anesthesia with volatile anesthetics was associated with major benefits in outcome, including reduced mortality, as well as lower incidence of pulmonary and other complications. Further studies are warranted to address the impact of volatile anesthetics on outcome in noncardiac surgery.

Naringin improves zidovudine- and stavudine-induced skeletal muscle complications in rats.

PubMed

Adebiyi, O O; Adebiyi, O A; Owira, Pmo

2016-03-22

Chronic use of nucleoside reverse transcriptase inhibitors (NRTIs) in managing human immunodeficiency virus (HIV) infection has been associated with several complications. Available management options for these complications have yielded controversial results, thus the need to urgently find newer alternatives. Naringin, a plant-derived flavonoid, has been shown to possess antioxidant and antiapoptotic properties which can be exploited in managing NRTI-induced complications. This study therefore investigated the effects of naringin on some NRTI-induced complications. Forty-nine rats (200-250 g) were divided into seven groups and were orally treated with stavudine (d4T)-only, d4T + naringin, d4T + vitamin E, zidovudine (AZT)-only, AZT + naringin, AZT + vitamin E, and distilled water, respectively. Drugs were administered once daily for 56 days, and oral glucose tolerance tests conducted on day 54 of the experiments and rats were thereafter sacrificed on day 56 by halothane overdose. Plasma samples and the left gastrocnemius muscles were stored at -80°C for further analysis. There was significant glucose intolerance, insulin resistance, oxidative stress, and apoptosis in the skeletal muscles of AZT- or d4T-only-treated rats. Naringin, however, significantly reduced fasting blood glucose and fasting plasma insulin concentrations, mitigated glucose intolerance, and insulin resistance in addition to reducing malondialdehyde and carbonyl protein concentrations when coadministered with either NRTIs. Furthermore, naringin improved antioxidant enzyme activities, reduced skeletal muscle BCL-2-associated X protein expression, and improved B-cell lymphoma-2 protein expression compared to AZT- or d4T-only-treated rats. Naringin ameliorated AZT- and d4T-induced complications and therefore should be further investigated as a possible nutritional supplement in managing HIV infection. © The Author(s) 2016.

Reduction of Complications of Local Anaesthesia in Dental Healthcare Setups by Application of the Six Sigma Methodology: A Statistical Quality Improvement Technique.

PubMed

Akifuddin, Syed; Khatoon, Farheen

2015-12-01

Health care faces challenges due to complications, inefficiencies and other concerns that threaten the safety of patients. The purpose of his study was to identify causes of complications encountered after administration of local anaesthesia for dental and oral surgical procedures and to reduce the incidence of complications by introduction of six sigma methodology. DMAIC (Define, Measure, Analyse, Improve and Control) process of Six Sigma was taken into consideration to reduce the incidence of complications encountered after administration of local anaesthesia injections for dental and oral surgical procedures using failure mode and effect analysis. Pareto analysis was taken into consideration to analyse the most recurring complications. Paired z-sample test using Minitab Statistical Inference and Fisher's exact test was used to statistically analyse the obtained data. The p-value <0.05 was considered as significant value. Total 54 systemic and 62 local complications occurred during three months of analyse and measure phase. Syncope, failure of anaesthesia, trismus, auto mordeduras and pain at injection site was found to be most recurring complications. Cumulative defective percentage was 7.99 in case of pre-improved data and decreased to 4.58 in the control phase. Estimate for difference was 0.0341228 and 95% lower bound for difference was 0.0193966. p-value was found to be highly significant with p= 0.000. The application of six sigma improvement methodology in healthcare tends to deliver consistently better results to the patients as well as hospitals and results in better patient compliance as well as satisfaction.

Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System.

PubMed

Massarweh, Nader N; Kougias, Panagiotis; Wilson, Mark A

2016-12-01

The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system. To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years. A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014. Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time. Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P < .001 for all). Although there were no clinically meaningful differences in rates of complications and major complications across hospital risk-adjusted mortality quintiles (any complications: lowest quintile, 20 945 of 147 721 [14.2%] vs highest quintile, 18 938 of 135 557 [14%]; major complications: lowest quintile, 14 044 of 147 721 [9.5%] vs highest quintile, 12 881 of 135 557 [9.5%]), FTR rates (any complications: lowest quintile, 2249 of 20 945 [10.7%] vs highest quintile, 2769 of 18 938 [14.6%]; major complications: lowest quintile, 2161 of 14 044 [15.4%] vs highest quintile, 2663 of 12 881 [20.7%]) were significantly higher with increasing quintile (P < .001). However, across hospital quintiles, there were significant decreases in morbidity (20.6%-29.9% decrease; trend test, P < .001 for all) and FTR (29.2%-50.6% decrease; trend test, P < .001 for all) during the study period. After hierarchical modeling, the odds of postoperative mortality, FTR, and FTR after a major complication were approximately 40% to 50% lower in the most recent study year compared with 15 years ago (P < .001 for all). For the past 15 years, morbidity, mortality, and FTR have improved within the VA health system. Other integrated health systems providing a high volume of surgical care for their enrollees may benefit by critically evaluating the system-level approaches of the VA health system to surgical quality improvement.

Complicating College Students' Conception of the American Dream through Community Service Learning

ERIC Educational Resources Information Center

Seider, Scott C.; Gillmor, Susan C.; Rabinowicz, Samantha A.

2010-01-01

This study considered the impact of the SERVE Program upon participating college students' belief in the American Dream. The SERVE Program is a community service learning program sponsored by the philosophy and theology departments at Ignatius University. Using a mixed methods approach, the authors found that participating students demonstrated…

Application of DNA barcoding in forest biosecurity surveillance programs

Treesearch

Leland M. Humble; Jeremy R. deWaard

2011-01-01

The ability to distinguish non-indigenous species from the background diversity of native taxa is critical to the success of surveillance programs for detecting new introductions. Surveillance programs for alien taxa rely on the precise diagnosis of species, which can be complicated by sizable trap samples, damaged specimens, immature life stages, and incomplete...

[Female teenager students: what they know about induced abortion complications].

PubMed

Correia, Divanise Suruagy; Monteiro, Vera Grácia Neumann; Cavalcante, Jairo Calado; Maia, Eulália Maria Chaves

2011-09-01

This study aimed to identify the knowledge about induced abortion complications and its relation to age. This is a cross-sectional study performed in schools of Maceió, state of Alagoas, Brazil, with students 12 to 19 years old. The sample was calculated considering post-abortion curettage data. The Epi Info computer program was used for data analysis. From 2,592 female adolescents studied 65.64% didn't know about any complications of induced abortion. The most mentioned complications were death and sterility. Clinical manifestations of abortion were wrongly mentioned by them as complications. Signification was found between the knowledge of the complications sterility, hemorrhage, and age. Death was significant fo rgirls under 15 and sterility for the older ones. The conclusion is that female adolescents don't have a correct knowledge of induced abortion complications, which shows the risk suffered by the ones that induce it. Thus, there is a need to further clarify the issue and for sexual education.

Fisetin Lowers Methylglyoxal Dependent Protein Glycation and Limits the Complications of Diabetes

PubMed Central

Maher, Pamela; Dargusch, Richard; Ehren, Jennifer L.; Okada, Shinichi; Sharma, Kumar; Schubert, David

2011-01-01

The elevated glycation of macromolecules by the reactive dicarbonyl and α-oxoaldehyde methylglyoxal (MG) has been associated with diabetes and its complications. We have identified a rare flavone, fisetin, which increases the level and activity of glyoxalase 1, the enzyme required for the removal of MG, as well as the synthesis of its essential co-factor, glutathione. It is shown that fisetin reduces two major complications of diabetes in Akita mice, a model of type 1 diabetes. Although fisetin had no effect on the elevation of blood sugar, it reduced kidney hypertrophy and albuminuria and maintained normal levels of locomotion in the open field test. This correlated with a reduction in proteins glycated by MG in the blood, kidney and brain of fisetin-treated animals along with an increase in glyoxalase 1 enzyme activity and an elevation in the expression of the rate-limiting enzyme for the synthesis of glutathione, a co-factor for glyoxalase 1. The expression of the receptor for advanced glycation end products (RAGE), serum amyloid A and serum C-reactive protein, markers of protein oxidation, glycation and inflammation, were also increased in diabetic Akita mice and reduced by fisetin. It is concluded that fisetin lowers the elevation of MG-protein glycation that is associated with diabetes and ameliorates multiple complications of the disease. Therefore, fisetin or a synthetic derivative may have potential therapeutic use for the treatment of diabetic complications. PMID:21738623

Postoperative socket irrigation with drinking tap water reduces the risk of inflammatory complications following surgical removal of third molars: a multicenter randomized trial.

PubMed

Ghaeminia, H; Hoppenreijs, Th J M; Xi, T; Fennis, J P; Maal, T J; Bergé, S J; Meijer, G J

2017-01-01

The primary aim of the present study was to evaluate the effectiveness of postoperative irrigation of the socket with drinking tap water on inflammatory complications following lower third molar removal. A multicenter randomized controlled trial was carried out from June 2013 to June 2014. In one arm of the study, patients were instructed to irrigate the tooth socket and surgical site with a Monoject® Curved 412 Tip Syringe (Tyco/healthcare-Kendall, Mansfield, MA, USA) with tap water. In a second arm of the study, the standard postoperative instructions did not include irrigation instructions. The incidences of alveolar osteitis and wound infection were recorded for each group and analyzed by the Fisher's exact test. A total of 280 patients with 333 mandibular third molars were analyzed. According to the intention-to-treat (ITT) analysis, inflammatory complications occurred in 18 cases in the Monoject® group (11.4 %) compared to 34 cases (19.1 %) in the control group (p = 0.04). These complications were associated with significant worse outcomes regarding quality of life, pain, and trismus and caused significantly more missed days of work or study. Female gender, age >26, bone removal, deep impacted third molars, less experienced surgeons, and a high amount of debris at the surgical site were also identified as risk factors for developing inflammatory complications following lower third molar removal. Irrigation of the surgical site with drinking tap water using a curved syringe following removal of third molars is effective in reducing the risk of inflammatory complications. Water is a very accessible, cost-effective irrigant without side effects and the results from this study have proven that it can be used to reduce the risk of inflammatory complications and associated morbidity following lower third molar removal.

Diabetes in Thailand: Status and Policy.

PubMed

Reutrakul, Sirimon; Deerochanawong, Chaicharn

2016-03-01

Like other countries in the Western Pacific region, Thailand is facing increasing numbers of patients with diabetes due to unhealthy diets, high obesity rates, and an aging society. Diabetes is a considerable burden for developing countries as it reduces quality of life, increases mortality, and drives up healthcare costs. The disease detection rate in Thailand has improved in recent years, but glycemic control remains suboptimal and significant numbers of patients suffer from complications. Universal healthcare coverage has increased access to care, but inequality exists between different health plans and non-medication diabetes supplies are not yet widely covered. Diabetes self-management education has not yet been standardized and a multidisciplinary team approach is not widely utilized. The Thai government recognizes the burden of diabetes and has launched nationwide programs of health promotion and disease prevention. In addition, local initiatives have targeted reductions in specific complications, including retinopathy and diabetic foot problems, which has resulted in better disease prevention and treatment. Along with strategic public health planning, increased collaboration between private and public sectors, enhanced professional training, increased use of technology and data management, and equitable distribution of care are all needed to improve outcomes of patients with diabetes in Thailand.

[Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases].

PubMed

Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A

2010-01-01

Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

Lessons learned from the American College of Surgeons National Surgical Quality Improvement Program Database: has centralized data collection improved immediate breast reconstruction outcomes and safety?

PubMed

Wang, Frederick; Koltz, Peter F; Sbitany, Hani

2014-11-01

The American College of Surgeons National Surgical Quality Improvement Program database was implemented to longitudinally track surgical 30-day surgical outcomes and complications. The authors analyze the program-reported outcomes for immediate breast reconstruction from 2007 to 2011, to assess whether longitudinal data collection has improved national outcomes and to highlight areas in need of continued improvement. The authors reviewed the database from 2007 to 2011 and identified encounters for immediate breast reconstruction using Current Procedural Terminology codes for prosthetic and autologous reconstruction. Demographics and comorbidities were tabulated for all patients. Postoperative complications analyzed included surgical-site infection, wound dehiscence, implant or flap loss, pulmonary embolism, and respiratory infections. A total of 15,978 patients underwent mastectomy and immediate reconstruction. Fewer smokers underwent immediate reconstruction over time (p=0.126), whereas more obese patients (p=0.001) and American Society of Anesthesiologists class 3 and 4 patients (p<0.001) underwent surgery. An overall increase in superficial surgical-site infection was noted, from 1.7 percent to 2.3 percent (p=0.214). Wound dehiscence (p=0.036) increased over time, whereas implant loss (p=0.015) and flap loss (p=0.012) decreased over time. Mean operative times increased over the analyzed years, as did all complications for prosthetic and autologous reconstruction. The American College of Surgeons National Surgical Quality Improvement Program data set has shown an increase in complications for immediate breast reconstruction over time, because of a longitudinally higher number of comorbid patients and longer operative times. This knowledge allows plastic surgeons the unique opportunity to improve patient selection criteria and efficiency. Therapeutic, III.

Deepwater Gulf of Mexico turbidites -- Compaction effects on porosity and permeability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ostermeier, R.M.

1995-06-01

The deepwater Gulf of Mexico is now a major area of activity for the US oil industry. Compaction causes particular concern because most prospective deepwater reservoirs are highly geo-pressured and many have limited aquifer support; water injection may also be problematic. To address some of the issues associated with compaction, the authors initiated a special core-analysis program to study compaction effects on turbidite sand porosity and permeability specifically. This program also addressed a number of subsidiary but no less important issues, such as sample characterization and quality, sample preparation, and test procedures. These issues are particularly pertinent, because Gulf ofmore » Mexico turbidites are generally unconsolidated, loose sands, and are thus susceptible to a whole array of potentially serious core-disturbing processes. One key result of the special core analysis program is that turbidite compressibilities exhibit large variations in both magnitude and stress dependence. These variations correlate with creep response in the laboratory measurements. The effects of compaction on permeability are significant. To eliminate complicating effects caused by fines movement, the authors made oil flow measurements at initial water saturation. The measurements indicate compaction reduces permeability four to five times more than porosity on a relative basis.« less

User-friendly program for multitask analysis

NASA Astrophysics Data System (ADS)

Caporali, Sergio A.; Akladios, Magdy; Becker, Paul E.

2000-10-01

Research on lifting activities has led to the design of several useful tools for evaluating tasks that involve lifting and material handling. The National Institute for Occupational Safety and Health (NIOSH) has developed a single task lifting equation. This formula has been frequently used as a guide in the field of ergonomics and material handling. While being much more complicated, the multi-task formula will provide a more realistic analysis for the evaluation of lifting and material handling jobs. A user friendly tool has been developed to assist professionals in the field of ergonomics in analyzing multitask types of material handling jobs. The program allows for up to 10 different tasks to be evaluated. The program requires a basic understanding of the NIOSH lifting guidelines and the six multipliers that are involved in the analysis of each single task. These multipliers are: Horizontal Distance Multiplier (HM), Vertical Distance Multiplier (VM), Vertical Displacement Multiplier (DM), Frequency of lifting Multiplier (FM), Coupling Multiplier (CM), and the Asymmetry Multiplier (AM). Once a given job is analyzed, a researched list of recommendations is provided to the user in an attempt to reduce the potential risk factors that are associated with each task.

Therapeutic approach to respiratory infections in lung transplantation.

PubMed

Clajus, Carolina; Blasi, Francesco; Welte, Tobias; Greer, Mark; Fuehner, Thomas; Mantero, Marco

2015-06-01

Lung transplant recipients (LTRs) are at life-long risk for infections and disseminated diseases owing to their immunocompromised state. Besides organ failure and sepsis, infection can trigger acute and chronic graft rejection which increases mortality. Medical prophylaxis and treatment are based on comprehensive diagnostic work-up including previous history of infection and airway colonisation to reduce long-term complications and mortality. Common bacterial pathogens include Pseudomonas and Staphylococcus, whilst Aspergillus and Cytomegalovirus (CMV) are respectively the commonest fungal and viral pathogens. Clinical symptoms can be various in lung transplant recipients presenting an asymptomatic to severe progress. Regular control of infection parameters, daily lung function testing and lifelong follow-up in a specialist transplant centre are mandatory for early detection of bacterial, viral and fungal infections. After transplantation each patient receives intensive training with rules of conduct concerning preventive behaviour and to recognize early signs of post transplant complications. Early detection of infection and complications are important goals to reduce major complications after lung transplantation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Influence of early neurological complications on clinical outcome following lung transplant.

PubMed

Gamez, Josep; Salvado, Maria; Martinez-de La Ossa, Alejandro; Deu, Maria; Romero, Laura; Roman, Antonio; Sacanell, Judith; Laborda, Cesar; Rochera, Isabel; Nadal, Miriam; Carmona, Francesc; Santamarina, Estevo; Raguer, Nuria; Canela, Merce; Solé, Joan

2017-01-01

Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients' survival. The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

Influence of early neurological complications on clinical outcome following lung transplant

PubMed Central

Salvado, Maria; Martinez-de La Ossa, Alejandro; Deu, Maria; Romero, Laura; Roman, Antonio; Sacanell, Judith; Laborda, Cesar; Rochera, Isabel; Nadal, Miriam; Carmona, Francesc; Santamarina, Estevo; Raguer, Nuria; Canela, Merce; Solé, Joan

2017-01-01

Background Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. Methods We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Results Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients’ survival. Conclusions The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors. PMID:28301586

Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries.

PubMed

Osborne, Nicholas H; Nicholas, Lauren H; Ryan, Andrew M; Thumma, Jyothi R; Dimick, Justin B

2015-02-03

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) provides feedback to hospitals on risk-adjusted outcomes. It is not known if participation in the program improves outcomes and reduces costs relative to nonparticipating hospitals. To evaluate the association of enrollment and participation in the ACS NSQIP with outcomes and Medicare payments compared with control hospitals that did not participate in the program. Quasi-experimental study using national Medicare data (2003-2012) for a total of 1,226,479 patients undergoing general and vascular surgery at 263 hospitals participating in ACS NSQIP and 526 nonparticipating hospitals. A difference-in-differences analytic approach was used to evaluate whether participation in ACS NSQIP was associated with improved outcomes and reduced Medicare payments compared with nonparticipating hospitals that were otherwise similar. Control hospitals were selected using propensity score matching (2 control hospitals for each ACS NSQIP hospital). Thirty-day mortality, serious complications (eg, pneumonia, myocardial infarction, or acute renal failure and a length of stay >75th percentile), reoperation, and readmission within 30 days. Hospital costs were assessed using price-standardized Medicare payments during hospitalization and 30 days after discharge. After accounting for patient factors and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes at 1, 2, or 3 years after (vs before) enrollment in ACS NSQIP. For example, in analyses comparing outcomes at 3 years after (vs before) enrollment, there were no statistically significant differences in risk-adjusted 30-day mortality (4.3% after enrollment vs 4.5% before enrollment; relative risk [RR], 0.96 [95% CI, 0.89 to 1.03]), serious complications (11.1% after enrollment vs 11.0% before enrollment; RR, 0.96 [95% CI, 0.91 to 1.00]), reoperations (0.49% after enrollment vs 0.45% before enrollment; RR, 0.97 [95% CI, 0.77 to 1.16]), or readmissions (13.3% after enrollment vs 12.8% before enrollment; RR, 0.99 [95% CI, 0.96 to 1.03]). There were also no differences at 3 years after (vs before) enrollment in mean total Medicare payments ($40 [95% CI, -$268 to $348]), or payments for the index admission (-$11 [95% CI, -$278 to $257]), hospital readmission ($245 [95% CI, -$231 to $721]), or outliers (-$86 [95% CI, -$1666 to $1495]). With time, hospitals had progressively better surgical outcomes but enrollment in a national quality reporting program was not associated with the improved outcomes or lower Medicare payments among surgical patients. Feedback on outcomes alone may not be sufficient to improve surgical outcomes.

Advantages and disadvantages of endoscopically assisted front-lift.

PubMed

Dusková, M; Padĕra, J; Kristen, M

2002-01-01

Reduced surgical risk, a diminution of visible scars, rapid recovery, long-termed results and reduced costs are at present the most important demands on development in aesthetic plastic surgery. Endoscopically assisted front-lift meets perfectly the need of reduced invasiveness. It is technically simple and associated with a minimum of complications. It brings minimal scars beyond the hairline with a favourable effect after eliminating the drop of the brows, and wrinkles on the forehead. The duration of the effect in the aging face depends, however, similarly as other methods, on the characteristics of the skin, changes in other parts and the individual disposition. A marked disadvantage is the high initial, cost of special equipment. Their recovery ensues from the reduced time of surgery, reduced consumption of material, lower number of complications and more rapid return to normal life.

Rosette-Disrupting Effect of an Anti-Plasmodial Compound for the Potential Treatment of Plasmodium falciparum Malaria Complications

PubMed Central

Ch’ng, Jun-Hong; Moll, Kirsten; Quintana, Maria del Pilar; Chan, Sherwin Chun Leung; Masters, Ellen; Moles, Ernest; Liu, Jianping; Eriksson, Anders B.; Wahlgren, Mats

2016-01-01

The spread of artemisinin-resistant parasites could lead to higher incidence of patients with malaria complications. However, there are no current treatments that directly dislodge sequestered parasites from the microvasculature. We show that four common antiplasmodial drugs do not disperse rosettes (erythrocyte clusters formed by malaria parasites) and therefore develop a cell-based high-throughput assay to identify potential rosette-disrupting compounds. A pilot screen of 2693 compounds identified Malaria Box compound MMV006764 as a potential candidate. Although it reduced rosetting by a modest 20%, MMV006764 was validated to be similarly effective against both blood group O and A rosettes of three laboratory parasite lines. Coupled with its antiplasmodial activity and drug-likeness, MMV006764 represents the first small-molecule compound that disrupts rosetting and could potentially be used in a resource-limited setting to treat patients deteriorating rapidly from malaria complications. Such dual-action drugs that simultaneously restore microcirculation and reduce parasite load could significantly reduce malaria morbidity and mortality. PMID:27403804

A comparison of two methods of infiltration in breast reduction surgery.

PubMed

Armour, A D; Rotenberg, B W; Brown, M H

2001-08-01

The superwet technique has been shown in previous studies to dramatically reduce blood loss in breast reduction surgery, compared with standard infiltration. A retrospective chart review of 303 consecutive patients undergoing bilateral breast reduction surgery was undertaken to demonstrate additional differences in complication rate, operative time, or sponge use in the operating room. In this series, 132 consecutive patients received standard infiltration along incision lines (25 cc per breast of 1:100,000 epinephrine), and 171 patients received superwet infiltration with 240 cc per breast of 1:1,000,000 epinephrine. The average operative time was significantly reduced in the superwet group, from 78.5 minutes to 70.7 minutes (p < 0.01 level). The average number of sponges used intraoperatively was also decreased significantly (p < 0.01), from 26 to 20 sponges. Complication rates were equally low in both groups, demonstrating the safety of the superwet technique. In addition to limiting blood loss, the superwet infiltration effectively reduces operative time and sponge use without increasing complications in breast reduction surgery.

Risk factors for 30-day postoperative complications and mortality after below-knee amputation: a study of 2,911 patients from the national surgical quality improvement program.

PubMed

Belmont, Philip J; Davey, Shaunette; Orr, Justin D; Ochoa, Leah M; Bader, Julia O; Schoenfeld, Andrew J

2011-09-01

This investigation sought to evaluate risk factors for morbidity and mortality from a large series of below-knee amputees prospectively entered in a national database. All patients undergoing below-knee amputations in the years 2005-2008 were identified in the database of the National Surgical Quality Improvement Program (NSQIP). Demographic data, medical comorbidities, and medical history were obtained. Mortality and postoperative complications within 30 days of the below-knee amputation were also documented. Chi-square test, univariate, and multivariate logistic regression analyses were used to assess the effect of specific risk factors on mortality, as well as the likelihood of developing major, minor, or any complications developing. Below-knee amputations were performed in 2,911 patients registered in the NSQIP database between 2005 and 2008. The average age of patients was 65.8 years old and 64.3% were male. There was a 7.0% 30-day mortality rate and 1,627 complications occurred in 1,013 patients (34.4%). Multivariate logistic regression analysis identified renal insufficiency, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age as independent predictors of mortality. The most common major complications were return to the operating room (15.6%), wound infection (9.3%), and postoperative sepsis (9.3%). History of sepsis, alcohol use, steroid use, cardiac issues, renal insufficiency, and contaminated/infected wounds were independent predictors of one or more complications developing. Renal disease, cardiac issues, history of sepsis, steroid use, COPD, and increased patient age were identified as predictors of mortality after below-knee amputation. Renal disease, cardiac issues, history of sepsis, steroid use, contaminated/infected wounds, and alcohol use were also found to be predictors of postoperative complications. Published by Elsevier Inc.

Coma and Stroke Following Surgical Treatment of Unruptured Intracranial Aneurysm: An American College of Surgeons National Surgical Quality Improvement Program Study.

PubMed

McCutcheon, Brandon A; Kerezoudis, Panagiotis; Porter, Amanda L; Rinaldo, Lorenzo; Murphy, Meghan; Maloney, Patrick; Shepherd, Daniel; Hirshman, Brian R; Carter, Bob S; Lanzino, Giuseppe; Bydon, Mohamad; Meyer, Fredric

2016-07-01

A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. The American College of Surgeons National Surgical Quality Improvement Program data set between 2007 and 2013 was used for this retrospective cohort analysis. Demographic, comorbidity, and operative characteristics associated with the development of a major neurologic complication (i.e., coma or stroke) were elucidated using a backward selection stepwise logistic regression analysis. This model was subsequently used to fit a predictive score for major neurologic complications. Inclusion criteria were met by 662 patients. Of these patients, 57 (8.61%) developed a major neurologic complication (i.e., coma or stroke) within the 30-day postoperative period. On multivariable analysis, operative time (log odds 0.004 per minute; 95% confidence interval [CI], 0.002-0.007), age (log odds 0.05 per year; 95% CI, 0.02-0.08), history of chronic obstructive pulmonary disease (log odds 1.26; 95% CI, 0.43-2.08), and diabetes (log odds 1.15; 95% CI, 0.38-1.91) were associated with an increased odds of major neurologic complications. When patients were categorized according to quartile of a predictive score generated from the multivariable analysis, rates of major neurologic complications were 1.8%, 4.3%, 6.7%, and 21.2%. Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates. Copyright © 2016 Elsevier Inc. All rights reserved.

Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

PubMed Central

Alhusen, Jeanne L.; Bullock, Linda; Bhandari, Shreya; Ghazarian, Sharon; Udo, Ifeyinwa E.; Campbell, Jacquelyn

2013-01-01

OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. PMID:24187115

Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.

PubMed

White, David R; Sonnenburg, Robert E; Ewend, Matthew G; Senior, Brent A

2004-11-01

Transsphenoidal hypophysectomy is becoming progressively less invasive. Recent endoscopic techniques avoid nasal or intraoral incisions, use of nasal speculums, and nasal packing. Several case series of endoscopic endonasal pituitary surgery have been reported, but relatively little data exists comparing complication rates to more traditional approaches. We compare the complications of our first 50 cases of endoscopic, minimally invasive pituitary surgery (MIPS) to our last 50 sublabial transseptal (SLTS) procedures. Retrospective case control study. Fifty consecutive MIPS procedures and 50 consecutive SLTS procedures were reviewed retrospectively. Complication rates were analyzed and compared. Total complications per patient (P = .005), postoperative epistaxis (P = .031), lip anesthesia (P = .013), and deviated septum (P = .028) occurred more often in the SLTS group. No significant difference was seen in cerebrospinal fluid leak, meningitis, ophthalmoplegia, visual acuity loss, diabetes insipidus, intracranial hemorrhage, or death. In the MIPS group, length of stay (P < .001), use of lumbar drainage (P = .007), and nasal packing (P < .001) were also significantly reduced. Endoscopic endonasal pituitary surgery provides improved complication rates when compared with SLTS approaches. In addition, we note advantages of the MIPS approach, including reduced length of hospital stay and decreased use of lumbar drainage and nasal packing.

[Complications associated with the use of polypropylene mesh in women under colposacropexy].

PubMed

Aguilera-Maldonado, Lizzete Verónica; Jiménez-Vieyra, Carlos Ramón; Solís-Moreno, Tania Kristal

2015-10-01

There have been numerous surgical procedures and modi fied in the hope of obtaining a lasting cure for pelvic organ prolapse These surgeries were performed using the traditionally native tissues of the patient. In an effort to reduce morbidity, improve surgical outcomes and reduce the complexity of these operations, we used a growing number of synthetic mesh repairs and biomaterials used tissue from cadaver or animal. To evaluate the frequency of complications associated with the use of polypropylene mesh in women undergoing colposacropexy. Retrospective, observational and descriptive study conducted at the Hospitalde Ginecología y Obstetricia 3 IMSS (Mexico) between 1 January 2006 and 15 February 2013. The main risk factors associated with pelvic organ prolapse were considered, comorbidity and complications directly linked to the procedure. With respect to the related complications colposacropexy procedure using polypropylene mesh were documented in 20 of 67 patients which corresponded to 30%. A number of complications have been associated with the use of meshes between these include: extrusion, erosion, pelvic pain, dyspareunia, bladder or bowel condition, but one aspect is poorly evaluated sexual dysfunction without to definitely plays an important role in the field bio-psychosocial.

Assessing the Risk of Occult Cancer and 30-day Morbidity in Women Undergoing Risk-reducing Surgery: A Prospective Experience.

PubMed

Bogani, Giorgio; Tagliabue, Elena; Signorelli, Mauro; Chiappa, Valentina; Carcangiu, Maria Luisa; Paolini, Biagio; Casarin, Jvan; Scaffa, Cono; Gennaro, Massimiliano; Martinelli, Fabio; Borghi, Chiara; Ditto, Antonino; Lorusso, Domenica; Raspagliesi, Francesco

To investigate the incidence and predictive factors of 30-day surgery-related morbidity and occult precancerous and cancerous conditions for women undergoing risk-reducing surgery. A prospective study (Canadian Task Force classification II-1). A gynecologic oncology referral center. Breast-related cancer antigen (BRCA) mutation carriers and BRCAX patients (those with a significant family history of breast and ovarian cancer). Minimally invasive risk-reduction surgery. Overall, 85 women underwent risk-reducing surgery: 30 (35%) and 55 (65%) had hysterectomy plus bilateral salpingo-oophorectomy (BSO) and BSO alone, respectively. Overall, in 6 (7%) patients, the final pathology revealed unexpected cancer: 3 early-stage ovarian/fallopian tube cancers, 2 advanced-stage ovarian cancers (stage IIIA and IIIB), and 1 serous endometrial carcinoma. Additionally, 3 (3.6%) patients had incidental finding of serous tubal intraepithelial carcinoma. Four (4.7%) postoperative complications within 30 days from surgery were registered, including fever (n = 3) and postoperative ileus (n = 1); no severe (grade 3 or more) complications were observed. All complications were managed conservatively. The presence of occult cancer was the only factor predicting the development of postoperative complications (p = .02). Minimally invasive risk-reducing surgery is a safe and effective strategy to manage BRCA mutation carriers. Patients should benefit from an appropriate counseling about the high prevalence of undiagnosed cancers observed at the time of surgery. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

[Systemic complications of subarachnoid hemorrhage from spontaneous rupture of a cerebral aneurysm].

PubMed

Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

2010-12-01

Systemic complications secondary to subarachnoid hemorrhage from an aneurysm are common (40%) and the mortality attributable to them (23%) is comparable to mortality from the primary lesion, rebleeding, or vasospasm. Although nonneurologic medical complications are avoidable, they worsen the prognosis, lengthen the hospital stay, and generate additional costs. The prevention, early detection, and appropriate treatment of systemic complications will be essential for managing the individual patient's case. Treatment should cover major symptoms (headache, nausea, and dizziness) and ambient noise should be reduced, all with the aim of achieving excellence and improving the patient's perception of quality of care.

Developing Metrics in Systems Integration (ISS Program COTS Integration Model)

NASA Technical Reports Server (NTRS)

Lueders, Kathryn

2007-01-01

This viewgraph presentation reviews some of the complications in developing metrics for systems integration. Specifically it reviews a case study of how two programs within NASA try to develop and measure performance while meeting the encompassing organizational goals.

Health and economic consequences of septic induced abortion.

PubMed

Konje, J C; Obisesan, K A; Ladipo, O A

1992-03-01

Over a period of 7 years, 230 cases of illegally induced abortions complicated by sepsis were treated at the University College Hospital, Ibadan, Nigeria. The number of terminations complicated by sepsis doubled from 25.4 (between 1981 and 1985) to 51.0 (between 1986 and 1987) cases per year. Peritonitis was the commonest associated complication while maternal mortality was 8.3%. The average cost of treatment was US$223.11, while the average monthly earnings was US$45.00. Legalization of abortion would have resulted in a saving of US$50,022.28. Provision of legal abortion would reduce the incidence of sepsis after termination while reproductive health education and information dissemination and provision of easily accessible family planning services would greatly reduce the number of unwanted pregnancies.

Effectiveness of a home-based missing incident prevention program for community-dwelling elderly patients with dementia.

PubMed

Lau, Wing Man; Chan, Tak Yeung; Szeto, Sze Lok

2018-05-03

ABSTRACTBackground:Getting lost is a recognized complication in patients with dementia. Preventive measures are lacking. This study aims to investigate the effectiveness of a home-based missing incident prevention program (HMIPP) in reducing missing incidents, time of searching, and caregivers' stress. The design was a pre- and post-intervention study. Patients were recruited from a hospital-based Geriatric Memory Clinic. Inclusion criteria were as follows: aged 60 years or above, established dementia, and Modified Functional Ambulation Categories score VI or VII. An occupational therapist performed the interventions at the patients's home. These included dementia education, prescription of assistive devices, on-site skills training, environmental modifications, community service referrals, and redesigning of daily life routine tasks. The number of missing incidents and caregivers' stress at three months and one year were compared with baseline data from one year before and the secondary outcome was time for searching of the last incident. A total of 54 patients were recruited. The mean age was 78.8 years and 54% were females. Majority of patients had moderate dementia. The mean number of missing incidents per year was significantly reduced at three months and one year (0.70, 0.22, and 0.14 at 0, 3, and 12 months, respectively; p < 0.001). The time for searching of last missing episode was reduced significantly (6.25, 0.13, and 0.35 hours, respectively; p < 0.001). The caregivers' stress also decreased significantly at three months and one year. The HMIPP was effective in reducing the number of missing incidents, searching time, and caregivers' stress at three months and one year.

Programming of maternal and offspring disease: impact of growth restriction, fetal sex and transmission across generations

PubMed Central

Cheong, Jean N.; Moritz, Karen M.; Cuffe, James S. M.

2016-01-01

Abstract Babies born small are at an increased risk of developing myriad adult diseases. While growth restriction increases disease risk in all individuals, often a second hit is required to unmask ‘programmed’ impairments in physiology. Programmed disease outcomes are demonstrated more commonly in male offspring compared with females, with these sex‐specific outcomes partly attributed to different placenta‐regulated growth strategies of the male and female fetus. Pregnancy is known to be a major risk factor for unmasking a number of conditions and can be considered a ‘second hit’ for women who were born small. As such, female offspring often develop impairments of physiology for the first time during pregnancy that present as pregnancy complications. Numerous maternal stressors can further increase the risk of developing a maternal complication during pregnancy. Importantly, these maternal complications can have long‐term consequences for both the mother after pregnancy and the developing fetus. Conditions such as preeclampsia, gestational diabetes and hypertension as well as thyroid, liver and kidney diseases are all conditions that can complicate pregnancy and have long‐term consequences for maternal and offspring health. Babies born to mothers who develop these conditions are often at a greater risk of developing disease in adulthood. This has implications as a mechanism for transmission of disease across generations. In this review, we discuss the evidence surrounding long‐term intergenerational implications of being born small and/or experiencing stress during pregnancy on programming outcomes. PMID:26970222

Open versus robot-assisted radical cystectomy: 30-day perioperative comparison and predictors for cost-to-patient, complication, and readmission.

PubMed

Flamiatos, Jason F; Chen, Yiyi; Lambert, William E; Martinez Acevedo, Ann; Becker, Thomas M; Bash, Jasper C; Amling, Christopher L

2018-06-08

The objectives of this study are to evaluate if robotic cystectomy demonstrates reduced complications, readmissions, and cost-to-patient compared to open approach 30-day post-operatively, and to identify predictors of complication, readmission, and cost-to-patient. This retrospective cohort study analyzed 249 patients who underwent open (n = 149) or robotic (n = 100) cystectomy from 2009 to 2015 at our institution. Outcomes included 30-day post-operative complication, readmission, and cost-to-patient charges. We used modified Clavien-Dindo/MSKCC classifications. Multivariable logistic and linear regression models were used to evaluate associations to outcomes and to build predictive models. Patient, clinical, and surgical characteristics differed by open and robotic groups, respectively, only for estimated blood loss (median: 600 versus 150 cc, p < 0.01), operative time (mean: 6.19 versus 6.85 h, p < 0.01), and length of stay (median: 7 versus 5 days, p < 0.01). Complication: frequency of patients with at least one 30-day complication was 85% compared to 66% (p < 0.01). Minor gastrointestinal and bleeding complications were increased in the open group (50% versus 41%, p = 0.01; 52% versus 11%, p < 0.01, respectively). Fifty percent of patients required blood transfusion in open compared to 11% (p < 0.01). Patients in the open group experienced more major complications (19% versus 10%, p = 0.04). Robotic approach was a predictor for fewer complications (OR 0.44, 95% CI 0.20-0.99, p = 0.049). Readmission: no significant difference in number of patients readmitted was found. Cost-to-patient: Robotic approach predicted an 18% reduction in total cost-to-patient compared to open approach (p < 0.01). Robotic cystectomy demonstrated reduced total cost-to-patient when taking into account all 30-day post-operative services with fewer complications compared to open cystectomy.

Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A1chieve study.

PubMed

Litwak, Leon; Goh, Su-Yen; Hussein, Zanariah; Malek, Rachid; Prusty, Vinay; Khamseh, Mohammad E

2013-10-24

Current International Diabetes Federation guidelines recommend a target HbA1c <7.0%, but many people with diabetes worldwide find this difficult to achieve, increasing their risk of developing complications. This publication examines the prevalence of diabetes complications and its association with baseline characteristics in people with type 2 diabetes who participated in the A1chieve study. A1chieve was a 24-week, multinational, open-label, observational study of 66,726 people with type 2 diabetes who had begun using biphasic insulin aspart 30, insulin aspart, or insulin detemir in routine clinical care. Participants were enrolled from 28 countries across four continents (Asia, Africa, Europe and South America). Baseline measurements of disease characteristics included: glycated haemoglobin (HbA1c), fasting (FPG) and post-prandial plasma glucose (PPG), high- and low-density lipoprotein cholesterol (H- or LDL-C), systolic blood pressure (SBP), and body mass index (BMI). Data on complications and use of vascular disease preventative drugs were collected. Complication rates were high (27.2% had macrovascular complications and 53.5% had microvascular complications), particularly in Russia, and use of vascular disease preventative drugs was lower than expected. Age, BMI, diabetes duration, LDL-C, and SBP were positively associated, and HDL-C negatively associated, with macro- and microvascular complications (all p < 0.05). HbA1c and FPG were negatively associated with macrovascular complications (both p < 0.05), which may be linked to the cross-sectional study design. These results suggest a worldwide failure to achieve glycaemic targets. Better diabetes management with earlier initiation and optimisation of insulin regimens (e.g., with insulin analogues in the A1chieve population) may reduce the prevalence of vascular complications, improve the lives of people with diabetes and reduce the burden on healthcare systems.

Implementation and evaluation of a clinical pathway for TRAM breast reconstruction.

PubMed

Hwang, T G; Wilkins, E G; Lowery, J C; Gentile, J

2000-02-01

Among strategies recently proposed to reduce practice variation, promote quality, and control costs in health care delivery, the concept of the clinical pathway has received considerable attention. Because transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a common and often costly intervention, this institution sought to evaluate cost and quality outcomes of a clinical pathways program for this procedure. The TRAM reconstruction clinical pathway was implemented in April of 1996 to standardize postoperative care in this patient population. Outcomes of consecutive pathway cases for the first 14 months of the program were assessed in a retrospective cohort design, by using all nonpathway TRAM cases from the 18 months immediately before pathway implementation as controls. Outcomes assessed included length of hospital stay, postoperative complications, total postoperative charges, and total postoperative costs in relative value units. Data on these dependent variables were collected from hospital charts and billing records. The effects of pathway implementation on the outcomes of interest were analyzed by using analysis of covariance to control for potential confounding by other independent variables, including surgical site (unilateral versus bilateral reconstructions), technique (pedicle versus free TRAMs), timing (immediate versus delayed reconstructions), and patient age. Finally, a comparison of variances in the outcomes of interest between the two groups was analyzed by using an Ftest. For all statistical tests, p values of < or = 0.05 were considered significant. Twenty-nine patients were treated in the TRAM pathway group, whereas the control population included 40 nonpathway patients. After implementation of the TRAM pathway, length of stay decreased from 6.0 to 5.2 days; total postoperative charges were reduced from $8587 to $7744; and total postoperative relative value unit utilization declined from 1686 to 1104. Analysis of covariance showed that the decreases in length of hospital stay and relative value units in the TRAM pathway were statistically significant (p = 0.05 and p = 0.007, respectively). By contrast, no significant increase in complications was observed after pathway implementation. Variability in the TRAM pathway group, as measured by SD, decreased significantly for both length of hospital stay (p = 0.039) and relative value units (p = 0.023). Implementation of the TRAM reconstruction clinical pathway resulted in significant declines in length of hospital stay and total costs. These decreases in resource utilization had no significant effect on postoperative complication rates. Although additional research is needed to further assess the impact of clinical pathways, this approach offers considerable promise for improving the cost-effectiveness of health care.

Preoperative patient education: evaluating postoperative patient outcomes.

PubMed

Meeker, B J

1994-04-01

Preoperative teaching is an important part of patient care and can prevent complications, as well as promote patient fulfillment during hospitalization. A study was conducted at Alton Ochsner Medical Foundation in New Orleans, LA, in 1989, to determine the impact of a preoperative teaching program on the incidence of postoperative atelectasis and patient satisfaction. Results showed no significant difference of postoperative complications and patient gratification after participating in a structured preoperative teaching program. As part of this study, it was identified that a patient evaluation tool for a preoperative teaching class needed to be developed. The phases of this process are explained in the following article.

Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial.

PubMed

van Son, Jenny; Nyklíček, Ivan; Pop, Victor J M; Pouwer, François

2011-02-24

Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored. The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analyzed with repeated measures analysis of covariance.The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee. It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, self-care, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012. Dutch Trial Register NTR2145.

Developing Inventory and Monitoring Programs Based on Multiple Objectives

Treesearch

Daniel L. Schmoldt; David L. Peterson; David G. Silsbee

1995-01-01

Resource inventory and monitoring (I&M) programs in national parks combine multiple objectives in order to create a plan of action over a finite time horizon. Because all program activities are constrained by time and money, it is critical to plan I&M activities that make the best use of available agency resources. However, multiple objectives complicate a...

Resource values in analyzing fire management programs for economic efficiency

Treesearch

Irene A. Althaus; Thomas J. Mills

1982-01-01

In analyzing fire management programs for their economic efficiency, it is necessary to assign monetary values to the changes in resource outputs caused by, fire. The derivation of resource values is complicated by imperfect or nonexistent commercial market structures. The valuation concept recommended for fire program analyses is willingness-to-pay because it permits...

An observational study of complications in chickenpox with special reference to unusual complications in an apex infectious disease hospital, Kolkata, India.

PubMed

Kole, A K; Roy, R; Kole, D C

2013-01-01

Chickenpox can cause serious complications and even death in persons without any risk factors. To observe the different complications with special reference to unusual complications of chickenpox and their outcomes. The present study was a prospective observational study where 300 patients suffering from chickenpox were evaluated with special reference to unusual complications and outcomes. The usual complications of chickenpox commonly observed were acute hepatitis in 30 (10%) and cerebellar ataxia in 22 patients (7.3%), whereas common unusual complications were acute pancreatitis in 45 (15%), hemorrhagic rash in 10 (3.3%), Guillain-Barrι syndrome in 4 (1.3%), disseminated intravascular coagulation in 4 (1.3%), necrotizing fasciitis in 4 (1.3%), and acute renal failure in 3 patients (1%). It had been observed that most of these unusual complications occurred in patients without any risk factor. A total of 18 patients (6%) died in this study and of them 12 patients (4%) died due to unusual complications. Compulsory childhood varicella vaccination including vaccination of risk groups and susceptible individuals are all essential to reduce the incidence of chickenpox, associated complications, and subsequent death.

Risk reducing mastectomy, breast reconstruction and patient satisfaction in Norwegian BRCA1/2 mutation carriers.

PubMed

Hagen, Anne Irene; Mæhle, Lovise; Vedå, Nina; Vetti, Hildegunn Høberg; Stormorken, Astrid; Ludvigsen, Trond; Guntvedt, Bente; Isern, Anne Elisabeth; Schlichting, Ellen; Kleppe, Geir; Bofin, Anna; Gullestad, Hans Petter; Møller, Pål

2014-02-01

The aim of this study was to evaluate the outcome of risk-reducing mastectomy in BRCA1/2 mutation carriers with and without breast cancer. Uptake, methods of operation and reconstruction, complications, patient satisfaction and histopathological findings were registered at all five departments of genetics in Norway. Data from 267 affected and unaffected BRCA1/2 mutation carriers were analyzed, including a study-specific questionnaire returned by 178 mutation carriers. There was a steady increase in the uptake of risk-reducing mastectomies during the study period. Complications were observed in 106/266 (39.7%) women. Patient satisfaction was high. The majority of women expressed great relief after risk-reducing mastectomy and would have chosen the same option again. Copyright © 2013 Elsevier Ltd. All rights reserved.

Ethical, legal and societal considerations on Zika virus epidemics complications in scaling-up prevention and control strategies.

PubMed

Tambo, Ernest; Madjou, Ghislaine; Khayeka-Wandabwa, Christopher; Olalubi, Oluwasogo A; Chengho, Chryseis F; Khater, Emad I M

2017-08-25

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus (ZIKV) complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized.

Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study.

PubMed

2015-11-01

Effective prevention is needed to combat the worldwide epidemic of type 2 diabetes. We investigated the long-term extent of beneficial effects of lifestyle intervention and metformin on diabetes prevention, originally shown during the 3-year Diabetes Prevention Program (DPP), and assessed whether these interventions reduced diabetes-associated microvascular complications. The DPP (1996-2001) was a randomised trial comparing an intensive lifestyle intervention or masked metformin with placebo in a cohort selected to be at very high risk of developing diabetes. All participants were offered lifestyle training at the end of the DPP. 2776 (88%) of the surviving DPP cohort were followed up in the DPP Outcomes Study (DPPOS, Sept 1, 2002, to Jan 2, 2014) and analysed by intention to treat on the basis of their original DPP assignment. During DPPOS, the original lifestyle intervention group was offered lifestyle reinforcement semi-annually and the metformin group received unmasked metformin. The primary outcomes were the development of diabetes and the prevalence of microvascular disease. For the assessment of microvascular disease, we used an aggregate microvascular outcome, composed of nephropathy, retinopathy, and neuropathy. During a mean follow-up of 15 years, diabetes incidence was reduced by 27% in the lifestyle intervention group (hazard ratio 0·73, 95% CI 0·65-0·83; p<0·0001) and by 18% in the metformin group (0·82, 0·72-0·93; p=0·001), compared with the placebo group, with declining between-group differences over time. At year 15, the cumulative incidences of diabetes were 55% in the lifestyle group, 56% in the metformin group, and 62% in the placebo group. The prevalences at the end of the study of the aggregate microvascular outcome were not significantly different between the treatment groups in the total cohort (placebo 12·4%, 95% CI 11·1-13·8; metformin 13·0%, 11·7-14·5; lifestyle intervention 11·3%, 10·1-12·7). However, in women (n=1887) the lifestyle intervention was associated with a lower prevalence (8·7%, 95% CI 7·4-10·2) than in the placebo (11·0%, 9·6-12·6) and metformin (11·2%, 9·7-12·9) groups, with reductions in the lifestyle intervention group of 21% (p=0·03) compared with placebo and 22% (p=0·02) compared with metformin. Compared with participants who developed diabetes, those who did not develop diabetes had a 28% lower prevalence of microvascular complications (relative risk 0·72, 95% CI 0·63-0·83; p<0·0001). Lifestyle intervention or metformin significantly reduced diabetes development over 15 years. There were no overall differences in the aggregate microvascular outcome between treatment groups; however, those who did not develop diabetes had a lower prevalence of microvascular complications than those who did develop diabetes. This result supports the importance of diabetes prevention. National Institute of Diabetes and Digestive and Kidney Diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preventing adolescent pregnancy and associated risks.

PubMed Central

Miller, R.

1995-01-01

Adolescent pregnancy is a complex and frustrating problem that exacts a large social and personal cost. This year approximately 40,000 Canadian teenagers will become pregnant. With proper prevention, this number could be reduced. Pregnant teenagers seem to be at increased risk for some obstetric complications and their children for some neonatal complications. Family physicians who see patients over the course of a lifetime are in a good position to prevent adolescent pregnancy and the associated complications. PMID:8520241

Modelling effective diagnosis of risk complications in gestational diabetes mellitus: an e-diabetic expert system for pregnant women

NASA Astrophysics Data System (ADS)

Sreedevi, E.; Vijaya Lakshmi, K.; Chaitanya Krishna, E.; Padmavathamma, M.

2012-04-01

Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. This paper deals with study and development of algorithm to develop an initial stage expert system to provide diagnosis to the pregnant women who are suffering from Gestational Diabetes Mellitus (GDM) by means of Oral Glucose Tolerance Test (OGTT).

De-implementation strategy to Reduce the Inappropriate use of urinary and intravenous CATheters: study protocol for the RICAT-study.

PubMed

Laan, Bart J; Spijkerman, Ingrid J B; Godfried, Mieke H; Pasmooij, Berend C; Maaskant, Jolanda M; Borgert, Marjon J; Opmeer, Brent C; Vos, Margreet C; Geerlings, Suzanne E

2017-01-10

Urinary and (peripheral and central) intravenous catheters are widely used in hospitalized patients. However, up to 56% of the catheters do not have an appropriate indication and some serious complications with the use of these catheters can occur. The main objective of our quality improvement project is to reduce the use of catheters without an appropriate indication by 25-50%, and to evaluate the affecting factors of our de-implementation strategy. In a multicenter, prospective interrupted time series analysis, several interventions to avoid inappropriate use of catheters will be conducted in seven hospitals in the Netherlands. Firstly, we will define a list of appropriate indications for urinary and (peripheral and central) intravenous catheters, which will restrict the use of catheters and urge catheter removal when the indication is no longer appropriate. Secondly, after the baseline measurements, the intervention will take place, which consists of a kick-off meeting, including a competitive feedback report of the baseline measurements, and education of healthcare workers and patients. Additional strategies based on the baseline data and local conditions are optional. The primary endpoint is the percentage of catheters with an inappropriate indication on the day of data collection before and after the de-implementation strategy. Secondary endpoints are catheter-related infections or other complications, catheter re-insertion rate, length of hospital (and ICU) stay and mortality. In addition, the cost-effectiveness of the de-implementation strategy will be calculated. This study aims to reduce the use of urinary and intravenous catheters with an inappropriate indication, and as a result reduce the catheter-related complications. If (cost-) effective it provides a tool for a nationwide approach to reduce catheter-related infections and other complications. Dutch trial registry: NTR6015 . Registered 9 August 2016.

A Novel Skin and Fascia Opening for Subfascial Inserting of Intrathecal Baclofen Pump.

PubMed

Fiaschi, Pietro; Cama, Armando; Piatelli, Gianluca; Moretti, Paolo; Pavanello, Marco

2018-02-01

The aim of this article is to introduce a new skin and fascia opening for intrathecal baclofen pump implantation in the abdomen, with the purpose of reducing complications related to wound breakdown. We introduce a novel way of cutaneous and fascial opening that leads two opposed "L shaped" incisions. This method entails numerous advantages. The first advantage is avoiding the direct alignment of overlapped sutures, which creates a locus minoris resistentiae that can weaken and break under the push of the pump. Another advantage consists of an increased obstruction against deep extension of infective processes from cutaneous origin. The wide opening of the subfascial pocket permits the implantation of any type of pump available, and it reduces complexities in reopening the pouch for pump replacement. It also permits the fastening of all anchoring systems usually present in pumps. Another advantage is the improved possibility of careful muscle cauterization thanks to the wide fascia opening, with reduced risk of postsurgical hematoma. Our results showed a reduction of wound complications with this method. This method could contribute to reducing the rate of wound complications and patient discomfort. Copyright © 2017 Elsevier Inc. All rights reserved.

Blink Prosthesis For Facial Paralysis Patients

DTIC Science & Technology

2016-10-01

predisposes patients to corneal exposure and dry eye complications that are difficult to effectively treat. The proposed innovation will provide a...aesthetic and functional use of the paralyzed eyelid by preventing painful dry eye complications and profound facial disfiguration. The goal of this program... eye blink in patients with unilateral facial nerve paralysis. The system will electrically stimulate the paretic eyelid when EMG electrodes detect

Relationship of respiratory care bundle with incentive spirometry to reduced pulmonary complications in a medical general practice unit.

PubMed

Lamar, Joanne

2012-01-01

To address an increase in patient transfers to the intensive care unit because of respiratory distress, a respiratory care bundle utilizing incentive spirometry was developed for a medical general practice unit. This resulted in decreased respiratory complications over 12 months.

Medical abortion and manual vacuum aspiration for legal abortion protect women's health and reduce costs to the health system: findings from Colombia.

PubMed

Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E

2015-02-01

The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system. Copyright © 2015 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Reduction of Complications of Local Anaesthesia in Dental Healthcare Setups by Application of the Six Sigma Methodology: A Statistical Quality Improvement Technique

PubMed Central

Khatoon, Farheen

2015-01-01

Background Health care faces challenges due to complications, inefficiencies and other concerns that threaten the safety of patients. Aim The purpose of his study was to identify causes of complications encountered after administration of local anaesthesia for dental and oral surgical procedures and to reduce the incidence of complications by introduction of six sigma methodology. Materials and Methods DMAIC (Define, Measure, Analyse, Improve and Control) process of Six Sigma was taken into consideration to reduce the incidence of complications encountered after administration of local anaesthesia injections for dental and oral surgical procedures using failure mode and effect analysis. Pareto analysis was taken into consideration to analyse the most recurring complications. Paired z-sample test using Minitab Statistical Inference and Fisher’s exact test was used to statistically analyse the obtained data. The p-value <0.05 was considered as significant value. Results Total 54 systemic and 62 local complications occurred during three months of analyse and measure phase. Syncope, failure of anaesthesia, trismus, auto mordeduras and pain at injection site was found to be most recurring complications. Cumulative defective percentage was 7.99 in case of pre-improved data and decreased to 4.58 in the control phase. Estimate for difference was 0.0341228 and 95% lower bound for difference was 0.0193966. p-value was found to be highly significant with p= 0.000. Conclusion The application of six sigma improvement methodology in healthcare tends to deliver consistently better results to the patients as well as hospitals and results in better patient compliance as well as satisfaction. PMID:26816989

Dose-Dependent Effect of Statin Pretreatment on Preventing the Periprocedural Complications of Carotid Artery Stenting.

PubMed

Hong, Jeong-Ho; Sohn, Sung-Il; Kwak, Jaehyuk; Yoo, Joonsang; Chang, Hyuk Won; Kwon, O-Ki; Jung, Cheolkyu; Chung, Inyoung; Bae, Hee-Joon; Lee, Ji Sung; Han, Moon-Ku

2017-07-01

We investigated whether statin pretreatment can dose dependently reduce periprocedural complications in patients undergoing carotid artery stenting because of symptomatic carotid artery stenosis. We enrolled a consecutive series of 397 symptomatic carotid artery stenosis (≥50% stenosis on conventional angiography) treated with carotid artery stenting at 2 tertiary university hospitals over a decade. Definition of periprocedural complications included any stroke, myocardial infarction, and death within 1 month after or during the procedure. Statin pretreatment was divided into 3 categories according to the atorvastatin equivalent dose: none (n=158; 39.8%), standard dose (<40 mg of atorvastatin, n=155; 39.0%), and high dose (≥40 mg; n=84; 21.2%). A multivariable logistic regression analysis with the generalized estimating equation method was used to investigate independent factors in periprocedural complications. The patients' mean age was 68.7 years (81.6% men). The periprocedural complication rates across the 3 categories of statin use were 12.0%, 4.5%, and 1.2%. After adjustment, a change in the atorvastatin dose category was associated with reduction in the odds of periprocedural complications for each change in dose category (standard-dose statin: odds ratio, 0.24; 95% confidence interval, 0.07-0.81; high-dose statin: odds ratio, 0.11; 95% confidence interval, 0.01-0.96; P for trend=0.01). Administration of antiplatelet drugs was also an independent factor in periprocedural complications (OR, 0.18; 95% CI, 0.05-0.69). This study shows that statin pretreatment may reduce the incidence of periprocedural complications dose dependently in patients with symptomatic carotid artery stenting. © 2017 American Heart Association, Inc.

Treatment and outcome with traumatic lesions of the olecranon and prepatellar bursa: a literature review apropos a retrospective analysis including 552 cases.

PubMed

Raas, Christoph; Attal, René; Kaiser, Peter; Popovscaia, Marina; Zegg, Michael

2017-06-01

Traumatic lesions of the olecranon bursa (OB) and prepatellar bursa (PB) are injuries commonly seen in orthopaedic trauma units. These injuries are associated with a high rate of complications. At present, only little is known about the incidence, complication rate, and treatment approaches in patients with acute open bursae. A total of 552 patients who had been treated for acute traumatic lesions of either the olecranon bursa or the prepatellar bursa, or both at our department were retrospective identified in the years between 2009 and 2014. An analysis of the medical history of these patients was carried out to investigate the incidence of bursa injuries, circumstances, concomitant injuries, complication rate, and treatment approaches. In addition, a systematic literature search on PubMed was conducted. The incidence of traumatic lesions of the OB or PB in trauma patients was 0.2% (198/100,000; 62% OB, 38% PB). Bursectomy was performed in 83.7%. Concomitant injuries were present in 41% of the cases, with no significant influence on the complication rate (P = 0.367). The overall complication rate was 19.7%. Revision surgery was necessary in 4.5% of the patients. No significant differences between OB and PB injuries were noted with regard to the complication rate (P = 0.221). There were also no significant differences in the complication rate between patients who received bursectomy and those with conservative treatment (P = 0.364). Regression analyses showed that prophylactic antibiotic administration significantly reduced the risk of infection (P = 0.04). Traumatic lesions of the OB and PB are associated with a high risk of complications. Prophylactic antibiotic therapy can potentially reduce the risk of infection and the need for revision surgery.

Tailoring the operative approach for appendicitis to the patient: a prediction model from national surgical quality improvement program data.

PubMed

Senekjian, Lara; Nirula, Raminder

2013-01-01

Laparoscopic appendectomy (LA) is increasingly being performed in the United States, despite controversy about differences in infectious complication rates compared with open appendectomy (OA). Subpopulations exist in which infectious complication rates, both surgical site and organ space, differ with respect to LA compared with OA. All appendectomies in the National Surgical Quality Improvement Program database were analyzed with respect to surgical site infection (SSI) and organ space infection (OSI). Multivariate logistic regression analysis identified independent predictors of SSI or OSI. Probabilities of SSI or OSI were determined for subpopulations to identify when LA was superior to OA. From 2005 to 2009, there were 61,830 appendectomies performed (77.5% LA), of which 9,998 (16.2%) were complicated (58.7% LA). The risk of SSI was considerably lower for LA in both noncomplicated and complicated appendicitis. Across all ages, body mass index, renal function, and WBCs, LA was associated with a lower probability of SSI. The risk of OSI was considerably greater for LA in both noncomplicated and complicated appendicitis. In complicated appendicitis, OA was associated with a lower probability of OSI in patients with WBC >12 cells × 10(3)/μL. In noncomplicated appendicitis, OA was associated with a lower probability of OSI in patients with a body mass index <37.5 when compared with LA. Subpopulations exist in which OA is superior to LA in terms of OSI, however, SSI is consistently lower in LA patients. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

The business case for the reduction of surgical complications in VA hospitals.

PubMed

Vaughan-Sarrazin, Mary; Bayman, Levent; Rosenthal, Gary; Henderson, William; Hendricks, Ann; Cullen, Joseph J

2011-04-01

Surgical complications contribute substantially to costs. Most important, surgical complications contribute to morbidity and mortality, and some may be preventable. This study estimates costs of specific surgical complications for patients undergoing general surgery in VA hospitals using merged data from the VA Surgical Quality Improvement Program and VA Decision Support System. Costs associated with 19 potentially preventable complications within 6 broader categories were estimated using generalized, linear mixed regression models to control for patient-level determinants of costs (eg, type of operation, demographics, comorbidity, severity) and hospital-level variation in costs. Costs included costs of the index hospitalization and subsequent 30-day readmissions. In 14,639 patients undergoing general surgical procedures from 10/2005 through 9/2006, 20% of patients developed postoperative surgical complications. The presence of any complication significantly increased unadjusted costs nearly 3-fold ($61,083 vs $22,000), with the largest cost differential attributed to respiratory complications. Patients who developed complications had several markers for greater preoperative severity, including increased age and a lesser presurgery functional health status. After controlling for differences in patient severity, costs for patients with any complication were 1.89 times greater compared to costs for patients with no complications (P < .0001). Within major complication categories, adjusted costs were significantly greater for patients with respiratory, cardiac, central nervous system, urinary, wound, or other complications. Surgical complications contribute markedly to costs of inpatient operations. Investment in quality improvement that decreases the incidence of surgical complications could decrease costs. Copyright © 2011 Mosby, Inc. All rights reserved.

Gait rehabilitation for a patient with an osseointegrated prosthesis following transfemoral amputation.

PubMed

Leijendekkers, Ruud A; van Hinte, Gerben; Nijhuis-van der Sanden, Maria Wg; Staal, J Bart

2017-02-01

In patients with a transfemoral amputation socket-related problems are associated with reduced prosthetic use, activity, and quality of life. Furthermore, gait asymmetries are present that may explain secondary complaints. Bone-anchored prostheses (BAPs) may help these patients. Two types of BAP are available, screw and press-fit implants. Rehabilitation following surgery for a press-fit BAP is poorly described. To describe a rehabilitation program designed to minimize compensation strategies and increase activity using a case-report of an active, 70-year-old man with a traumatic transfemoral amputation who had used a socket prosthesis for 52 years and received a press-fit BAP [Endo-Exo Femoral Prosthesis - EEFP]. A 13-week physiotherapy program. Outcomes were assessed before surgery, at the end of rehabilitation, and six-month and one-year follow-ups. After rehabilitation gait had improved, the patient had more arm movement, more pelvic shift, less hip rotation during swing phase on the prosthetic side, and absence of vaulting on the sound side. Isometric hip abductor strength was 15% higher on the sound side and 16% higher on the prosthetic side, and walking distance increased from 200 m to 1500 m. At the six-month follow-up, the patient had lower back complications and reduced hip abductor strength and walking distance. At one-year follow-up, walking distance had recovered to 1000 m and gait pattern had improved again, with yielding and absence of terminal impact on the prosthetic side. The described rehabilitation program may be an effective method of improving gait in patients with an EEFP even after long-term socket usage.

Diabetes benefit management: evolving strategies for payers.

PubMed

Tzeel, Albert L

2011-11-01

Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

School Choice: Private School Choice Programs Are Growing and Can Complicate Providing Certain Federally Funded Services to Eligible Students. Report to Congressional Requesters. GAO-16-712

ERIC Educational Resources Information Center

US Government Accountability Office, 2016

2016-01-01

Voucher and education savings account (ESA) programs fund students' private school education expenses, such as tuition. In school year 2014-15, 22 such school choice programs were operating nationwide, all but one of which was state funded. Under two federal grant programs, one for students with disabilities and one for students from disadvantaged…

Association of postdischarge complications with reoperation and mortality in general surgery.

PubMed

Kazaure, Hadiza S; Roman, Sanziana A; Sosa, Julie A

2012-11-01

To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files. A total of 551,510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting. Postdischarge complications, reoperation, and mortality. Of 551,510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use. The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.

Care and Respect for Elders in Emergencies program: a preliminary report of a volunteer approach to enhance care in the emergency department.

PubMed

Sanon, Martine; Baumlin, Kevin M; Kaplan, Shari Sirkin; Grudzen, Corita R

2014-02-01

Older adults who present to an emergency department (ED) generally have more-complex medical conditions with complicated care needs and are at high risk for preventable adverse outcomes during their ED visit. The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric-focused volunteer program developed to help prevent avoidable complications such as falls, delirium and use of restraints, and functional decline in vulnerable elders in the ED. The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high-risk, older, unaccompanied individuals in the ED. This article describes the development and characteristics of the CARE program, the services provided, the experiences of the elderly patients and their volunteers, and the growth of the program over time. CARE volunteers provide elders with the additional attention needed in an often chaotic, unfamiliar environment by enhancing their care, improving satisfaction, and preventing potential decline. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

TIP hypospadias repair: A pediatric urology indicator operation.

PubMed

Snodgrass, Warren; Bush, Nicol

2016-02-01

We review development and evolution of TIP hypospadias repair, including technical changes made to improve its results. We also discuss general risk factors for hypospadias surgical complications. We describe use of a database with prospective data entry to first identify our most common complications and their frequency, and then to monitor results of technical modifications made to reduce their occurrence. Multiple logistic regression of various factors recorded in the database was done to identify those predicting increased risk for urethroplasty complications. Fistula and glans dehiscence are the two most common complications we encountered after TIP repair. Changes in urethral plate tubularization and barrier layers covering the neourethra resulted in a significant reduction in fistulas after proximal TIP. Changes in glansplasty sutures and use of preoperative testosterone to increase glans size did not reduce likelihood for dehiscence, whereas increasing the extent of glans wings dissection did. Logistic regression analysis confirmed proximal meatal location and reoperation predicted increased complications, but also identified glans width ≤ 14 mm as an independent risk factor for hypospadias urethroplasty complications. Systematic, prospective data collection facilitated identification of complications and their risk factors, and provided a means to assess results of modifications made to address them. Limiting the algorithm used for hypospadias repair increases expertise in those techniques used. Reported low surgical volumes for proximal hypospadias repair suggest subspecialization of these cases be carried out so that designated surgeons can achieve sufficient volume to analyze their results and make improvements. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

North American Pediatric Gastroenterology Fellowship Needs Assessment in Inflammatory Bowel Disease: Trainee and Program Director Perspectives.

PubMed

Dotson, Jennifer L; Falaiye, Tolulope; Bricker, Josh B; Strople, Jennifer; Rosh, Joel

2016-07-01

Pediatric inflammatory bowel disease (IBD) care is complex and rapidly evolving. The Crohn's and Colitis Foundation of America and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition cosponsored a needs assessment survey of pediatric gastroenterology trainees and program directors (PDs) to inform on educational programming. A Web-based, self-completed survey was provided to North American trainees and PDs during the 2013-2014 academic year. Standard descriptive statistics summarized demographics and responses. One hundred sixty-six of 326 (51%) trainees (62% female) and 37 of 74 (50%) PDs responded. Median trainees per program = 5 and median total faculty = 10 (3 IBD experts); 15% of programs did not have a self-identified "IBD expert" faculty member. Sixty-nine percent of trainees were confident/somewhat confident in their IBD inpatient training, whereas 54% were confident/somewhat confident in their outpatient training. Trainees identified activities that would most improve their education, including didactics (55%), interaction with national experts (50%), trainee-centered IBD Web resources (42%), and increased patient exposure (42%). Trainees were most confident in managing inpatient active Crohn's disease/ulcerative colitis, phenotype classification, managing biological therapies, and using clinical disease activity indices. They were least confident in managing J-pouch complications, performing pouchoscopy, managing extraintestinal manifestations, and ostomy-related complications. Eighty-five percent would like an IBD-focused training elective. Most directors (86%) would allow trainees to do electives at other institutions. This IBD needs assessment survey of pediatric gastroenterology trainees and PDs demonstrated a strong resource commitment to IBD training and clinical care. Areas for educational enrichment emerged, including pouch and ostomy complications.

Lung Involvement in Systemic Sclerosis

PubMed Central

Hassoun, Paul M.

2011-01-01

Summary Scleroderma is a multisystem disease characterized by a severe inflammatory process and exuberant fibrosis. Lung involvement is a frequent complication and a leading cause of morbidity and mortality in this syndrome. Two major pulmonary syndromes are associated with scleroderma; a pulmonary vascular disorder evolving over time into relatively isolated pulmonary arterial hypertension (PAH), and interstitial lung disease (ILD). Each syndrome, when present, is a cause of morbidity and significantly reduces survival of scleroderma patients when compared to patients free of lung complication. When pulmonary hypertension and ILD are combined, survival is further reduced. Current therapy appears to have no meaningful effect on either condition and, thus, there is a need for better understanding of underlying pathogenic mechanisms. This review focuses on clinical, diagnostic, and therapeutic features of PAH and ILD as well as other frequent but less debilitating lung complications of scleroderma. PMID:21195581

Are "Human Factors" the Primary Cause of Complications in the Field of Implant Dentistry?

PubMed

Renouard, Franck; Amalberti, René; Renouard, Erell

Complications in medicine and dentistry are usually analyzed from a purely technical point of view. Rarely is the role of human behavior or judgment considered as a reason for adverse outcomes. When the role of human factors is considered, these are usually described in general terms rather than specifically identifying the factors responsible for an adverse event. The impact of cognitive and behavioral factors in the explanation of adverse events has been studied in other high-stakes areas such as aviation and nuclear power. Specific protocols have been developed to reduce rates of human error, and, where human error is unavoidable, to lessen its impact. This approach has dramatically reduced the incidence of accidents in these fields. This article aims to review how a similar approach may prove valuable in the reduction of complications in implant dentistry.

Readmissions After Colectomy: The Upstate New York Surgical Quality Initiative Experience.

PubMed

Hensley, Bradley J; Cooney, Robert N; Hellenthal, Nicholas J; Aquina, Christopher T; Noyes, Katia; Monson, John R; Kelly, Kristin N; Fleming, Fergal J

2016-05-01

Hospital readmissions remain a major medical and financial concern to the healthcare system and have become an area of interest in health outcomes performance metrics. There is a pressing need to identify process measures that may help reduce readmissions. Our aim was to assess the patient characteristics and surgical factors associated with 30-day readmissions for colorectal surgery in Upstate New York. This was a retrospective cohort study. The study included colectomy cases abstracted for the National Surgical Quality Improvement Program in the Upstate New York Surgical Quality Initiative from June 2013 to June 2014. The study consists of 630 colectomies. Patients with a length of stay >30 days or who died during the index admission were excluded. Readmission within 30 days of surgery was the main outcome measure. Of 630 colectomy patients, 76 patients (12%) were readmitted within 30 days of surgery. Major and minor complications were associated with 30-day postoperative readmission (OR = 2.99 (95% CI, 1.70-5.28) and OR = 2.19 (95% CI, 1.09-4.43)) but excluded from final analysis because they included both predischarge and postdischarge complications. Risk factors independently associated with 30-day postoperative readmission included diabetes mellitus (OR = 1.94 (95% CI, 1.02-3.67)), smoker within the past year (OR = 2.01 (95% CI, 1.12-3.60)), no scheduled follow-up (OR = 2.20 (95% CI, 1.25-3.86)), and ileostomy formation (OR = 1.97 (95% CI, 1.03-3.77)). Limitations include the retrospective design and only 30 days of postoperative follow-up. Consistent with national trends, 1 in 8 patients in the Upstate New York Surgical Quality Initiative program was readmitted within 30 days after colorectal surgery. This study identified several risk factors that may act as tangible targets for intervention, including preoperative smoking cessation programs, optimization of diabetic management, mandatory scheduled follow-up appointments on discharge, and ostomy care pathways.

42 CFR 416.195 - Determination of membership in new classes of new technology IOLs.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) Reduced risk of intraoperative or postoperative complication or trauma; (ii) Accelerated postoperative recovery; (iii) Reduced induced astigmatism; (iv) Improved postoperative visual acuity; (v) More stable...

42 CFR 416.195 - Determination of membership in new classes of new technology IOLs.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Reduced risk of intraoperative or postoperative complication or trauma; (ii) Accelerated postoperative recovery; (iii) Reduced induced astigmatism; (iv) Improved postoperative visual acuity; (v) More stable...

Recent refinements to cranial implants for rhesus macaques (Macaca mulatta)

PubMed Central

Johnston, Jessica M.; Cohen, Yale E.; Shirley, Harry; Tsunada, Joji; Bennur, Sharath; Christison-Lagay, Kate; Veeder, Christin L.

2017-01-01

The advent of cranial implants revolutionized primate neurophysiological research because they allow researchers to stably record neural activity from monkeys during active behavior. Cranial implants have improved over the years since their introduction, but chronic implants still increase the risk for medical complications including bacterial contamination and resultant infection, chronic inflammation, bone and tissue loss and complications related to the use of dental acrylic. These complications can lead to implant failure and early termination of study protocols. In an effort to reduce complications, we describe several refinements that have helped us improve cranial implants and the wellbeing of implanted primates. PMID:27096188

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report.

PubMed

Sammartino, G; Riccitiello, F; Trosino, O; Marenzi, G; Cioffi, A; Mortellaro, C

2012-05-01

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.

Etiology of Readmissions Following Orthopaedic Procedures and Medical Admissions. A Comparative Analysis.

PubMed

Maslow, Jed; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-12-01

The Federal Government, the largest payer of health care, considers readmission within 30 days of discharge an indicator of quality of care. Many studies have focused on causes for and strategies to reduce readmissions following medical admissions. However, few studies have focused on the differences between them. We believe that the causes for readmission following orthopaedic surgery are markedly different than those following medical admissions, and therefore, the strategies developed to reduce medical readmissions will not be as effective in reducing readmissions after elective orthopaedic surgery. All unplanned 30-day readmissions following an index hospitalization for an elective orthopaedic procedure (primary and revision total joint arthroplasty and spine procedure) or for one of the three publicly reported medical conditions (AMI, HF, and pneumonia, which accounted for 11% of readmissions) were identified at our institution from 2010 through 2012. A total of 268 patients and 390 medical patients were identified as having an unplanned 30-day readmission. We reviewed a prospectively collected data base to determine the reason for readmission in each encounter. A total of 233 (86.9%) orthopaedic patients were readmitted for surgical complications, most commonly for a wound infection (56.0%) or wound complication (11.6%). Following an index admission of HF or AMI, the primary reason for readmission was a disease of the circulatory system (55.9% and 57.4%, respectively). Following an index admission for pneumonia, the primary reason for readmission was a disease of the respiratory system (34.5%). The causes of readmissions following orthopaedic surgery and medical admissions are different. Patients undergoing orthopaedic procedures are readmitted for surgical complications, frequently unrelated to aftercare, and medicine patients are readmitted for reasons related to the index diagnosis. Interventions designed to reduce orthopaedic readmissions must focus on reducing surgical complications, differing from interventions designed to reduce readmissions following medical admissions, which focus on medical diagnoses.

The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Does Not Accurately Predict Risk of 30-Day Complications Among Patients Undergoing Microvascular Head and Neck Reconstruction.

PubMed

Arce, Kevin; Moore, Eric J; Lohse, Christine M; Reiland, Matthew D; Yetzer, Jacob G; Ettinger, Kyle S

2016-09-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC) is a novel universal risk calculator designed to aid in risk stratification of patients undergoing various types of major surgery. The purpose of this study was to assess the validity of the ACS NSQIP SRC in predicting postoperative complications in patients undergoing microvascular head and neck reconstruction. A retrospective cohort study of patients undergoing head and neck microvascular reconstruction with fibular free flaps at a single institution was completed. The NSQIP SRC was used to compute complication risk estimates and length of stay (LOS) estimates for all patients under study. Associations between complication risk estimates generated by the SRC and actual rates of observed complications were evaluated using logistic regression models. Logistic regression models also were used to evaluate the SRC estimates for LOS duration compared with the actual observed LOS after surgery. Of 153 patients under study, 46 (30%) developed a postoperative complication corresponding to those defined by NSQIP SRC. Thirty-eight patients (25%) developed a postoperative complication categorized as severe in the parameters of the NSQIP SRC. None of the SRC complication estimates showed a statistically relevant association with the corresponding observed rates of complications. The mean LOS predicted by the SRC was 8.0 days (median, 7.5 days; interquartile range [IQR], 6.5 to 9; range, 5.0 to 18.5 days). The mean observed LOS for the study group was 9.6 days (median, 7.0 days; IQR, 6 to 9; range, 5 to 67 days). Lin's (Biometrics 45:255, 1989) concordance correlation coefficient to measure agreement between observed and predicted LOS was 0.10, indicating only slight agreement between the 2 values. The ACS NSQIP SRC is not a useful risk-stratifying metric for patients undergoing major head and neck reconstruction with microvascular fibular free flaps. The SRC also does not accurately predict hospital LOS for this same patient cohort. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Algunos aspectos sicolinguisticos de la Instruccion Programada en el laboratorio de idiomas (Some Psycholinguistic Aspects of Programed Instruction in the Language Laboratory).

ERIC Educational Resources Information Center

Monteverde G., Luisa

1971-01-01

This paper presents ideas on using programed instruction in the language laboratory for second language learning. Linear programing is more suited to language instruction than is branching, because the former more easily allows comparison between the students' and teachers' solutions and is technically less complicated and less expensive to…

A Blended Learning Approach for Teaching Computer Programming: Design for Large Classes in Sub-Saharan Africa

ERIC Educational Resources Information Center

Bati, Tesfaye Bayu; Gelderblom, Helene; van Biljon, Judy

2014-01-01

The challenge of teaching programming in higher education is complicated by problems associated with large class teaching, a prevalent situation in many developing countries. This paper reports on an investigation into the use of a blended learning approach to teaching and learning of programming in a class of more than 200 students. A course and…

Race, Power, and Equity in a Multiethnic Urban Elementary School with a Dual-Language "Strand" Program

ERIC Educational Resources Information Center

Palmer, Deborah

2010-01-01

Dual-language education is often lauded for providing high-caliber bilingual instruction in an integrated classroom. This is complicated, however, when a dual-language program does not include all members of a school community. This article examines a "strand" dual-language program that attracts middle-class white students to a predominantly black…

Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2015-2016.

PubMed

Hinkle, Lawrence E; Toledo, Carlos; Grund, Jonathan M; Byams, Vanessa R; Bock, Naomi; Ridzon, Renee; Cooney, Caroline; Njeuhmeli, Emmanuel; Thomas, Anne G; Odhiambo, Jacob; Odoyo-June, Elijah; Talam, Norah; Matchere, Faustin; Msungama, Wezi; Nyirenda, Rose; Odek, James; Come, Jotamo; Canda, Marcos; Wei, Stanley; Bere, Alfred; Bonnecwe, Collen; Choge, Isaac Ang'Ang'A; Martin, Enilda; Loykissoonlal, Dayanund; Lija, Gissenge J I; Mlanga, Erick; Simbeye, Daimon; Alamo, Stella; Kabuye, Geoffrey; Lubwama, Joseph; Wamai, Nafuna; Chituwo, Omega; Sinyangwe, George; Zulu, James Exnobert; Ajayi, Charles A; Balachandra, Shirish; Mandisarisa, John; Xaba, Sinokuthemba; Davis, Stephanie M

2018-03-23

Male circumcision reduces the risk for female-to-male human immunodeficiency virus (HIV) transmission by approximately 60% (1) and has become a key component of global HIV prevention programs in countries in Eastern and Southern Africa where HIV prevalence is high and circumcision coverage is low. Through September 2017, the President's Emergency Plan for AIDS Relief (PEPFAR) had supported 15.2 million voluntary medical male circumcisions (VMMCs) in 14 priority countries in Eastern and Southern Africa (2). Like any surgical intervention, VMMC carries a risk for complications or adverse events. Adverse events during circumcision of males aged ≥10 years occur in 0.5% to 8% of procedures, though the majority of adverse events are mild (3,4). To monitor safety and service quality, PEPFAR tracks and reports qualifying notifiable adverse events. Data reported from eight country VMMC programs during 2015-2016 revealed that bleeding resulting in hospitalization for ≥3 days was the most commonly reported qualifying adverse event. In several cases, the bleeding adverse event revealed a previously undiagnosed or undisclosed bleeding disorder. Bleeding adverse events in men with potential bleeding disorders are serious and can be fatal. Strategies to improve precircumcision screening and performance of circumcisions on clients at risk in settings where blood products are available are recommended to reduce the occurrence of these adverse events or mitigate their effects (5).

Interventional radiology in living donor liver transplant

PubMed Central

Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Hsu, Hsien-Wen; Concerjero, Allan M; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yong, Chee-Chien; Lin, Yu-Hung; Lin, Chih-Che; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

2014-01-01

The shortage of deceased donor liver grafts led to the use of living donor liver transplant (LDLT). Patients who undergo LDLT have a higher risk of complications than those who undergo deceased donor liver transplantation (LT). Interventional radiology has acquired a key role in every LT program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplant. The aim of this paper is to review indications, diagnostic modalities, technical considerations, achievements and potential complications of interventional radiology procedures after LDLT. PMID:24876742

Coil Migration, Malposition, Stretching and Retrieval

PubMed Central

Abe, T.; Hirohata, M.; Tanaka, N.; Uchiyama, Y.; Morimitsu, H.; Kojima, K.; Hayabuchi, N.

2000-01-01

Summary In this educational program for complicated coil placements, we report several cases of coil malposition, migration, and retrieval. We emphasize that a decrease in the expected one-to-one motion of the coil is the earliest sign of a possible imminent complication, and the over the core wire technique with a fixed-loop snare (Gooseneck microsnare) is a very effective potential solution for elongated coil retrieval. PMID:20667237

Reducing the Risk of Postoperative Genital Complications in Male Adolescents

ERIC Educational Resources Information Center

Dossanova, ?ssem; Lozovoy, Vasiliy; Wood, Dan; ??nekenova, ?enzhekyz; Botabayeva, ?igul; Dossanov, Bolatbek; Lozovaya, Yelena; ?marov, ?algat

2016-01-01

The reproductive system of adolescents is exposed to a high risk of anomalies. In spite of the successes of surgical correction, the percentage of postoperative complications remains high. Special attention should be paid to circumcision, which is regarded as a religious tradition in many countries and carried out with sanitary violations. This…

The Burden of Diverticular Disease on Patients and Healthcare Systems

PubMed Central

Reddy, Vikram B.; Longo, Walter E.

2013-01-01

Diverticulitis is a debilitating complication of diverticular disease that affects approximately 2.5 million individuals in the United States. Compared to many other gastrointestinal conditions, diverticular disease is poorly understood in terms of its burden on patients and healthcare systems. This review examines the existing literature and discusses the current knowledge of the burden of diverticular disease. Literature confirmed that bothersome symptoms (such as abdominal pain and bloating) and potentially serious, disease-related complications (such as diverticulitis and diverticular bleeding) place a significant burden on patients. Broad-spectrum antibiotic therapy and surgery are the generally accepted mainstays of treatment for acute complications of diverticular disease. Despite these options, patients frequently experience substantially reduced quality of life (particularly in terms of social and emotional functioning) and increased mortality (predominantly due to disease-related complications) compared to healthy controls. Furthermore, diverticular disease accounted for 254,179 inpatient discharges and 1,493,865 outpatient clinic visits in the United States in 2002, at an estimated cost per hospitalization of $9,742-$11,729. Enhancing the quality of life of patients with diverticular disease and reducing disease exacerbations and complications will substantially benefit patients and healthcare systems. However, long-established treatment algorithms fall short of these therapeutic goals. Research into new treatment options for patients with diverticular disease should therefore be pursued. PMID:24707230

[Problems and complications of leg lengthening with the Wagner apparatus].

PubMed

Herzog, R; Hefti, F

1992-06-01

Since 1971, we have performed 189 leg lengthening procedures using the Wagner method at our institution. The results obtained in the first 26 cases (1971-1973) showed a high complication rate, which led us to reconsider the indications for this procedure. In the present paper, we analyze the results of 37 leg lengthening procedures carried out in 32 patients during the last 10 years (1981-1990) in the children's unit of the orthopedic department of the University of Basle. We found a complication rate of 78%, and in 46% of cases there was more than one major complication. We did not distinguish between "complications" and "problems", because such distinctions are of little importance to the patient. The average age at the time of surgery was 14.8 years, and the average increase in length was 4.3 (2.2-9.2) cm. For each 1 cm of lengthening, an average of 21 days in hospital and 64 days of reduced weight-bearing were needed. Our conclusion is that the Wagner method makes it possible to attain the goal of leg lengthening, but the second step cannot reduce the length of stay in hospital or the length of time the patient needs the help of crutches. Bone remodeling is disturbed. Our preliminary experience with the Ilizarov method is more encouraging.

Successful treatment of lymphoproliferative disease complicating primary immunodeficiency/immunodysregulatory disorders with reduced-intensity allogeneic stem-cell transplantation.

PubMed

Cohen, Jonathan M; Sebire, Neil J; Harvey, Julia; Gaspar, H Bobby; Cathy, Cale; Jones, Alison; Rao, Kanchan; Cubitt, David; Amrolia, Persis J; Davies, E Graham; Veys, Paul

2007-09-15

Lymphoproliferative disease (LPD) is a recognized complication of primary immunodeficiency (PID) and immunodysregulatory syndromes. Historically, it has a very poor outcome. For patients surviving LPD, myeloablative hematopoietic stem cell transplantation (SCT) was the only cure for the underlying PID, with a high risk of developing posttransplantation complications, including recurrent lymphoproliferative disease. We describe 8 patients with a range of PID and immunodysregulatory syndromes complicated by LPD. After initial treatment of the LPD (including the use of anti-CD20 monoclonal antibody, rituximab, in 6 of the patients), all patients underwent reduced-intensity conditioning (RIC) SCT with prospective monitoring for Epstein-Barr virus (EBV) viremia. After transplantation, 3 patients received rituximab, and 3 patients received prophylactic EBV-specific cytotoxic T-lymphocytes. Only 1 patient developed recurrent LPD posttransplantation, which responded to rituximab. All patients who underwent transplantation survive free of LPD and are cured of their PID at a median follow-up of 4 years (range, 1-7 years). With careful monitoring and pre-emptive therapy, we advocate this RIC SCT approach to patients with PID who have pre-existing EBV-LPD.

Contemporary insights into the management of type A aortic dissection.

PubMed

Tolis, George; Sundt, Thoralf M

2016-10-01

Acute Type A Dissection remains a surgical emergency with a relatively high operative mortality despite advances in cardiac surgical techniques and medical management over the past thirty years. In this presentation we will discuss the issues surrounding diagnosis, triage, surgical treatment and perioperative medical management as well as long term surveillance of patients suffering from Acute Type A Dissection and present the literature that supports our management strategies. Expert commentary: The ultimate goal of surgical intervention for patients with Type A Acute Aortic Dissection is an alive patient. A more complicated operation which addresses the root and arch and potentially reduces late complications should be approached with caution since it may increase the operative mortality of the procedure itself. With the recent evolution in endovascular techniques, there is hope that later complications can be reduced without increasing the risk of the primary operation. It remains to be seen whether the improved distal aortic remodeling afforded by a combined open/endovascular approach to Acute Type A Dissection will lead to decreased need for aortic reinterventions and overall long term complications of a residual descending thoracic chronic dissection.

The impact of obesity on 30-day complications in pediatric surgery.

PubMed

Train, A T; Cairo, S B; Meyers, H A; Harmon, C M; Rothstein, D H

2017-11-01

To examine the effects of obesity on specialty-specific surgical outcomes in children. Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis. Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures. Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.

[Complications in pediatric anesthesia].

PubMed

Becke, K

2014-07-01

As in adult anesthesia, morbidity and mortality could be significantly reduced in pediatric anesthesia in recent decades. This fact cannot conceal the fact that the incidence of anesthetic complications in children is still much more common than in adults and sometimes with a severe outcome. Newborns and infants in particular but also children with emergency interventions and severe comorbidities are at increased risk of potential complications. Typical complications in pediatric anesthesia are respiratory problems, medication errors, difficulties with the intravenous puncture and pulmonal aspiration. In the postoperative setting, nausea and vomiting, pain, and emergence delirium can be mentioned as typical complications. In addition to the systematic prevention of complications in pediatric anesthesia, it is important to quickly recognize disturbances of homeostasis and treat them promptly and appropriately. In addition to the expertise of the performing anesthesia team, the institutional structure in particular can improve quality and safety in pediatric anesthesia.

Program Aids Visualization Of Data

NASA Technical Reports Server (NTRS)

Truong, L. V.

1995-01-01

Living Color Frame System (LCFS) computer program developed to solve some problems that arise in connection with generation of real-time graphical displays of numerical data and of statuses of systems. Need for program like LCFS arises because computer graphics often applied for better understanding and interpretation of data under observation and these graphics become more complicated when animation required during run time. Eliminates need for custom graphical-display software for application programs. Written in Turbo C++.

Simulation improves procedural protocol adherence during central venous catheter placement: a randomized-controlled trial

PubMed Central

Peltan, Ithan D.; Shiga, Takashi; Gordon, James A.; Currier, Paul F.

2015-01-01

Background Simulation training may improve proficiency at and reduces complications from central venous catheter (CVC) placement, but the scope of simulation’s effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes. Methods Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns’ performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees. Results We observed 52 interns place 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (p=0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores or complication rates. Conclusions Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety. PMID:26154250

Building a Network for Children of Divorce.

ERIC Educational Resources Information Center

McGann, John; Strauss, Jane

Divorce is a complicated situation, requiring multifaceted interventions and supports. This paper describes a program designed to enhance the ability of social structures to support children experiencing the impact of parental separation and divorce. The program is a four-part, school-based intervention aimed at educating significant adults…

BARIUM REDUCTION OF INTUSSUSCEPTION IN INFANCY

PubMed Central

Denenholz, Edward J.; Feher, George. S.

1955-01-01

Barium enema reduction was used as the initial routine treatment in 29 infants with intussusception. In 22 of them the intussusception was reduced by this means. In three of eight patients operated upon the intussusception was found to be reduced. Four of the remaining five patients had clinical or x-ray evidence of complications before reduction by barium enema was attempted. Twenty-one of the patients, all of whom were observed in private practice, were treated without admission to the hospital. After reduction, these patients were observed closely by the clinician. None of these patients showed clinical or x-ray signs of complications before reduction. Certain clinical and roentgen criteria must be satisfied before it can be concluded that reduction by barium enema is complete. If there are clinical signs of complications with x-ray evidence of small bowel obstruction, only a very cautious attempt at hydrostatic reduction should be made. As the time factor is generally a reliable clinical guide to reducibility, the late cases should be viewed with greater caution. Long duration of symptoms, however, is not per se a contraindication to an attempt at hydrostatic reduction. PMID:13230908

[Esophageal complications of gastroesophageal reflux disease: consequences or defensive reactions?

PubMed

Horváth, Örs Péter; Bognár, Laura; Papp, András; Vereczkei, András

2017-05-01

Gastroesophageal reflux disease affects more than 10% of the adult population. Most patients can be effectively treated with lifestyle changes and adequate acid-reducing therapy. However, about 10% of the patients remain symptomatic despite treatment and severe complications may develop. Interestingly, some of these complications seem to be a sort of defensive mechanism that may either alleviate the patient's symptoms or prevent developing further complications. In Barrett's esophagus, which can be unambigously considered as a complication of gastroesophageal reflux disease, reflux symptoms ruining the quality of life may significantly improve, since the metaplastic Barrett epithelium is much more resistent to gastric acid, than the normal epithelial lining of the esophagus. Furthermore, the motility disorders (hypertensive lower esophageal sphincter, achalasia, cricopharyngeal achalasia) and structural changes (Schatzki's ring, esophageal stricture, subglottic trachea stenosis), which develop as a complication of reflux may help to prevent aspiration that can cause new complaints and may lead to further complications. Orv Hetil. 2017; 158(20): 763-769.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series *

PubMed Central

Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello

2015-01-01

Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

The effect of health care reform on academic medicine in Canada. Editorial Committee of the Canadian Institute for Academic Medicine.

PubMed

Hollenberg, C H

1996-05-15

Although Canadian health care reform has constrained costs and improved efficiency, it has had a profound and mixed effect on Canadian academic medicine. Teaching hospitals have been reduced in number and size, and in patient programs have shifted to ambulatory and community settings. Specialized care programs are now multi-institutional and multidisciplinary. Furthermore, the influence of regional planning bodies has grown markedly. Although these changes have likely improved clinical service, their impact on the quality of clinical education is uncertain. Within the academic clinical department, recruitment of young faculty has been greatly complicated by constraints on licensing, billing numbers, fee-for-service income and research funding. The departmental practice plan based on university funds and fee-for-service income is being replaced by less favourable funding arrangements. However, emphasis on multidisciplinary programs has rendered these departments more flexible in structure. The future of Canadian academic medicine depends on an effective alliance with government. Academia and government must agree, particularly on human-resource requirements, research objectives and the delivery of clinical and academic programs in regional and community settings. The establishment of focal points for academic health sciences planning within academic health sciences centres and within governments would assist in these developments. Finally, government and the academic health sciences sector must work together to remove the current impediments to the recruitment of highly qualified young faculty.

Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.

PubMed

Landais, Alain; Morel, Morgane; Goldstein, Jacques; Loriau, Jerôme; Fresnel, Annie; Chevalier, Corinne; Rejasse, Gilles; Alfonsi, Pascal; Ecoffey, Claude

2017-06-01

Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. The billing of 2388 patients who underwent scheduled high-risk surgery (i.e. major abdominal, gynaecologic, urological, vascular, and orthopaedic interventions) over three years was retrospectively collected from three French hospitals (one public-teaching, one public, and one private hospital). A relationship between mortality, length of hospital stays, cost/patient, and severity scores, based mainly on postoperative complications but also on preoperative clinical status, were analysed. Statistical analysis was performed using Student's t-tests or Wilcoxon tests. Our analyses determined that a severity score of 3 or 4 was associated with complications in 90% of cases and this represented 36% of patients who, compared with those with a score of 1 or 2, were associated with significantly increased costs (€ 8205±3335 to € 22,081±16,090; P<0.001, delta of € 13,876) and a prolonged length of hospital stay (mean of 10 to 27 days; P<0.001, delta of 17 days). According to estimates for complications avoided by PGDT, there was a projected reduction in average healthcare costs of between € 854 and € 1458 per patient and a reduction in total hospital bed days from 1755 to 4423 over three years. Based on French National data (47,000 high risk surgeries per year), the potential financial savings ranged from € 40M to € 68M, not including the costs of PGDT and its implementation. Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures. Copyright © 2017. Published by Elsevier Masson SAS.

Retrospective case-control non-inferiority analysis of intravenous lidocaine in a colorectal surgery enhanced recovery program.

PubMed

Naik, Bhiken I; Tsang, Siny; Knisely, Anne; Yerra, Sandeep; Durieux, Marcel E

2017-01-31

Enhanced recovery after surgery (ERAS) programs typically utilizes multi-modal analgesia to reduce perioperative opioid consumption. Systemic lidocaine is used in several of these ERAS algorithms and has been shown to reduce opioid use after colorectal surgery. However it is unclear how much the other components of an ERAS protocol contribute to the final outcome. Using a noninferiority analysis we sought to assess the role of perioperative lidocaine in an ERAS program for colorectal surgery, using pain and opioid consumption as outcomes. We conducted a retrospective review of patients who had received intravenous lidocaine perioperatively during colorectal surgery. We matched them with patients who were managed using a multi-component ERAS protocol, which included perioperative lidocaine. We tested a joint hypothesis of noninferiority of lidocaine infusion to ERAS protocol in postoperative pain scores and opioid consumption. We assigned a noninferiority margin of 1 point (on an 11-point numerical rating scale) difference in pain and a ratio [mean (lidocaine) / mean (ERAS)] of 1.2 in opioid consumption, respectively. Fifty-two patients in the lidocaine group were matched with patients in the ERAS group. With regards to opioid consumption, in the overall [1.68 (1.43-1.98)] [odds ratio (95% confidence interval)] analysis and on postoperative day (POD) 1 [2.38 (1.74-3.31)] lidocaine alone was inferior to multi-modal analgesia. On POD 2 and beyond, although the mean odds ratio for opioid consumption was 1.43 [1.43 (1.17-1.73)], the lower limit extended beyond the pre-defined cut-off of 1.2, rendering the outcome inconclusive. For pain scores lidocaine is non-inferior to ERAS [-0.17 (-1.08-0.74)] on POD 2 and beyond. Pain scores on POD 1 and in the overall cohort were inconclusive based on the noninferiority analysis. The addition of a multi-component ERAS protocol to intravenous lidocaine incrementally reduces opioid consumption, most evident on POD 1. For pain scores the data is inconclusive on POD 1, however on POD 2 and beyond lidocaine alone is non-inferior to an ERAS program with lidocaine. Opioid-related complications, including return of bowel function, were not different between the groups despite reduced opioid use in the ERAS group.

Maternal High-Fat Diet Programming of the Neuroendocrine System and Behavior

PubMed Central

Sullivan, Elinor L.; Riper, Kellie M.; Lockard, Rachel; Valleau, Jeanette C.

2015-01-01

Maternal obesity, metabolic state, and diet during gestation have profound effects on offspring development. The prevalence of neurodevelopmental and mental health disorders has risen rapidly in the last several decades in parallel with the rise in obesity rates. Evidence from epidemiological studies indicates that maternal obesity and metabolic complications increase the risk of offspring developing behavioral disorders such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), and schizophrenia. Animal models show that a maternal diet high in fat similarly disrupts behavioral programming of offspring, with animals showing social impairments, increased anxiety and depressive behaviors, reduced cognitive development, and hyperactivity. Maternal obesity, metabolic conditions, and high fat diet consumption increase maternal leptin, insulin, glucose, triglycerides, and inflammatory cytokines. This leads to increased risk of placental dysfunction, and altered fetal neuroendocrine development. Changes in brain development that likely contribute to the increased risk of behavioral and mental health disorders include increased inflammation in the brain, as well as alterations in the serotonergic system, dopaminergic system and hypothalamic pituitary adrenal (HPA) axis. PMID:25913366

Evaluation of potential interactions between mycophenolic acid derivatives and proton pump inhibitors.

PubMed

Gabardi, Steven; Olyaei, Ali

2012-01-01

To evaluate the incidence of gastrointestinal (GI) complications in solid organ transplant (SOT) recipients, impact of the complications on transplant outcomes, and the potential interactions between mycophenolic acid (MPA) derivatives and proton pump inhibitors (PPIs). An unrestricted literature search (1980-January 2012) was performed with MEDLINE and EMBASE using the following key words: drug-drug interaction, enteric-coated mycophenolic acid, GI complications, mycophenolate mofetil, solid organ transplant, and proton pump inhibitor, including individual agents within the class. Abstracts from scientific meetings were also evaluated. Additionally, reference citations from identified publications were reviewed. Relevant English-language, original research articles and review articles were evaluated if they focused on any of the topics identified in the search or included substantial content addressing GI complications in SOT recipients or drug interactions. GI complications are frequent among SOT recipients, with some studies showing prevalence rates as high as 70%. Transplant outcomes among renal transplant recipients are significantly impacted by GI complications, especially in patients requiring immunosuppressant dosage reductions or premature discontinuation. To this end, PPI use among patients receiving transplants is common. Recent data demonstrate that PPIs significantly reduce the overall exposure to MPA after oral administration of mycophenolate mofetil. Similar studies show this interaction does not exist between PPIs and enteric-coated mycophenolic acid (EC-MPA). Unfortunately, most of the available data evaluating this interaction are pharmacokinetic analyses that do not investigate the clinical impact of this interaction. A significant interaction exists between PPIs and mycophenolate mofetil secondary to reduced dissolution of mycophenolate mofetil in higher pH environments. EC-MPA is not absorbed in the stomach; therefore, low intragastric acidity does not impact EC-MPA and bioavailability is maintained with this formulation during PPI coadministration. The clinical impact of this interaction is unknown, yet one can theorize that reduced exposure to MPA in SOT recipients can increase the risk of allograft rejection and/or failure.

[A randomized controlled trial of preoperative oral immunonutrition in patients undergoing surgery for colorectal cancer: hospital stay and health care costs].

PubMed

Manzanares Campillo, María Del Carmen; Martín Fernández, Jesús; Amo Salas, Mariano; Casanova Rituerto, Daniel

The use of enteral formulas with immunonutrients in patients with gastrointestinal malignancies susceptible to surgery can reduce postoperative morbidity, at the expense of reduced infectious complications, with the consequent reduction in hospital stay and health care costs. Prospective randomized study. 84 patients operated on a scheduled basis for resectable colorectal cancer were recruited. In the group YES IN Impact © Oral was administered for 8 days (3 sachets a day), compared with the NOT IN group who did not receive it. 40.5% (17) patients without immunonutrition suffered infectious complications vs. 33.3% (14) of YES IN. In patients with rectal cancer NOT IN, 50% (8) suffered minor infectious complications (p=.028). In each group (YES IN, NOT IN, colon and rectal cancer) when infectious complications were observed, the variables total hospital stay and costs doubled, with significant differences. These variables showed higher values in the group NOT IN compared with those who received immunonutrition, although these differences were not statistically significant. NOT IN patients suffered infectious complications more frequently than YES IN, with significant results in the subgroup of patients with rectal cancer. The total hospital stay and costs were slightly higher in the group not supplemented, doubling in each category significantly (YES IN, NOT IN, colon and rectal cancer), when infectious complications were observed. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study.

PubMed

Little, Paul; Stuart, Beth; Hobbs, F D Richard; Butler, Chris C; Hay, Alastair D; Delaney, Brendan; Campbell, John; Broomfield, Sue; Barratt, Paula; Hood, Kerenza; Everitt, Hazel; Mullee, Mark; Williamson, Ian; Mant, David; Moore, Michael

2014-03-01

Data from trials suggest that antibiotics reduce the risk of complications of sore throat by at least 50%, but few trials for complications have been done in modern settings, and datasets of delayed antibiotic prescription are underpowered. Observational evidence is important in view of poor compliance with antibiotic treatment outside trials, but no prospective observational cohort studies have been done to date. We generated a large prospective cohort from the DESCARTE study, and the PRISM component of DESCARTE, of 12,829 adults presenting with sore throat (≤ 2 weeks duration) in primary care. Our follow-up of the cohort was based on a detailed and structured review of routine medical records, and analysis of the comparison of three antibiotic prescription strategies (no antibiotic prescription, immediate antibiotic prescription, and delayed antibiotic prescription) to control for the propensity to prescribe antibiotics. Information about antibiotic prescription was recorded in 12,677 individuals (4805 prescribed no antibiotics, 6088 prescribed antibiotics immediately, and 1784 prescribed delayed antibiotics). We documented by review of patients' notes (n=11,950) the development of suppurative complications (eg, quinsy, impetigo and cellulitis, otitis media, and sinusitis) or reconsultation with new or non-resolving symptoms). We used multivariate analysis to control for variables significantly related to the propensity to prescribe antibiotics and for clustering by general practitioner. 164 (1.4%) of the 11,950 patients with information available developed complications; otitis media and sinusitis were the most common complications (101 patients [62%]). Compared with no antibiotic prescription, immediate antibiotic prescription was associated with fewer complications (adjusted risk ratio [RR] 0.62, 95% CI 0.43-0.91, estimated number needed to treat [NNT 193) as was delayed prescription of antibiotics (0.58, 0.34-0.98; NNT 174). 1787 of the 11,950 patients (15%) reconsulted with new or non-resolving symptoms; the risk of reconsultation was also reduced by immediate (0.83, 0.73-0.94; NNT 40) or delayed antibiotics (0.61, 0.50-0.74; NNT 18). Suppurative complications are not common in primary care and most are not serious. The risks of suppurative complications or reconsultation in adults are reduced by antibiotics, but not as much as the trial evidence suggests. In most cases, no antibiotic is needed, but a delayed prescription strategy is likely to provide similar benefits to an immediate antibiotic prescription. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Obesity-Fertility Protocol: a randomized controlled trial assessing clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women.

PubMed

Duval, Karine; Langlois, Marie-France; Carranza-Mamane, Belina; Pesant, Marie-Hélène; Hivert, Marie-France; Poder, Thomas G; Lavoie, Hélène B; Ainmelk, Youssef; St-Cyr Tribble, Denise; Laredo, Sheila; Greenblatt, Ellen; Sagle, Margaret; Waddell, Guy; Belisle, Serge; Riverin, Daniel; Jean-Denis, Farrah; Belan, Matea; Baillargeon, Jean-Patrice

2015-01-01

Obesity in infertile women increases the costs of fertility treatments, reduces their effectiveness and increases significantly the risks of many complications of pregnancy and for the newborn. Studies suggest that even a modest loss of 5-10 % of body weight can restore ovulation. However, there are gaps in knowledge regarding the benefits and cost-effectiveness of a lifestyle modification program targeting obese infertile women and integrated into the fertility clinics. This study will evaluate clinical outcomes and costs of a transferable interdisciplinary lifestyle intervention, before and during pregnancy, in obese infertile women. We hypothesize that the intervention will: 1) improve fertility, efficacy of fertility treatments, and health of mothers and their children; and 2) reduce the cost per live birth, including costs of fertility treatments and pregnancy outcomes. Obese infertile women (age: 18-40 years; BMI ≥30 kg/m(2) or ≥27 kg/m(2) with polycystic ovary syndrome) will be randomised to either a lifestyle intervention followed by standard fertility treatments after 6 months if no conception has been achieved (intervention group) or standard fertility treatments only (control group). The intervention and/or follow-up will last for a maximum of 18 months or up to the end of pregnancy. Evaluation visits will be planned every 6 months where different outcome measures will be assessed. The primary outcome will be live-birth rates at 18 months. The secondary outcomes will be sub-divided into four categories: lifestyle and anthropometric, fertility, pregnancy complications, and neonatal outcomes. Outcomes and costs will be also compared to similar women seen in three fertility clinics across Canada. Qualitative data will also be collected from both professionals and obese infertile women. This study will generate new knowledge about the implementation, impacts and costs of a lifestyle management program in obese infertile women. This information will be relevant for decision-makers and health care professionals, and should be generalizable to North American fertility clinics. ClinicalTrials.gov NCT01483612. Registered 25 November 2011.

Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database.

PubMed

Liu, Jen-Jane; Leppert, John T; Maxwell, Bryan G; Panousis, Periklis; Chung, Benjamin I

2014-05-01

We sought to examine the trends in perioperative outcomes of kidney cancer surgery stratified by type (radical nephrectomy [RN] vs. partial nephrectomy [PN]) and approach (open vs. minimally invasive). We queried the National Surgical Quality Improvement Program database to identify kidney cancer operations performed from 2005 to 2011. We examined 30-day perioperative outcomes including operative time, transfusion rate, length of stay, major morbidity (cardiovascular, pulmonary, renal, and infectious), and mortality. A total of 2,902 PN and 5,459 RN cases were identified. The use of PN increased over time, accounting for 39% of all nephrectomies in 2011. Minimally invasive approaches also increased over time for both RN and PN. Open surgery was associated with increased length of stay, receipt of transfusion, major complications, and perioperative mortality. Resident involvement and open approach were independent predictors of major complications for both PN and RN. Additionally, the presence of a medical comorbidity was also a risk factor for complications after RN. The overall complication rates decreased for all approaches over the study period. Minimally invasive approaches to kidney cancer renal surgery have increased with favorable outcomes. The safety of open and minimally invasive PN improved significantly over the study period. Although pathologic features cannot be determined from this data set, these data show that complications from renal surgical procedures are decreasing in an era of increasing use. © 2013 Published by Elsevier Inc.

A randomized controlled trial of interim methadone maintenance.

PubMed

Schwartz, Robert P; Highfield, David A; Jaffe, Jerome H; Brady, Joseph V; Butler, Carol B; Rouse, Charles O; Callaman, Jason M; O'Grady, Kevin E; Battjes, Robert J

2006-01-01

Effective alternatives to long waiting lists for entry into methadone hydrochloride maintenance treatment are needed to reduce the complications of continuing heroin dependence and to increase methadone treatment entry. To compare the effectiveness of interim methadone maintenance with that of the usual waiting list condition in facilitating methadone treatment entry and reducing heroin and cocaine use and criminal behavior. Randomized, controlled, clinical trial using 2 conditions, with treatment assignment on a 3:2 basis to interim maintenance-waiting list control. A methadone treatment program in Baltimore. A total of 319 individuals meeting the criteria for current heroin dependence and methadone maintenance treatment. Participants were randomly assigned to either interim methadone maintenance, consisting of an individually determined methadone dose and emergency counseling only for up to 120 days, or referral to community-based methadone treatment programs. Entry into comprehensive methadone maintenance therapy at 4 months from baseline; self-reported days of heroin use, cocaine use, and criminal behavior; and number of urine drug test results positive for heroin and cocaine at the follow-up interview conducted at time of entry into comprehensive methadone treatment (or at 4 months from baseline for participants who did not enter regular treatment). Significantly more participants assigned to the interim methadone maintenance condition entered comprehensive methadone maintenance treatment by the 120th day from baseline (75.9%) than those assigned to the waiting list control condition (20.8%) (P<.001). Overall, in the past 30 days at follow-up, interim participants reported significantly fewer days of heroin use (P<.001), had a significant reduction in heroin-positive drug test results (P<.001), reported spending less money on drugs (P<.001), and received less illegal income (P<.02) than the waiting list participants. Interim methadone maintenance results in a substantial increase in the likelihood of entry into comprehensive treatment, and is an effective means of reducing heroin use and criminal behavior among opioid-dependent individuals awaiting entry into a comprehensive methadone treatment program.

The true incidence of near-term postoperative complications in prosthetic breast reconstruction utilizing human acellular dermal matrices: a meta-analysis.

PubMed

Newman, Martin I; Swartz, Kimberly A; Samson, Michel C; Mahoney, Chris Brown; Diab, Khaled

2011-02-01

The use of human acellular dermal matrix (HADM) materials in prosthetic-based breast reconstruction has gained popularity in recent years. Questions remain, however, regarding the nature and incidence of postoperative complications associated with this technique. The results reported in the available literature vary widely. This meta-analysis examines this question further with a broad review of the available literature in an effort to better define the true nature and incidence of near-term complications associated with the use of HADM in prosthetic-based breast reconstruction. It does not aim to compare this method of reconstruction to others. A review of the available literature was performed in July 2009. The goal was to identify all previous works describing the placement of HADM at prosthetic-based breast reconstruction. Included were studies that documented the use of HADM for coverage of tissue expanders or permanent implants following therapeutic or prophylactic mastectomy. Excluded were studies that reported on the use of HADM in cosmetic breast surgery or studies that included the use of xenografts. Data collected included demographics as well as the nature and incidence of complications, with separate categories assigned for seroma, infection, flap necrosis, and "other." Data were analyzed using Comprehensive Meta-Analysis(®) software (Biostat, Englewood, NJ). Raw proportions, fixed-effect models, and random-effect models were used to assess the complication rates across studies. Eleven published articles and one abstract that was later published as an article were identified. Within these 12 studies, a total of 789 breasts were identified that had undergone reconstruction with HADM. The mean follow-up was 13.7 months. Under the random-effects model, the total complication rate was 12.0%. The most common complications were flap necrosis (3.3%), seroma (3.3%), and infection (5.6%). All complications not included in these categories were set apart in a separate category, "Other," and totaled 3.0% The true incidence of postoperative complications in the near term utilizing HADM in prosthetic-based breast reconstruction appears to be approximately 12%. The incidence of long-term complications such as capsular contracture remains unknown. However, as surgical experience with HADM grows, operative techniques designed at reducing risks will mature, strategies for managing complications will advance, and more advanced products designed to reduce the incidence of complications are likely to become available.

Relative to open surgery, minimally-invasive renal and ureteral pediatric surgery offers no improvement in 30-day complications, yet requires longer operative time: Data from the National Surgical Quality Improvement Program Pediatrics.

PubMed

Colaco, Marc; Hester, Austin; Visser, William; Rasper, Alison; Terlecki, Ryan

2018-05-01

Performance of minimally-invasive surgery (MIS) is increasing relative to open surgery. We sought to compare the contemporary rates of short-term complications of open versus laparoscopic renal and ureteral surgery in pediatric patients. A retrospective cross-sectional analysis of the National Surgical Quality Improvement Program Pediatrics database was performed of all cases in 2014 identified using CPT procedure codes for nephrectomy, partial nephrectomy (PN), ureteroneocystostomy (UNC), and pyeloplasty, and reviewed for postoperative complications. Univariate analysis was performed to determine 30-day complications, with comparison between open and MIS approaches. Receiver operator curve (ROC) analysis was performed to determine differences in body surface area (BSA) and age for open versus MIS. Review identified 207 nephrectomies, 72 PN, 920 UNC, and 625 pyeloplasties. MIS was associated with older age and larger BSA except for cases of UNC. Apart from PN, operative durations were longer with MIS. However, only PN was associated with significantly longer length of hospital stay (LOS). There was no difference in incidence of all other 30-day complications. When evaluating BSA via ROC, the area under the curve (AUC) was found to be 0.730 and was significant. Children with a BSA greater than 0.408 m 2 were more likely to have MIS (sensitivity, 66.9%; specificity, 69.3%). Regarding age, the AUC was 0.732. Children older than 637.5 days were more likely to have MIS (sensitivity, 72.8%; specificity, 63.3%). Pediatric MIS is associated with longer operative time for nephrectomy, but shorter LOS following PN. Surgical approach was not associated with difference in short-term complications.

Assessment of failure to rescue after abdominal aortic aneurysm repair using the National Surgical Quality Improvement Program procedure-targeted data set.

PubMed

Dakour-Aridi, Hanaa; Paracha, Nawar Z; Locham, Satinderjit; Nejim, Besma; Malas, Mahmoud B

2018-05-18

Open aortic repair (OAR) is associated with higher risk of mortality compared with endovascular aneurysm repair (EVAR). The aim of this study was to compare failure to rescue (FTR) after major predischarge complications in patients undergoing OAR and EVAR. Patients who underwent OAR or EVAR in the American College of Surgeons National Surgical Quality Improvement Program between 2011 and 2015 were selected. Patients with ruptured aneurysm and those with type IV thoracoabdominal aneurysms were excluded. The primary outcome was FTR, defined as 30-day mortality in patients who developed at least one complication during their hospital stay. Univariable and multivariable statistics were used. A total of 9097 patients underwent abdominal aortic aneurysm repair. Of those, 3291 (36.2%) had at least one major predischarge complication, 82.5% after OAR (95% confidence interval [CI], 80.9%-84.1%) vs 21.3% after EVAR (95% CI, 20.4%-22.3%; P < .001). Increased FTR was seen after aneurysm rupture, cardiac arrest, septic shock, and acute kidney injury. On multivariable analysis, FTR was not significantly different between OAR and EVAR (adjusted odds ratio, 0.87; 95% CI, 0.61-1.24; P = .44). Propensity score matching and coarsened exact matching showed similar results. Although EVAR has fewer complications and lower in-hospital mortality than OAR, FTR after major predischarge complications does not depend on the type of surgical approach. When an in-hospital major complication occurs after EVAR, surgeons should be alert that FTR risk resulting in mortality is similar to that of OAR. Therefore, there is no safety net with EVAR. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Safety, efficacy and cost-effectiveness of consecutive bilateral cataract surgery on two successive days in tribes at base hospital through community outreach program: A prospective study of Aravali Mountain, North West India

PubMed Central

Mohan, Amit; Kaur, Navjot; Bhatanagar, Vishal C

2017-01-01

Purpose: The aim of the study was to evaluate the safety and efficacy of consecutive bilateral cataract surgery (CBCS) on two successive days in a single hospital visit. Methods: Prospective study was conducted on 565 patients of various tribes of hilly area of West Rajasthan who had come to our hospital through community outreach programmed (CORP) between January 2015 and March 2016. Patients with significant bilateral cataract without any other ocular morbidity were advised bilateral manual small incision cataract surgery on two consecutive days. Intraoperative and postoperative complications were evaluated, and follow-up was done at 1 week, 1 month, and 3 months. Results: Out of 565 patients, 519 underwent both eye surgeries. Second eye surgery was deferred for a later date in 46 cases. Because of intraoperative and postoperative complications in the first eye, 31 had delayed surgeries while 15 patients refused to undergo another eye surgery either because of postoperative day 1 poor vision in the operated eye due to retinal pathologies (n = 8) or unwillingness (n = 7). The second eye surgery was performed for 519 patients, out of whom six had intra or postoperative complications. At 1 month follow-up, four patients had unilateral cystoid macular edema and three had prolonged postoperative inflammation. At 3 months, all patients were satisfied and had no complications. None of the patients had sight-threatening complications such as endophthalmitis, corneal decompensation, or vitreoretinal complications. Conclusion: CBCS may be considered safe and cost-effective for patients living in remote locations, dependent on CORP. PMID:29208839

Comprehensive computerized diabetes registry. Serving the Cree of Eeyou Istchee (eastern James Bay).

PubMed Central

Dannenbaum, D.; Verronneau, M.; Torrie, J.; Smeja, H.; Robinson, E.; Dumont, C.; Kovitch, I.; Webster, T.

1999-01-01

PROBLEM BEING ADDRESSED: Diabetes is rapidly evolving as a major health concern in the Cree population of eastern James Bay (Eeyou Istchee). The Cree Board of Health and Social Services of James Bay (CBHSSJB) diabetes registry was the initial phase in the development of a comprehensive program for diabetes in this region. OBJECTIVE OF PROGRAM: The CBHSSJB diabetes registry was developed to provide a framework to track the prevalence of diabetes and the progression of diabetic complications. The database will also identify patients not receiving appropriate clinical and laboratory screening for diabetic complications, and will provide standardized clinical flow sheets for routine patient management. MAIN COMPONENTS OF PROGRAM: The CBHSSJB diabetes registry uses a system of paper registration forms and clinical flow sheets kept in the nine community clinics. Information from these sheets is entered into a computer database annually. The flow sheets serve as a guideline for appropriate management of patients with diabetes, and provide a one-page summary of relevant clinical and laboratory information. CONCLUSIONS: A diabetes registry is vital to follow the progression of diabetes and diabetic complications in the region served by the CBHSSJB. The registry system incorporates both a means for regional epidemiologic monitoring of diabetes mellitus and clinical tools for managing patients with the disease. PMID:10065310

The UCLA Alzheimer’s and Dementia Care Program for Comprehensive, Coordinated, Patient-centered Care: Preliminary Data

PubMed Central

Reuben, David B.; Evertson, Leslie Chang; Wenger, Neil S.; Serrano, Katherine; Chodosh, Joshua; Ercoli, Linda; Tan, Zaldy S.

2013-01-01

Dementia is a chronic disease that requires both medical and social services to provide high quality of care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poor compared to other diseases that affect older persons. The UCLA Alzheimer’s and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient-centered care for patients with Alzheimer’s disease and other dementias. The goals of the program are to maximize patient function, independence and dignity, minimize caregiver strain and burnout and reduce unnecessary costs. The UCLA ADC program consists of five key components: patient recruitment and a dementia registry, structured needs assessments of patients in the registry and their caregivers, creation and implementation of individualized dementia care plans based on needs assessments and input from the primary care physicians, monitoring and revising care plans, as needed, and access 24/7, 365 days a year for assistance and advice. The program uses a co-management model with a nurse practitioner Dementia Care Manager working with primary care physicians and CBOs. Based on the first 150 patients served, the most common recommendations in the initial care plans were referrals to support groups (73%), Alzheimer’s Association Safe Return (73%), caregiver training (45%), and medication adjustment (41%). The program will be evaluated on its ability to achieve the triple aim of better care for individuals, better health for populations, and lower costs. PMID:24329821

Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics.

PubMed

Hicks, Caitlin W; Bronsert, Michael; Hammermeister, Karl E; Henderson, William G; Gibula, Douglas R; Black, James H; Glebova, Natalia O

2017-04-01

Although postoperative readmissions are frequent in vascular surgery patients, the reasons for these readmissions are not well characterized, and effective approaches to their reduction are unknown. Our aim was to analyze the reasons for vascular surgery readmissions and to report potential areas for focused efforts aimed at readmission reduction. The 2012 to 2013 American College of Surgeons National Quality Improvement Program (ACS NSQIP) data set was queried for vascular surgery patients. Multivariable models were developed to analyze risk factors for postdischarge infections, the major drivers of unplanned 30-day readmissions. We identified 86,403 vascular surgery patients for analysis. Thirty-day readmission occurred in 8827 (10%), of which 8054 (91%) were unplanned. Of the unplanned readmissions, 61% (n = 4951) were related to the index vascular surgery procedure. Infectious complications were the most common reason for a surgery-related readmission (1940 [39%]), with surgical site infection being the most common type of infection related to unplanned readmission. Multivariable analysis showed the top five preoperative risk factors for postdischarge infections were the presence of a preoperative open wound, inpatient operation, obesity, work relative value unit, and insulin-dependent diabetes (but not diabetes managed with oral medications). Cigarette smoking was a weak predictor and came in tenth in the mode (overall C index, 0.657). When operative and postoperative factors were included in the model, total operative time was the strongest predictor of postdischarge infectious complications (odds ratio [OR] 1.2 for each 1-hour increase in operative time), followed by presence of a preoperative open wound (OR, 1.5), inpatient operation (OR, 2), obesity (OR, 1.8), and discharge to rehabilitation facility (OR, 1.7; P < .001 for all). Insulin-dependent diabetes, cigarette smoking, dialysis dependence, and female gender were also predictive, albeit with smaller effects (OR, 1.1-1.3 for all; P < .001). The overall fit of the multivariable model was fair (C statistic, 0.686). Infectious complications dominate the reasons for unplanned 30-day readmissions in vascular surgery patients. We have identified preoperative, operative, and postoperative risk factors for these infections with the goal of reducing these complications and thus readmissions. Expected patient risk factors, such as diabetes, obesity, renal insufficiency, and cigarette smoking, were less important in predicting infectious complications compared with operative time, presence of a preoperative open wound, and inpatient operation. Our findings suggest that careful operative planning and expeditious operations may be the most effective approaches to reducing infections and thus readmissions in vascular surgery patients. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Two-year clinical follow-up after pulmonary vein isolation using high-intensity focused ultrasound (HIFU) and an esophageal temperature-guided safety algorithm.

PubMed

Neven, Kars; Metzner, Andreas; Schmidt, Boris; Ouyang, Feifan; Kuck, Karl-Heinz

2012-03-01

High-intensity frequency ultrasound (HIFU) can achieve pulmonary vein isolation (PVI), but severe complications have happened. An esophageal temperature (ET)-guided safety algorithm was implemented. We investigated medium-term outcome. After left atrial access, HIFU was applied until complete PVI. The safety algorithm was as follows: ≤3 complete ablations per pulmonary vein, early abortion when ET ≥40.0°C, use of Power Modulation at ET >39.0°C or when after 20 to 30 seconds no change in PV electrograms: to reduce the ablation temperature in the surrounding tissue, acoustic power is switched on and off with a frequency of 1 Hz; in all first ablations, use of Power Modulation after 50% of programmed time. Touch-up radiofrequency ablation when PVI failed. Follow-up included interviews and Holter electrocardiograms. Recurrence was defined as atrial fibrillation (AF) >30 seconds without a blanking period. A total of 28 symptomatic patients (18 males, age 63 years), with paroxysmal AF (n = 19) and persistent AF (n = 9) were included. After a median follow-up of 738 days, 22 of the 28 patients (79%) were free of AF without antiarrhythmic drugs. After 1 repeat procedure with radiofrequency ablation, 5 patients remained free of AF. The complications were as follows: 1 lethal atrial-to-esophageal fistula at day 31, 1 pericardial effusion at day 48, 1 unexplained death at day 49, and 2 persistent phrenic nerve palsies with full recovery within 12 months. Two-year follow-up after PVI using HIFU and an ET-guided safety algorithm shows success rates similar to those of radiofrequency-based procedures but with higher complication rates. Importantly, the ET-guided safety algorithm failed to prevent severe complications. HIFU does not meet safety standards required for the treatment of AF, and this led to a halt of its clinical use. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Grief interventions for people bereaved by suicide: A systematic review

PubMed Central

Steinig, Jana; Nagl, Michaela; Kersting, Anette

2017-01-01

Background Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. Methods We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. Results Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. Limitation On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. Conclusions People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals. PMID:28644859

Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

PubMed Central

Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia

2015-01-01

Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Discussion Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Conclusion Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach. PMID:26327392

Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

PubMed

Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

2015-01-01

Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

Real money: complications and hospital costs in trauma patients.

PubMed

Hemmila, Mark R; Jakubus, Jill L; Maggio, Paul M; Wahl, Wendy L; Dimick, Justin B; Campbell, Darrell A; Taheri, Paul A

2008-08-01

Major postoperative complications are associated with a substantial increase in hospital costs. Trauma patients are known to have a higher rate of complications than the general surgery population. We used the National Surgical Quality Improvement Program (NSQIP) methodology to evaluate hospital costs, duration of stay, and payment associated with complications in trauma patients. Using NSQIP principles, patient data were collected for 512 adult patients admitted to the trauma service for > 24 hours at a Level 1 trauma center (2004-2005). Patients were placed in 1 of 3 groups: no complications (none), >or=1 minor complication (minor, eg, urinary tract infection), or >or=1 major complication (major, eg, pneumonia). Total hospital charges, costs, payment, and duration of stay associated with each complication group were determined from a cost-accounting database. Multiple regression was used to determine the costs of each type of complication after adjusting for differences in age, sex, new injury severity score, Glasgow coma scale score, maximum head abbreviated injury scale, and first emergency department systolic blood pressure. A total of 330 (64%) patients had no complications, 53 (10%) had >or= 1 minor complication, and 129 (25%) had >or= 1 major complication. Median hospital charges increased from $33,833 (none) to $81,936 (minor) and $150,885 (major). The mean contribution to margin per day was similar for the no complication and minor complication groups ($994 vs $1,115, P = .7). Despite higher costs, the patients in the major complication group generated a higher mean contribution to margin per day compared to the no complication group ($2,168, P < .001). The attributable increase in median total hospital costs when adjusted for confounding variables was $19,915 for the minor complication group (P < .001), and $40,555 for the major complication group (P < .001). Understanding the costs associated with traumatic injury provides a window for assessing the potential cost reductions associated with improved quality care. To optimize system benefits, payers and providers should develop integrated reimbursement methodologies that align incentives to provide quality care.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis.

PubMed

Eichler, Klaus; Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R; Beck-Schimmer, Beatrice; Ganter, Michael T

2017-03-01

Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. Treatment-related costs per patient showed a nonsignificant change by -12,697 US dollars (95% confidence interval [CI], 10,956 to -36,352; P = .29) with preconditioning and by -6139 US dollars (95% CI, 6723 to -19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications.

Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis

PubMed Central

Urner, Martin; Twerenbold, Claudia; Kern, Sabine; Brügger, Urs; Spahn, Donat R.; Beck-Schimmer, Beatrice; Ganter, Michael T.

2017-01-01

BACKGROUND: Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. METHODS: An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. RESULTS: Treatment-related costs per patient showed a nonsignificant change by −12,697 US dollars (95% confidence interval [CI], 10,956 to −36,352; P = .29) with preconditioning and by −6139 US dollars (95% CI, 6723 to −19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. CONCLUSIONS: In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications. PMID:28067701

Antibiotics for pre-term pre-labour rupture of membranes: prevention of neonatal deaths due to complications of pre-term birth and infection.

PubMed

Cousens, Simon; Blencowe, Hannah; Gravett, Michael; Lawn, Joy E

2010-04-01

In high-income countries, it is standard practice to give antibiotics to women with pre-term, pre-labour rupture of membranes (pPROM) to delay birth and reduce the risk of infection. In low and middle-income settings, where some 2 million neonatal deaths occur annually due to complications of pre-term birth or infection, many women do not receive antibiotic therapy for pPROM. To review the evidence for and estimate the effect on neonatal mortality due to pre-term birth complications or infection, of administration of antibiotics to women with pPROM, in low and middle-income countries. We performed a systematic review to update a Cochrane review. Standardized abstraction forms were used. The quality of the evidence provided by individual studies and overall was assessed using an adapted GRADE approach. Eighteen RCTs met our inclusion criteria. Most were from high-income countries and provide strong evidence that antibiotics for pPROM reduce the risk of respiratory distress syndrome [risk ratio (RR) = 0.88; confidence interval (CI) 0.80, 0.97], and early onset postnatal infection (RR = 0.61; CI 0.48, 0.77). The data are consistent with a reduction in neonatal mortality (RR = 0.90; CI 0.72, 1.12). Antibiotics for pPROM reduce complications due to pre-term delivery and post-natal infection in high-income settings. There is moderate quality evidence that, in low-income settings, where access to other interventions (antenatal steroids, surfactant therapy, ventilation, antibiotic therapy) may be low, antibiotics for pPROM could prevent 4% of neonatal deaths due to complications of prematurity and 8% of those due to infection.

Household costs and time to seek care for pregnancy related complications: The role of results-based financing.

PubMed

Chinkhumba, Jobiba; De Allegri, Manuela; Mazalale, Jacob; Brenner, Stephan; Mathanga, Don; Muula, Adamson S; Robberstad, Bjarne

2017-01-01

Results-based financing (RBF) schemes-including performance based financing (PBF) and conditional cash transfers (CCT)-are increasingly being used to encourage use and improve quality of institutional health care for pregnant women in order to reduce maternal and neonatal mortality in low-income countries. While there is emerging evidence that RBF can increase service use and quality, little is known on the impact of RBF on costs and time to seek care for obstetric complications, although the two represent important dimensions of access. We conducted this study to fill the existing gap in knowledge by investigating the impact of RBF (PBF+CCT) on household costs and time to seek care for obstetric complications in four districts in Malawi. The analysis included data on 2,219 women with obstetric complications from three waves of a population-based survey conducted at baseline in 2013 and repeated in 2014(midline) and 2015(endline). Using a before and after approach with controls, we applied generalized linear models to study the association between RBF and household costs and time to seek care. Results indicated that receipt of RBF was associated with a significant reduction in the expected mean time to seek care for women experiencing an obstetric complication. Relative to non-RBF, time to seek care in RBF areas decreased by 27.3% (95%CI: 28.4-25.9) at midline and 34.2% (95%CI: 37.8-30.4) at endline. No substantial change in household costs was observed. We conclude that the reduced time to seek care is a manifestation of RBF induced quality improvements, prompting faster decisions on care seeking at household level. Our results suggest RBF may contribute to timely emergency care seeking and thus ultimately reduce maternal and neonatal mortality in beneficiary populations.

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

PubMed

Mudokwenuy-Rawdon, C; Ehlers, V J; Bezuidenhout, M C

2005-11-01

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.

Infectious Complications after Umbilical Cord-Blood Transplantation from Unrelated Donors

PubMed Central

Montoro, Juan; Piñana, José Luis; Moscardó, Federico; Sanz, Jaime

2016-01-01

Umbilical cord-blood (UCB) is a well-recognized alternative source of stem cells for unrelated donor hematopoietic stem cell transplantation (HSCT). As compared with other stem cell sources from adult donors, it has the advantages of immediate availability of cells, absence of risk to the donor and reduced risk of graft-versus-host disease despite donor-recipient HLA disparity. However, the use of UCB is limited by the delayed post-transplant hematologic recovery due, at least in part, to the reduced number of hematopoietic cells in the graft and the delayed or incomplete immune reconstitution. As a result, severe infectious complications continue to be a leading cause of morbidity and mortality following UCB transplantation (UCBT). We will address the complex differences in the immune properties of UCB and review the incidence, characteristics, risk factors, and severity of bacterial, fungal and viral infectious complications in patients undergoing UCBT. PMID:27872731

A Checklist-based Intervention to Improve Surgical Outcomes in Michigan: Evaluation of the Keystone Surgery Program

PubMed Central

Reames, Bradley N.; Krell, Robert W.; Campbell, Darrell A.; Dimick, Justin B.

2015-01-01

Importance Previous studies of checklist-based quality improvement interventions have reported mixed results. Objective To evaluate whether implementation of a checklist-based quality improvement intervention, Keystone Surgery, was associated with improved outcomes in patients undergoing general surgery in large statewide population. Design, Setting and Exposure Retrospective longitudinal study examining surgical outcomes in Michigan patients using Michigan Surgical Quality Collaborative clinical registry data from the years 2006–2010 (n=64,891 patients in 29 hospitals). Multivariable logistic regression and difference-in-differences analytic approaches were used to evaluate whether Keystone Surgery program implementation was associated with improved surgical outcomes following general surgery procedures, apart from existing temporal trends toward improved outcomes during the study period. Main Outcome Measures Risk-adjusted rates of superficial surgical site infection, wound complications, any complication, and 30-day mortality. Results Implementation of Keystone Surgery in participating centers (n=14 hospitals) was not associated with improvements in surgical outcomes during the study period. Adjusted rates of superficial surgical site infection (3.2 vs. 3.2%, p=0.91), wound complications (5.9 vs. 6.5%, p=0.30), any complication (12.4 vs. 13.2%, p=0.26), and 30-day mortality (2.1 vs. 1.9%, p=0.32) at participating hospitals were similar before and after implementation. Difference-in-differences analysis accounting for trends in non-participating centers (n=15 hospitals), and sensitivity analysis excluding patients receiving surgery in the first 6- or 12-months after program implementation yielded similar results. Conclusions and Relevance Implementation of a checklist-based quality improvement intervention did not impact rates of adverse surgical outcomes among patients undergoing general surgery in participating Michigan hospitals. Additional research is needed to understand why this program was not successful prior to further dissemination and implementation of this model to other populations. PMID:25588183

Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers.

PubMed

Güldner, Andreas; Kiss, Thomas; Serpa Neto, Ary; Hemmes, Sabrine N T; Canet, Jaume; Spieth, Peter M; Rocco, Patricia R M; Schultz, Marcus J; Pelosi, Paolo; Gama de Abreu, Marcelo

2015-09-01

Postoperative pulmonary complications are associated with increased morbidity, length of hospital stay, and mortality after major surgery. Intraoperative lung-protective mechanical ventilation has the potential to reduce the incidence of postoperative pulmonary complications. This review discusses the relevant literature on definition and methods to predict the occurrence of postoperative pulmonary complication, the pathophysiology of ventilator-induced lung injury with emphasis on the noninjured lung, and protective ventilation strategies, including the respective roles of tidal volumes, positive end-expiratory pressure, and recruitment maneuvers. The authors propose an algorithm for protective intraoperative mechanical ventilation based on evidence from recent randomized controlled trials.

Screening Adult Patients with a Tracheostomy Tube for Dysphagia: A Mixed-Methods Study of Practice in the UK

ERIC Educational Resources Information Center

Ginnelly, Aeron; Greenwood, Nan

2016-01-01

Background: Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia), and because of their medical acuity, complications in this patient population can be severe. It is well recognized that swallow screening in stroke significantly reduces potential complications by allowing early identification and…

Transition of Care from Childhood to Adulthood: Congenital Adrenal Hyperplasia.

PubMed

Bachelot, Anne

2018-01-01

Deficiency of the 21-hydroxylase enzyme is the most common form of congenital adrenal hyperplasia (CAH), accounting for more than 95% of the cases. With the advent of newborn screening and hormone replacement therapy, most children with CAH survive into adulthood. Adolescents and adults with CAH experience a number of complications, including short stature, obesity, infertility, impaired bone mineral density, and reduced quality of life. Transition from pediatric to adult care and management of long-term complications are challenging for both patients and practitioners. In adulthood, the aims of the medical treatment are to substitute cortisol and, when necessary, aldosterone deficiency, to ensure normal fertility, and to avoid the long-term consequences of glucocorticoid use on bone, metabolism, and cardiovascular risk. Recent data suggest that poor health status is likely to begin in adolescence and persist into adulthood, highlighting the importance of this time period in a patient's endocrine care. During transition from pediatric to adult specific care, a shift in treatment goals is thus needed. Successful transition from pediatric to adult health care requires a regular follow-up of patients by a multidisciplinary team including pediatric endocrinologists, urologists, gynecologists, psychiatrists, and adult endocrinologists. All of this could be included in a specific therapeutic education program regarding transition and/or CAH. © 2018 S. Karger AG, Basel.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bilbao, Jose Ignacio; Quiroga, Jorge; Herrero, Jose Ignacio

Since the insertion of the first TIPS in 1989 much has been learned about this therapeutic procedure. It has an established role for the treatment of some complications of portal hypertension: prevention of recurrent variceal bleeding and rescue of patients with acute uncontrollable variceal bleeding. In addition TIPS is useful for Budd-Chiari syndrome, refractory ascites and hepatorenal syndrome, although its specific role in these indications remains to be definitively established. However, the decrease in sinusoidal blood flow induced by TIPS can lead to the patient developing hepatic encephalopathy and liver failure in some cases. Therefore, TIPS should be used withmore » caution in patients with very poor liver function. From a technical point of view, successful placement of TIPS is achieved in more than 98% of cases by experienced groups. At present, evaluation of TIPS dysfunction based on morphology probably leads to an overdiagnosis of this complication since most of these cases are not associated with clinical manifestations (recurrent bleeding or refractory ascites). The major disadvantage of TIPS remains its poor long-term patency requiring a mandatory surveillance program. The indicator for shunt function/malfunction should be the portosystemic pressure gradient, which is best assessed by intravascular measurements. Shunt obstructions may be prevented or reduced by the use of stent-grafts in the future.« less

Web-Based Parenting Skills Program for Pediatric Traumatic Brain Injury Reduces Psychological Distress Among Lower-Income Parents.

PubMed

Raj, Stacey P; Antonini, Tanya N; Oberjohn, Karen S; Cassedy, Amy; Makoroff, Kathi L; Wade, Shari L

2015-01-01

To examine changes in parent depression, psychological distress, parenting stress, and self-efficacy among participants in a randomized trial of a Web-based parent training program for pediatric traumatic brain injury (TBI). Primary caregivers of 37 children aged 3 to 9 years who sustained a moderate/complicated mild to severe TBI were randomly assigned to the intervention or control group, and both groups were equipped with home Internet access. The online parent training program was designed to increase positive parenting skills and improve caregiver stress management. It consisted of 10 core sessions and up to 4 supplemental sessions. Each session included self-guided Web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Families in the control group received links to TBI Web resources. Parent income moderated treatment effects on parent functioning. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences were found among higher-income parents for depression, parenting stress, or caregiver efficacy. Parent training interventions post-TBI may be particularly valuable for lower-income parents who are vulnerable to both environmental and injury-related stresses.

Preterm delivery and the severity of violence during pregnancy.

PubMed

Covington, D L; Hage, M; Hall, T; Mathis, M

2001-12-01

To determine the severity and consequences of physical violence during pregnancy among participants in a health department prenatal care coordination program. The prospective cohort study included all program participants from 1994 to 1996. Care coordinators screened participants for physical violence during pregnancy using a validated, systematic assessment protocol three times during prenatal care. The protocol was linked with prenatal records, delivery records and infant records to document complications and infant outcomes. Multiple logistic regression was used to assess the relationship between severe physical violence during pregnancy and pregnancy outcome while controlling for confounding factors. Among the 550 participants, 13.5% reported violence during pregnancy; it included 6.7% severe violence (hitting, kicking, injury with a weapon and abdominal injury) and 6.7% moderate violence (threats, slapping, shoving and sexual abuse). Severe physical prenatal violence was significantly associated with spontaneous preterm labor, preterm delivery, very preterm delivery, very low birth weight, preterm/low birth weight, mean birth weight, mean newborn hospital charges, five-minute Apgar < 7, neonatal intensive care unit admission, and fetal or neonatal death. Body site injured, timing of violence and number of violent incidents were significant factors associated with violence during pregnancy and preterm delivery. Because severe physical violence during pregnancy was a significant problem in this population, intervention programs are needed to reduce prenatal violence and its consequences.

Vascular complications following intra-aortic balloon pump implantation: an updated review

PubMed Central

de Jong, Monique M; Lorusso, Roberto; Al Awami, Fatima; Matteuci, Francesco; Parise, Orlando; Lozekoot, Pieter; Bonacchi, Massimo; Maessen, Jos G; Johnson, Daniel M; Gelsomino, Sandro

2017-01-01

Background: The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation. Methods: A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016. Results: A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications. Conclusion: Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP. PMID:28816093

Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team Training

PubMed Central

Walker, Dilys M.; Cohen, Susanna R.; Fritz, Jimena; Olvera-García, Marisela; Zelek, Sarah T.; Fahey, Jenifer O.; Romero-Martínez, Martín; Montoya-Rodríguez, Alejandra; Lamadrid-Figueroa, Héctor

2016-01-01

Introduction Most maternal deaths in Mexico occur within health facilities, often attributable to suboptimal care and lack of access to emergency services. Improving obstetric and neonatal emergency care can improve health outcomes. We evaluated the impact of PRONTO, a simulation-based low-cost obstetric and neonatal emergency and team training program on patient outcomes. Methods We conducted a pair-matched hospital-based trial in Mexico from 2010 to 2013 with 24 public hospitals. Obstetric and neonatal care providers participated in PRONTO trainings at intervention hospitals. Control hospitals received no intervention. Outcome measures included hospital-based neonatal mortality, maternal complications, and cesarean delivery. We fitted mixed-effects negative binomial regression models to estimate incidence rate ratios and 95% confidence intervals using a difference-in-differences approach, cumulatively, and at follow-up intervals measured at 4, 8, and 12 months. Results There was a significant estimated impact of PRONTO on the incidence of cesarean sections in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P = 0.005) and in intervals measured at 4 (16% decrease, P = 0.02), 8 (20% decrease, P = 0.004), and 12 months’ (20% decrease, P = 0.003) follow-up. We found no statistically significant impact of the intervention on the incidence of maternal complications. A significant impact of a 40% reduction in neonatal mortality adjusting for baseline differences was apparent at 8 months postintervention but not at 4 or 12 months. Conclusions PRONTO reduced the incidence of cesarean delivery and may improve neonatal mortality, although the effect on the latter might not be sustainable. Further study is warranted to confirm whether obstetric and neonatal emergency simulation and team training can have lasting results on patient outcomes. PMID:26312613

Five months of physical exercise in hemodialysis patients: effects on aerobic capacity, physical function and self-rated health.

PubMed

Molsted, Stig; Eidemak, Inge; Sorensen, Helle Tauby; Kristensen, Jens Halkjaer

2004-01-01

The number of chronic renal failure patients treated by hemodialysis (HD) is continuously increasing. Most patients have reduced physical capacity and have a high risk of cardiac and vascular diseases. The aim of this study was to determine the effects of 5 months physical exercise of HD patients' physical capacity, self-rated health and risk factors for cardiovascular disease. 33 HD patients were included in the study. HD for more than 3 months, age >18 years. Diabetes mellitus, symptomatic cardiovascular disease, musculoskeletal limitations, severe peripheral polyneuropathy, inability to speak Danish or English, dementia or other mental disorders. The patients were randomly assigned to an exercise group (EG, n = 22) or a control group (CG, n = 11). Prior to randomization, baseline testing was performed. The effects were measured by aerobic capacity, '2-min stair climbing', 'squat test', self-rated health (SF36), blood pressure and lipids. All tests were carried out by blinded testers. The intervention consisted of 1 h of physical exercise twice a week for 5 months. 20 patients completed the intervention. Attendance was 74% of all sessions. There were no dropouts caused by complications related to the intervention. The EG had a significant increase in aerobic capacity, 'squat test' and Physical Function and Physical Component Scale (SF36). No significant changes were observed in any of the parameters in the CG. Physical exercise twice a week for 5 months increases physical function and aerobic capacity in HD patients. An exercise program with only two exercise sessions per week seems easy to implement in clinical practice with high attendance among participants. Further investigation is needed to determine the effects on blood pressure and lipids. There were no medical complications related to the exercise program. Copyright 2004 S. Karger AG, Basel

Impact Evaluation of PRONTO Mexico: A Simulation-Based Program in Obstetric and Neonatal Emergencies and Team Training.

PubMed

Walker, Dilys M; Cohen, Susanna R; Fritz, Jimena; Olvera-García, Marisela; Zelek, Sarah T; Fahey, Jenifer O; Romero-Martínez, Martín; Montoya-Rodríguez, Alejandra; Lamadrid-Figueroa, Héctor

2016-02-01

Most maternal deaths in Mexico occur within health facilities, often attributable to suboptimal care and lack of access to emergency services. Improving obstetric and neonatal emergency care can improve health outcomes. We evaluated the impact of PRONTO, a simulation-based low-cost obstetric and neonatal emergency and team training program on patient outcomes. We conducted a pair-matched hospital-based trial in Mexico from 2010 to 2013 with 24 public hospitals. Obstetric and neonatal care providers participated in PRONTO trainings at intervention hospitals. Control hospitals received no intervention. Outcome measures included hospital-based neonatal mortality, maternal complications, and cesarean delivery. We fitted mixed-effects negative binomial regression models to estimate incidence rate ratios and 95% confidence intervals using a difference-in-differences approach, cumulatively, and at follow-up intervals measured at 4, 8, and 12 months. There was a significant estimated impact of PRONTO on the incidence of cesarean sections in intervention hospitals relative to controls adjusting for baseline differences during all 12 months cumulative of follow-up (21% decrease, P = 0.005) and in intervals measured at 4 (16% decrease, P = 0.02), 8 (20% decrease, P = 0.004), and 12 months' (20% decrease, P = 0.003) follow-up. We found no statistically significant impact of the intervention on the incidence of maternal complications. A significant impact of a 40% reduction in neonatal mortality adjusting for baseline differences was apparent at 8 months postintervention but not at 4 or 12 months. PRONTO reduced the incidence of cesarean delivery and may improve neonatal mortality, although the effect on the latter might not be sustainable. Further study is warranted to confirm whether obstetric and neonatal emergency simulation and team training can have lasting results on patient outcomes.

The open prototype for educational NanoSats: Fixing the other side of the small satellite cost equation

NASA Astrophysics Data System (ADS)

Berk, Josh; Straub, Jeremy; Whalen, David

Government supported nano-satellite launch programs and emerging commercial small satellite launch services are reducing the cost of access to space for educational and other CubeSat projects. The cost and complexity of designing and building these satellites remains a vexing complication for many would be CubeSat aspirants. The Open Prototype for Educational NanoSats (OPEN), a proposed nano-satellite development platform, is described in this paper. OPEN endeavors to reduce the costs and risks associated with educational, government and commercial nano-satellite development. OPEN provides free and publicly available plans for building, testing and operating a versatile, low-cost satellite, based on the standardized CubeSat form-factor. OPEN consists of public-domain educational reference plans, complete with engineering schematics, CAD files, construction and test instructions as well as ancillary reference materials relevant to satellite building and operation. By making the plan, to produce a small but capable spacecraft freely available, OPEN seeks to lower the barriers to access on the other side (non-launch costs) of the satellite cost equation.

General practitioners' knowledge, attitude and prescribing of antibiotics for upper respiratory tract infections in Selangor, Malaysia: findings and implications.

PubMed

Hassali, Mohamed Azmi; Kamil, Tengku Karmila Tengku; Md Yusof, Faridah Aryani; Alrasheedy, Alian A; Yusoff, Zuraidah Mohd; Saleem, Fahad; Al-Tamimi, Saleh Karamah; Wong, Zhi Yen; Aljadhey, Hisham; Godman, Brian

2015-04-01

Antibiotics are widely prescribed especially for upper respiratory tract infections (URTIs). Their irrational use can increase costs and resistance. Assess knowledge, attitude and prescribing of antibiotics for URTIs in Selangor, Malaysia, using a cross-sectional survey among general practitioners (GPs) working in private clinics in 2011. One hundred and thirty-nine physicians completed the questionnaire (response rate = 34.8%). 49.6% (n = 69) agreed antibiotics are helpful in treating URTIs, with most GPs agreeing antibiotics may reduce URTI duration and complications. The majority of GPs reported they felt patients expected antibiotics, with 36.7% (n = 51) agreeing patients would change doctors if they did not prescribe antibiotics and 21.6% (n = 30) agreeing when requested they prescribe antibiotics even if they believe them to be unnecessary. When assessed against six criteria, most GPs had a moderate level of knowledge of prescribing for URTIs. However, antibiotic prescriptions could be appreciably reduced. Further programs are needed to educate GPs and patients about antibiotics building on current initiatives.

Orthogeriatric care: improving patient outcomes

PubMed Central

Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

2016-01-01

Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

Oral health resources for cancer patients in Texas.

PubMed

Bitouni, Anneta; Urankar, Yashashri

2012-05-01

Over 1.4 million new cases of cancer are diagnosed each year, and many of these patients will, by necessity, be treated in private practice, including dental practice. Dental professionals play a key role in helping patients understand that good oral care can prevent or reduce oral complications. Treatment of oral cancers and other malignancies cause oral sequelae that can compromise patients' quality of life and dictate reduction or discontinuation of optimal therapeutic regimens, which in turn reduces the odds of long-term survival. This can be prevented or better managed if dental and medical health care providers work together. The purpose of this article is to identify the cancer centers associated with dental clinics and the dental practitioners in the state of Texas, including maxillofacial prosthodontists, with training and/or a special interest in providing oral care to cancer patients. To be included on the list, which will be available on the Dental Oncology Education Program (DOEP) Web site (doep.org), please contact Grady Basler at the DOEP office (grady@doep.org), or the Department of Public Health Sciences (214-828-8350).

Effects of a regular exercise program on biochemical parameters of type 2 diabetes mellitus patients.

PubMed

Dinçer, Şensu; Altan, Mehmet; Terzioğlu, Duygu; Uslu, Ezel; Karşidağ, Kubilay; Batu, Şule; Metin, Gökhan

2016-11-01

We aimed to investigate the effects of a regular exercise program on exercise capacity, blood biochemical profiles, certain antioxidant and oxidative stress parameters of type 2 Diabetes mellitus (DM) patients. Thirty one type 2 DM patients (ages ranging from 42-65 years) who have hemoglobin A1c (HbA1c) levels ≥7.5% and ≤9.5% were included to study and performed two cardiopulmonary exercise tests (CPET) before and after the exercise program. Subjects performed aerobic exercise training for 90 minutes a day; 3 days a week during 12 weeks. Blood samples were collected to analyze certain oxidant and antioxidant parameters (advanced oxidation protein products [AOPP], ferric reducing ability of plasma [FRAP], malondialdehyde [MDA], and sialic acid [SA]), blood lipid profile, fasting blood glucose (FBG) and HbA1c. At the end of the program HbA1c and FBG, triglyceride (TG) and very-low-density lipoprotein (VLDL) levels decreased and high-density lipoprotein (HDL) increased significantly (P=0.000, P=0.001, P=0.008, P=0,001 and P=0.02, respectively). AOPP, FRAP, SA levels of the patients increased significantly following first CPET (P=0.000, P=0.049, P=0.014 respectively). At the end of the exercise program AOPP level increased significantly following last CPET. Baseline SA level increased significantly following exercise program (P=0.002). We suggest that poor glycemic control which plays the major role in the pathogenesis of DM and its complications would be improved by 12 weeks of a regular exercise program. Whereas the acute exercise induces protein oxidation, regularly aerobic training may enhance the antioxidant status of type 2 DM patients.

Pathways and consequences of unsafe abortion: a comparison among women with complications after induced and spontaneous abortions in Madhya Pradesh, India.

PubMed

Banerjee, Sushanta K; Andersen, Kathryn L; Warvadekar, Janardan

2012-09-01

This study aimed to understand women's pathways of seeking care for postabortion complications in Madhya Pradesh, India. The study recruited 786 women between July and November 2007. Data were collected on service provision, abortion-related complications, care-seeking behavior, knowledge about abortion legality and availability, methods used, symptoms, referral source, and out-of-pocket costs. Women seeking care for complications from induced abortion followed more complex pathways to treatment than women with complications of spontaneous abortion. More complex pathways were associated with higher out-of-pocket costs. Improving community awareness on legal aspects, safe abortion methods, and trained providers are necessary to reduce morbidity associated with unsafe abortion. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Perioperative Hydrocortisone Reduces Major Complications After Pancreaticoduodenectomy: A Randomized Controlled Trial.

PubMed

Laaninen, Matias; Sand, Juhani; Nordback, Isto; Vasama, Kaija; Laukkarinen, Johanna

2016-11-01

The aim of this study was to study whether post-pancreaticoduodenectomy complications (PPDC) in high-risk patients can be reduced with hydrocortisone. Soft pancreas is a well-known risk factor for PPDC. Previously, we have shown that patients with >40% acini in the pancreatic transection line are most prone to PPDC. Recent studies have demonstrated that surgical trauma leads to inflammation of the pancreatic remnant, which precedes PPDC. On the basis of power analysis, randomized controlled trial (RCT) (Clinicaltrials.gov NCT01460615), 155 patients (February 2011-May 2015) scheduled for pancreaticoduodenectomy were randomized to intravenous (i.v.) treatment with hydrocortisone 100 mg or placebo. All patients received the first dose at the induction of anesthesia. During the operation, the percentage of acini was calculated from pancreatic transection line frozen samples by a pathologist. As planned, only the high-risk patients with >40% acini (n = 62) continued in the study to receive in total 8 doses of randomization-based hydrocortisone/placebo every 8 hours. Primary endpoints were urine trypsinogen positive days and overall complications (Clavien-Dindo III-IV). Postoperative pancreatic fistulas (POPFs), postpancreatectomy hemorrhage (PPH), and delayed gastric emptying (DGE) were also graded. Hydrocortisone treatment did not alter trypsinogen release (2 or more positive days 46% vs 50%), but it significantly reduced overall complications compared with placebo in the high-risk patients (18% vs 41%; P < 0.05; Clavien-Dindo III-IV). Also, clinically significant POPF (11% vs 27%), PPH (14% vs 24%), and DGE (29% vs 44%) tended to be lower in the hydrocortisone group. Ninety-day mortality was zero. This RCT shows that in high-risk patients, overall PPDC can be significantly reduced with hydrocortisone treatment. Inflammation may be an important mediator of PPDC.

Impact of the early use of immunomodulators or TNF antagonists on bowel damage and surgery in Crohn's disease.

PubMed

Safroneeva, E; Vavricka, S R; Fournier, N; Pittet, V; Peyrin-Biroulet, L; Straumann, A; Rogler, G; Schoepfer, A M

2015-10-01

The impact of early treatment with immunomodulators (IM) and/or TNF antagonists on bowel damage in Crohn's disease (CD) patients is unknown. To assess whether 'early treatment' with IM and/or TNF antagonists, defined as treatment within a 2-year period from the date of CD diagnosis, was associated with development of lesser number of disease complications when compared to 'late treatment', which was defined as treatment initiation after >2 years from the time of CD diagnosis. Data from the Swiss IBD Cohort Study were analysed. The following outcomes were assessed using Cox proportional hazard modelling: bowel strictures, perianal fistulas, internal fistulas, intestinal surgery, perianal surgery and any of the aforementioned complications. The 'early treatment' group of 292 CD patients was compared to the 'late treatment' group of 248 CD patients. We found that 'early treatment' with IM or TNF antagonists alone was associated with reduced risk of bowel strictures [hazard ratio (HR) 0.496, P = 0.004 for IM; HR 0.276, P = 0.018 for TNF antagonists]. Furthermore, 'early treatment' with IM was associated with reduced risk of undergoing intestinal surgery (HR 0.322, P = 0.005), and perianal surgery (HR 0.361, P = 0.042), as well as developing any complication (HR 0.567, P = 0.006). Treatment with immunomodulators or TNF antagonists within the first 2 years of CD diagnosis was associated with reduced risk of developing bowel strictures, when compared to initiating these drugs >2 years after diagnosis. Furthermore, early immunomodulators treatment was associated with reduced risk of intestinal surgery, perianal surgery and any complication. © 2015 John Wiley & Sons Ltd.

Reduced blood nrf-2 mRNA in local overweight boys at risk of metabolic complications: a study in San Luis City, San Luis, Argentina.

PubMed

Santillán, Lucas D; Moyano, Marta; Frau, Martín; Flores, Orlando; Siewert, Susana; Zirulnick, Fanny; Ramirez, Dario C; Giménez, Maria S

2013-10-01

Childhood overweight (OW) is a matter of public health concern because of its long-term impact on adulthood health. NF-E2-related factor 2 (Nrf-2) regulates the antioxidant/lipogenic response to a sustained positive energy balance that prevails during weight gain. Here we aimed at studying a possible link between OW and Nrf-2-dependent antioxidant/lipogenic response in a local population of boys at risk of metabolic complications. We measured clinical and biochemical parameters related to lipid metabolism, oxidative stress, and metabolic syndrome in a population of OW boys [body mass index (BMI) percentile ≥85(th) and <95(th), n=22] and normal weight boys (NW; BMI percentile<85(th), n=27) from San Luis City, San Luis, Argentina. Compared to NW, OW boys had lower insulin sensitivity, an altered plasma lipid profile, and increased markers of oxidative stress and inflammatory fatty acids. OW boys also had a higher atherogenic index and peripheral insulin resistance than NW boys. We also found that glutathione peroxidase activity and the reduced glutathione to oxidized glutathione ratio were lower in OW boys than NW boys, suggesting that OW boys may have an altered antioxidant response to oxidative stress. Finally, Nrf-2 expression negatively correlated with metabolic syndrome parameters in OW boys. Our data suggest that OW boys have a reduced antioxidant and lipogenic response to a positive energy balance, resulting in oxidative stress, insulin resistance, and risk of developing metabolic complications. Our data also provide a rationale for nutritional interventions aimed at restoring Nrf-2 expression to reduce the risk of metabolic complications in OW boys.

Diabetic foot complications and their risk factors from a large retrospective cohort study.

PubMed

Al-Rubeaan, Khalid; Al Derwish, Mohammad; Ouizi, Samir; Youssef, Amira M; Subhani, Shazia N; Ibrahim, Heba M; Alamri, Bader N

2015-01-01

Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economical threat. Identifying the extent of this problem and its risk factors will enable health providers to set up better prevention programs. Saudi National Diabetes Registry (SNDR), being a large database source, would be the best tool to evaluate this problem. This is a cross-sectional study of a cohort of 62,681 patients aged ≥ 25 years from SNDR database, selected for studying foot complications associated with diabetes and related risk factors. The overall prevalence of diabetic foot complications was 3.3% with 95% confidence interval (95% CI) of (3.16%-3.44%), whilst the prevalences of foot ulcer, gangrene, and amputations were 2.05% (1.94%-2.16%), 0.19% (0.16%-0.22%), and 1.06% (0.98%-1.14%), respectively. The prevalence of foot complications increased with age and diabetes duration predominantly amongst the male patients. Diabetic foot is more commonly seen among type 2 patients, although it is more prevalent among type 1 diabetic patients. The Univariate analysis showed Charcot joints, peripheral vascular disease (PVD), neuropathy, diabetes duration ≥ 10 years, insulin use, retinopathy, nephropathy, age ≥ 45 years, cerebral vascular disease (CVD), poor glycemic control, coronary artery disease (CAD), male gender, smoking, and hypertension to be significant risk factors with odds ratio and 95% CI at 42.53 (18.16-99.62), 14.47 (8.99-23.31), 12.06 (10.54-13.80), 7.22 (6.10-8.55), 4.69 (4.28-5.14), 4.45 (4.05-4.89), 2.88 (2.43-3.40), 2.81 (2.31-3.43), 2.24 (1.98-2.45), 2.02 (1.84-2.22), 1.54 (1.29-1.83), and 1.51 (1.38-1.65), respectively. Risk factors for diabetic foot complications are highly prevalent; they have put these complications at a higher rate and warrant primary and secondary prevention programs to minimize morbidity and mortality in addition to economic impact of the complications. Other measurements, such as decompression of lower extremity nerves, should be considered among diabetic patients.

Complications after Hypospadias Correction: Prognostic Factors and Impact on Final Clinical Outcome.

PubMed

Dokter, Elisabeth Maria; Mouës, Chantal M; Rooij, Iris A L M van; Biezen, Jan Jaap van der

2018-04-01

 The purpose of this study was to analyze the influence of patient and treatment characteristics on the occurrence of complications after hypospadias correction and the impact of complications on final clinical outcome.  The study cohort consisted of 205 hypospadias patients who had surgery in the Medical Centre Leeuwarden (1996-2011). Patient and treatment characteristics were hypospadias severity (preoperative meatal location and chordee), number of planned surgeries, reconstruction technique, operation year, and patient's age at the time of surgery. The final clinical outcome was measured with the Hypospadias Objective Scoring Evaluation (HOSE) (maximum score = 16) and compared between patients with and without complications.  Sixty-four patients (31%) had complications, most of which were fistulas ( n  = 40). An increased complication risk was seen in patients with severe hypospadias (preoperative proximal meatus or chordee), multistage reconstruction, reconstruction techniques other than Mathieu, and surgeries performed before 2005. Uncomplicated treatment resulted only in a marginally higher HOSE (15.7) compared with complicated treatment (15.4). Fistulas and multiple complications reduced clinical outcome more (15.3 and 14.9, respectively), while urinary tract infections, wound dehiscence, or prepuce related complications did not (16.0, 16.0, and 15.8, respectively).  The complication risk after hypospadias correction is influenced by hypospadias severity and type and year of reconstruction. Certain, but not all complications diminish final clinical outcome. Georg Thieme Verlag KG Stuttgart · New York.

Improving patient safety through the systematic evaluation of patient outcomes

PubMed Central

Forster, Alan J.; Dervin, Geoff; Martin, Claude; Papp, Steven

2012-01-01

Despite increased advocacy for patient safety and several large-scale programs designed to reduce preventable harm, most notably surgical checklists, recent data evaluating entire health systems suggests that we are no further ahead in improving patient safety and that hospital complications are no less frequent now than in the 1990s. We suggest that the failure to systematically measure patient safety is the reason for our limited progress. In addition to defining patient safety outcomes and describing their financial and clinical impact, we argue why the failure to implement patient safety measurement systems has compromised the ability to move the agenda forward. We also present an overview of how patient safety can be assessed and the strengths and weaknesses of each method and comment on some of the consequences created by the absence of a systematic measurement system. PMID:23177520

Prematurity and low weight at birth as new conditions predisposing to an increased cardiovascular risk.

PubMed

Mercuro, Giuseppe; Bassareo, Pier Paolo; Flore, Giovanna; Fanos, Vassilios; Dentamaro, Ilaria; Scicchitano, Pietro; Laforgia, Nicola; Ciccone, Marco Matteo

2013-04-01

Although the survival rate for preterm subjects has improved considerably, due to the progress in the field of perinatal medicine, preterm birth is frequently the cause underlying a series of notorious complications: morphological, neurological, ophthalmological, and renal alterations. In addition, it has recently been demonstrated how low gestational age and reduced foetal growth contribute towards an increased cardiovascular risk in preterm neonates. In fact, cardiovascular mortality is higher among former preterm adults than those born at term. This condition is referred to as cardiovascular perinatal programming. In the light of the above, an early, constant, and prolonged cardiological followup programme should be implemented in former preterm individuals. The aim of this paper was to perform a comprehensive literature review about two new emerging conditions predisposing to an increased cardiovascular risk: prematurity and low weight at birth.

Soft-laser use in the preoperative preparation and postoperative treatment of the patients with chronic lung abscesses

NASA Astrophysics Data System (ADS)

Ledin, A. O.; Dobkin, V. G.; Sadov, A. Y.; Galichev, K. V.; Rzeutsky, V. S.

1999-07-01

We counted expedient to include different methods of the soft-laser use in the preoperative medicinal program and in the postoperative period. During the preoperative preparation the basic group patients together with standard treatment received the combined soft-laser therapy, which included intravenous laser blood irradiation (ILBI) by He-Ve laser and external transcutaneous irradiation of the abscess projection by semi-conductorial arrenite-gallium laser. During postoperative treatment with ILBI remarkable changes were observed in the functional activity of the T- and B- cell. The soft-laser use allowed to achieve improvement of quality and shortening of terms of the preoperative preparation of 1,4 times, to level the immunosuppressive influence of surgery to reduce amount of the postoperative complications in 1,8 times and duration of the postoperative period in 1,5 times.

Model-based gene set analysis for Bioconductor.

PubMed

Bauer, Sebastian; Robinson, Peter N; Gagneur, Julien

2011-07-01

Gene Ontology and other forms of gene-category analysis play a major role in the evaluation of high-throughput experiments in molecular biology. Single-category enrichment analysis procedures such as Fisher's exact test tend to flag large numbers of redundant categories as significant, which can complicate interpretation. We have recently developed an approach called model-based gene set analysis (MGSA), that substantially reduces the number of redundant categories returned by the gene-category analysis. In this work, we present the Bioconductor package mgsa, which makes the MGSA algorithm available to users of the R language. Our package provides a simple and flexible application programming interface for applying the approach. The mgsa package has been made available as part of Bioconductor 2.8. It is released under the conditions of the Artistic license 2.0. peter.robinson@charite.de; julien.gagneur@embl.de.

Impact of Gender on 30-Day Complications After Primary Total Joint Arthroplasty.

PubMed

Robinson, Jonathan; Shin, John I; Dowdell, James E; Moucha, Calin S; Chen, Darwin D

2017-08-01

Impact of gender on 30-day complications has been investigated in other surgical procedures but has not yet been studied in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients who received THA or TKA from 2012 to 2014 were identified in the National Surgical Quality Improvement Program database. Patients were divided into 2 groups based on gender. Bivariate and multivariate analyses were performed to assess associations between gender and patient factors and complications after THA or TKA and to assess whether gender was an independent risk factor. THA patients consisted of 45.1% male and 54.9% female. In a multivariate analysis, female gender was found to be a protective factor for mortality, sepsis, cardiovascular complications, unplanned reintubation, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after THA. TKA patients consisted of 36.7% male and 62.3% female. Multivariate analysis revealed female gender as a protective factor for sepsis, cardiovascular complications, and renal complications and as an independent risk factor for urinary tract infection, blood transfusion, and nonhome discharge after TKA. There are discrepancies in the THA or TKA complications based on gender, and the multivariate analyses confirmed gender as an independent risk factor for certain complications. Physicians should be mindful of patient's gender for better risk stratification and informed consent. Copyright © 2017 Elsevier Inc. All rights reserved.

Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion Is Not Attributable to Baseline Illness Severity or Postoperative Complications.

PubMed

Adogwa, Owoicho; Lilly, Daniel T; Vuong, Victoria D; Desai, Shyam A; Ouyang, Bichun; Khalid, Syed; Khanna, Ryan; Bagley, Carlos A; Cheng, Joseph

2018-04-22

Health care systems are increasing efforts to minimize postoperative hospital stays to improve resource use. Common explanations for extended postoperative stay are baseline patient sickness, postoperative complications, or physician practice differences. However, the degree to which extended length of stay (LOS) represents patient illness or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and elderly patient comorbidities on extended LOS after anterior cervical discectomy and fusion. This retrospective study was performed from January 1, 2008, to December 31, 2014, on data from the American College of Surgeons National Surgical Quality Improvement Program. Patient demographics, comorbidities, LOS, and inpatient complications were recorded. Multivariable logistic regression analysis was used to determine the odds ratio for risk-adjusted extended LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications. Of 4730 participants, 1351 (28.56%) had extended LOS. A minority of patients with extended LOS had a history of relevant comorbidities-diabetes (29.53%), chronic obstructive pulmonary disease (9.4%), congestive heart failure (1.04%), myocardial infarction (0.33%), acute renal failure (0.3%), and stroke (5.92%). Among patients with normal LOS, 96.8% had no complications, 2.7% had 1 complication, and 0.5% had greater than 1 complication. In patients with extended LOS, 79.4% had no complications, 14.5% had 1 complication, and 6.1% had greater than 1 complication (P < 0.0001). Our study suggests much of LOS variation after an anterior cervical discectomy and fusion is not attributable to baseline patient illness or complications and most likely represents differences in practice style or surgeon preference. Copyright © 2018 Elsevier Inc. All rights reserved.

Extended Length of Stay in Elderly Patients After Lumbar Decompression and Fusion Surgery is May Not be Attributable to Baseline Illness Severity or Postoperative Complications.

PubMed

Adogwa, Owoicho; Desai, Shyam A; Vuong, Victoria D; Lilly, Daniel T; Ouyang, Bichun; Davison, Mark; Khalid, Syed; Bagley, Carlos A; Cheng, Joseph

2018-05-31

Hospital leaders are seeking ways to improve resource utilization and minimize long postoperative hospital stays. Common explanations for extended stay are baseline patient illness, postoperative complications, or physician practice differences. However, the degree extended length of stay (LOS) represents illness severity or postoperative complications remains unknown. The aim is to investigate the influence of postoperative complications and patient comorbidities on extended length of stay after lumbar spine surgery in elderly patients. In this retrospective cohort study from 2008-2014, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Program for elderly patients undergoing lumbar spine surgery. Patient demographics, comorbidities, LOS, and complications were recorded. Multivariable logistic regression analysis was used to determine the odds-ratio for risk-adjusted LOS. The primary outcome was the degree extended LOS represented patient illness or postoperative complications. Of 9,482 cases, 1,909 (20.13%) had extended LOS. A minority of extended LOS patients had a history of relevant comorbidities-diabetes (21.76%), COPD (8.17%), CHF (0.94%), MI (0%), acute renal failure (0.47%), and stroke (2.23%). 93% of patients with normal LOS had no complication, 5.19% had one complication, and 1.69% had greater than one complication. Among extended LOS patients, 73.65% had no complications, 18.96% had one complication, and 7.39% had greater than one complication (p<0.000). Our study suggests much of the variation in LOS for elderly lumbar spine surgery patients is not attributable to baseline patient illness or postoperative complications and therefore, most likely represents differences in practice style or surgeon preference. Copyright © 2018 Elsevier Inc. All rights reserved.

Enhanced Recovery After Surgery: A Review.

PubMed

Ljungqvist, Olle; Scott, Michael; Fearon, Kenneth C

2017-03-01

Enhanced Recovery After Surgery (ERAS) is a paradigm shift in perioperative care, resulting in substantial improvements in clinical outcomes and cost savings. Enhanced Recovery After Surgery is a multimodal, multidisciplinary approach to the care of the surgical patient. Enhanced Recovery After Surgery process implementation involves a team consisting of surgeons, anesthetists, an ERAS coordinator (often a nurse or a physician assistant), and staff from units that care for the surgical patient. The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced. The elements of the protocol reduce the stress of the operation to retain anabolic homeostasis. The ERAS Society conducts structured implementation programs that are currently in use in more than 20 countries. Local ERAS teams from hospitals are trained to implement ERAS processes. Audit of process compliance and patient outcomes are important features. Enhanced Recovery After Surgery started mainly with colorectal surgery but has been shown to improve outcomes in almost all major surgical specialties. Enhanced Recovery After Surgery is an evidence-based care improvement process for surgical patients. Implementation of ERAS programs results in major improvements in clinical outcomes and cost, making ERAS an important example of value-based care applied to surgery.

Maternal stress does not exacerbate long-term bone deficits in female rats born growth restricted, with differential effects on offspring bone health.

PubMed

Anevska, Kristina; Cheong, Jean N; Wark, John D; Wlodek, Mary E; Romano, Tania

2018-02-01

Females born growth restricted have poor adult bone health. Stress exposure during pregnancy increases risk of pregnancy complications. We determined whether maternal stress exposure in growth-restricted females exacerbates long-term maternal and offspring bone phenotypes. On gestational day 18, bilateral uterine vessel ligation (restricted) or sham (control) surgery was performed on Wistar-Kyoto rats. At 4 mo, control and restricted females were mated and allocated to unstressed or stressed pregnancies. Stressed pregnancies had physiological measurements performed; unstressed females were not handled. After birth, mothers were aged to 13 mo. Second-generation (F2) offspring generated four experimental groups: control unstressed, restricted unstressed, control stressed and restricted stressed. F2 offspring were studied at postnatal day 35 (PN35), 6, 12, and 16 mo. Peripheral quantitative computed tomography was performed on maternal and F2 offspring femurs. Restricted females, irrespective of stress during pregnancy, had decreased endosteal circumference, bending strength, and increased osteocalcin concentrations after pregnancy at 13 mo. F2 offspring of stressed mothers were born lighter. F2 male offspring from stressed pregnancies had decreased trabecular content at 6 mo and decreased endosteal circumference at 16 mo. F2 female offspring from growth-restricted mothers had reduced cortical thickness at PN35 and reduced endosteal circumference at 6 mo. At 12 mo, females from unstressed restricted and stressed control mothers had decreased trabecular content. Low birth weight females had long-term bone changes, highlighting programming effects on bone health. Stress during pregnancy did not exacerbate these programmed effects. Male and female offspring responded differently to maternal growth restriction and stress, indicating gender-specific programming effects.

Technical basis for the reduction of the maximum temperature TGA-MS analysis of oxide samples from the 3013 destructive examination program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Scogin, J. H.

2016-03-24

Thermogravimetric analysis with mass spectroscopy of the evolved gas (TGA-MS) is used to quantify the moisture content of materials in the 3013 destructive examination (3013 DE) surveillance program. Salts frequently present in the 3013 DE materials volatilize in the TGA and condense in the gas lines just outside the TGA furnace. The buildup of condensate can restrict the flow of purge gas and affect both the TGA operations and the mass spectrometer calibration. Removal of the condensed salts requires frequent maintenance and subsequent calibration runs to keep the moisture measurements by mass spectroscopy within acceptable limits, creating delays in processingmore » samples. In this report, the feasibility of determining the total moisture from TGA-MS measurements at a lower temperature is investigated. A temperature of the TGA-MS analysis which reduces the complications caused by the condensation of volatile materials is determined. Analysis shows that an excellent prediction of the presently measured total moisture value can be made using only the data generated up to 700 °C and there is a sound physical basis for this estimate. It is recommended that the maximum temperature of the TGA-MS determination of total moisture for the 3013 DE program be reduced from 1000 °C to 700 °C. It is also suggested that cumulative moisture measurements at 550 °C and 700°C be substituted for the measured value of total moisture in the 3013 DE database. Using these raw values, any of predictions of the total moisture discussed in this report can be made.« less

Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial 1

PubMed Central

Matte, Roselene; Hilário, Thamires de Souza; Reich, Rejane; Aliti, Graziella Badin; Rabelo-Silva, Eneida Rejane

2016-01-01

Abstract Objective: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856 PMID:27463113

Prediction of Combustion Gas Deposit Compositions

NASA Technical Reports Server (NTRS)

Kohl, F. J.; Mcbride, B. J.; Zeleznik, F. J.; Gordon, S.

1985-01-01

Demonstrated procedure used to predict accurately chemical compositions of complicated deposit mixtures. NASA Lewis Research Center's Computer Program for Calculation of Complex Chemical Equilibrium Compositions (CEC) used in conjunction with Computer Program for Calculation of Ideal Gas Thermodynamic Data (PAC) and resulting Thermodynamic Data Base (THDATA) to predict deposit compositions from metal or mineral-seeded combustion processes.

Healthcare workers' challenges in the implementation of tuberculosis infection prevention and control measures in Mozambique.

PubMed

Brouwer, Miranda; Coelho, Eliana; Mosse, Carla das Dores; Brondi, Luciana; Winterton, Laura; van Leth, Frank

2014-01-01

Healthcare Workers (HCWs) have a higher frequency of TB exposure than the general population and have therefore an occupational TB risk that infection prevention and control (IPC) measures aim to reduce. HCWs are crucial in the implementation of these measures. The objective of the study was to investigate Mozambican HCWs' perceptions of their occupational TB risk and the measures they report using to reduce this risk. In addition, we explored the challenges HCWs encounter while using these TBIPC measures. Focus group discussion. Analysis according content method. Four categories of HCWs: auxiliary workers, medical (doctors and clinical officers), nurses and TB program staff. HCWs are aware of their occupational TB risk and use various measures to reduce their risk of infection. HCWs find it challenging to employ measures that minimize such risks and a lack of clear guidelines contributes to these challenges. HCWs' and patient behavior further complicate the use of TBIPC measures. HCWs in Mozambique perceive a high occupational risk of TB infection. They report several challenges using measures to reduce this risk such as shortage of material, lack of clear guidelines, insufficient motivation and inadequate training. Robust training with motivational approaches, alongside supervision and support for HCWs could improve implementation of TBIPC measures. Healthcare management should address the areas for improvement that are beyond the individual HCW's control.

A health partnership to reduce neonatal mortality in four hospitals in Rwanda.

PubMed

Ntigurirwa, Placide; Mellor, Kathy; Langer, Daniel; Evans, Mari; Robertson, Emily; Tuyisenge, Lisine; Groves, Alan; Lissauer, Tom

2017-06-01

A health partnership to improve hospital based neonatal care in Rwanda to reduce neonatal mortality was requested by the Rwandan Ministry of Health. Although many health system improvements have been made, there is a severe shortage of health professionals with neonatal training. Following a needs assessment, a health partnership grant for 2 years was obtained. A team of volunteer neonatologists and paediatricians, neonatal nurses, lactation consultants and technicians with experience in Rwanda or low-income countries was assembled. A neonatal training program was provided in four hospitals (the 2 University hospitals and 2 district hospitals), which focused on nutrition, provision of basic respiratory support with nasal CPAP (Continuous Positive Airway Pressure), enhanced record keeping, thermoregulation, vital signs monitoring and infection control. To identify if care delivery improved, audits of nutritional support, CPAP use and its complications, and documentation in newly developed neonatal medical records were conducted. Mortality data of neonatal admissions was obtained. Intensive neonatal training was provided on 27 short-term visits by 10 specialist health professionals. In addition, a paediatric doctor spent 3 months and two spent 6 months each providing training. A total of 472 training days was conducted in the neonatal units. For nutritional support, significant improvements were demonstrated in reduction in time to initiation of enteral feeds and to achieve full milk feeds, in reduction in maximum postnatal weight loss, but not in days for regaining birth weight. Respiratory support with bubble CPAP was applied to 365 infants in the first 18 months. There were no significant technical problems, but tissue damage, usually transient, to the nose and face was recorded in 13%. New medical records improved documentation by doctors, but nursing staff were reluctant to use them. Mortality for University teaching hospital admissions was reduced from 23.6% in the 18 months before the project to 21.7%. For the two district hospitals, mortality reduced from 10% to 8.1%. A major barrier to training and improved care was low number of nurses working on neonatal units and staff turnover. This health partnership delivered an intensive program of capacity building by volunteer specialists. Improved care and documentation were demonstrated. CPAP was successfully introduced. Mortality was reduced. This format can be adapted for further training and improvement programs to improve the quality of facility-based care.

Army Aviation’s Role in USAFRICOM and United States Army Africa

DTIC Science & Technology

2010-02-16

objective of building partnership capacities, than saving a loved one’s life or welcoming a new baby after a pregnancy complication . The...disaster, with over 1.8 million people in need of food and healthcare assistance. Further complicating the issue is the presence of Violent Extremist...Africa and global health here yesterday. “In contrast, security- related programs receive only about $250 million from a multibillion dollar worldwide

[Effectiveness of a home hospitalization program for patients with urinary tract infection after discharge from an emergency department].

PubMed

Soledad Gallardo, María; Antón, Ane; Pulido Herrero, Esther; Itziar Larruscain, Miren; Guinea Suárez, Rocío; García Gutiérrez, Susana; Sandoval Negral, Julio César

2017-10-01

To compare outcomes of urinary tract infections (UTIs) in patients referred to a home hospitalization program or admitted to a conventional ward after initial management in the emergency department. Prospective, quasi-experimental study of patients with UTIs attended in 3 hospital emergency departments in the public health system of the Basque Country, Spain, between January 2012 and June 2013. Patients were assigned to 2 groups according to site of treatment (home or hospital ward) after discharge from the emergency department. We collected sociodemographic data, history of kidney or urologic symptoms, concomitant diseases, risk for complicated UTI, presentation on admission to the emergency department, diagnostic findings, and prescribed treatments. The main outcome was poor clinical course (local complications during hospital or home care, recurrence, or readmission related to UTI. Multivariate logistic modeling was used to analyze factors related to poor clinical course. Home hospitalization was the main independent variable of interest. Patients referred to home hospitalization were more often women (70.6% vs 57.1% men, P=.04). Fewer cases of prior admission were recorded in the group treated at home (2.4% vs 9.5% of hospitalized patients, P=.03). Likewise, fewer home-hospitalization patients had risk factors for complicated UTI (58.7% vs 83.3% in the hospitalized group, P<.001). The only significant difference in complications between the 2 groups was a lower rate of acute confusional state in patients assigned to home hospitalization (0.8% vs 8.3% in hospitalized patients, P=.007). The frequency of poor clinical course was similar in home-hospitalized and ward-admitted patients. The clinical course of UTI is similar whether patients are hospitalized after emergency department management or discharged to a home hospitalization program.

Incentive spirometry does not enhance recovery after thoracic surgery.

PubMed

Gosselink, R; Schrever, K; Cops, P; Witvrouwen, H; De Leyn, P; Troosters, T; Lerut, A; Deneffe, G; Decramer, M

2000-03-01

To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections. Randomized controlled trial. University hospital, intensive care unit, and surgical department. Sixty-seven patients (age, 59 +/- 13 yrs; forced expiratory volume in 1 sec, 93% +/- 22% predicted) undergoing elective thoracic surgery for lung (n = 40) or esophagus (n = 27) resection. Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone. Lung function, body temperature, chest radiograph, white blood cell count, and number of hospital and intensive care unit days were all measured. Pulmonary function was significantly reduced after surgery (55% of the initial value) and improved significantly in the postoperative period in both groups. However, no differences were observed in the recovery of pulmonary function between the groups. The overall score of the chest radiograph, based on the presence of atelectasis, was similar in both treatment groups. Eight patients (12%) (three patients with lobectomy and five with esophagus resection) developed a pulmonary complication (abnormal chest radiograph, elevated body temperature and white blood cell count), four in each treatment group. Adding IS to regular PT did not reduce hospital or intensive care unit stay. Pulmonary complications after lung and esophagus surgery were relatively low. The addition of IS to PT did not further reduce pulmonary complications or hospital stay. Although we cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.

Infectious Complications in Children With Acute Myeloid Leukemia and Down Syndrome: Analysis of the Prospective Multicenter Trial AML-BFM 2004.

PubMed

Hassler, Angela; Bochennek, Konrad; Gilfert, Julia; Perner, Corinna; Schöning, Stefan; Creutzig, Ursula; Reinhardt, Dirk; Lehrnbecher, Thomas

2016-06-01

Children with acute myeloid leukemia (AML) and Down syndrome have high survival rates with intensity-reduced chemotherapeutic regimens, although the optimal balance between dose intensity and treatment toxicity has not been determined. We, therefore, characterized infectious complications in children with AML and Down syndrome treated according to AML-BFM 2004 study (ClinicalTrials.gov NCT00111345; amended 2006 for Down syndrome with reduced intensity). Data on infectious complications were gathered from the medical records in the hospital where the patient was treated. Infectious complications were categorized as fever without identifiable source (FUO), or as microbiologically or clinically documented infections. A total of 157 infections occurred in 61 patients (60.5% FUO, 9.6% and 29.9% clinically and microbiologically documented infections, respectively). Almost 90% of the pathogens isolated from the bloodstream were Gram-positive bacteria, and approximately half of them were viridans group streptococci. All seven microbiologically documented episodes of pneumonia were caused by viruses. Infection-related mortality was 4.9%, and all three patients died due to viral infection. Our data demonstrate that a reduced-intensity chemotherapeutic regimen in children with AML and Down syndrome is still associated with high morbidity. Although no patient died due to bacteria or fungi, viruses were responsible for all lethal events. Future studies, therefore, have to focus on the impact of viruses on morbidity and mortality of patients with AML and Down syndrome. © 2016 Wiley Periodicals, Inc.

Guidance and examination by ultrasound versus landmark and radiographic method for placement of subclavian central venous catheters: study protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background Central venous catheters play an important role in patient care. Real-time ultrasound-guided subclavian central venous (SCV) cannulation may reduce the incidence of complications and the time between skin penetration and the aspiration of venous blood into the syringe. Ultrasonic diagnosis of catheter misplacement and pneumothorax related to central venous catheterization is rapid and accurate. It is unclear, however, whether ultrasound real-time guidance and examination can reduce procedure times and complication rates when compared with landmark guidance and radiographic examination for SCV catheterization. Methods/Design The Subclavian Central Venous Catheters Guidance and Examination by UltraSound (SUBGEUS) study is an investigator-initiated single center, randomized, controlled two-arm trial. Three hundred patients undergoing SCV catheter placement will be randomized to ultrasound real-time guidance and examination or landmark guidance and radiographic examination. The primary outcome is the time between the beginning of the procedure and control of the catheter. Secondary outcomes include the times required for the six components of the total procedure, the occurrence of complications (pneumothorax, hemothorax, or misplacement), failure of the technique and occurrence of central venous catheter infections. Discussion The SUBGEUS trial is the first randomized controlled study to investigate whether ultrasound real-time guidance and examination for SCV catheter placement reduces all procedure times and the rate of complications. Trial registration ClinicalTrials.gov Identifier: NCT01888094 PMID:24885789

Cinnamon effects on metabolic syndrome: a review based on its mechanisms

PubMed Central

Mollazadeh, Hamid; Hosseinzadeh, Hossein

2016-01-01

Objective(s): Nowadays, cardiovascular diseases (CVDs) are the major risk factors of death globally. One of the most undeniable reasons of CVDs is metabolic syndrome (MetS). MetS is defined as a complex of diseases including insulin resistance, hyperglycemia, obesity, high blood pressure and dyslipidemia. The use of complementary medicine such as traditional herbal species can be effective in treatment of MetS’s complications. Cinnamomum verum (family Lauraceae) is a medicinal global plant which has been used daily by people all over the world. Positive effects of cinnamon in reducing blood pressure, plasma glucose, obesity and ameliorating dyslipidemia which represented in traditional medicine introduced it as probable decreasing MetS’s complications agent. The aim of this review was to investigate the mechanisms of C. verum in reducing the MetS’s complications and CVDs risk factors. Materials and Methods: Various databases such as PubMed, Science Direct, Scopus, Web of Science, Google Scholar and Persian Websites such as www.sid.ir with keywords search of cinnamon, cinnamomum, cinnamaldehyde, atherogenic, hypertension, hyperglycemia, insulin resistance, obesity and dyslipidemia have been included in this search. Results: Clinical data and mechanisms of action of C. verum and its active ingredients that have been shown in this review indicated that cinnamon has protective effects against MetS’s aspects in various ways. Conclusion: The use of this plant can be effective in reducing MetS’s complications and its morbidity and mortality. PMID:28096957

[Safety of reducing the recovery time after percutaneous and laparoscopic liver biopsy].

PubMed

Nodarse-Pérez, Pablo Orlando; Pérez-Menéndez, Roberto; Heredia-Andrade, Enkly Dennys; Noa-Pedroso, Guillermo; Araluce-Cordoví, Roberto; Fernández-Sotolongo, José

2016-01-01

Liver biopsy is the main diagnostic tool for the study of the liver, and as such, its inherent complications have been minimised as much as possible over the years, through the modification of several factors regarding its procedure, including post-biopsy recovery time. The aim of this study was to evaluate the safety in the reduction of post-liver biopsy recovery time. A non-blinded, randomised clinical trial was conducted in the "Hermanos Ameijeiras" Hospital from November 2011 to October 2012, on 128 patients in order to assess safety when reducing post-biopsy recovery times. The patients were randomised into 2 groups. Group A was allowed a 6-hour recovery time, while Group B was allowed a 2-hour recovery time after liver biopsy. Complications were fully recorded. The Chi squared test of homogeneity and Student t test was used as appropriate, in the statistical analysis, a significance level of 0.05 was set. The main biopsy indication was elevated plasma transaminases. Pain in the puncture site was the most recurrent complication (67.2%), and the most serious complication was subcapsular liver haematoma in two cases (1.6%). There were no differences regarding the liver biopsy technique that could have caused complications in any group. There were no significant differences between 2 hours and 6 hours post-liver biopsy recovery time in terms of complications, so it is considered that after two hours the patient is incorporated more quickly into their activities, and the institution spends less material and human resources. Copyright © 2016. Published by Masson Doyma México S.A.

Analysis of complications and perioperative data after open or percutaneous dorsal instrumentation following traumatic spinal fracture of the thoracic and lumbar spine: a retrospective cohort study including 491 patients.

PubMed

Kreinest, Michael; Rillig, Jan; Grützner, Paul A; Küffer, Maike; Tinelli, Marco; Matschke, Stefan

2017-05-01

The aim of the current study is to analyze perioperative data and complications of open vs. percutaneous dorsal instrumentation after dorsal stabilization in patients suffering from fractures of the thoracic or lumbar spine. In the time period from 01/2007 to 06/2009, open surgical approach was used for dorsal stabilization. The percutaneous surgical approach was used from 05/2009 to 03/2014. In every time period, all types of fractures were treated only by open or by percutaneous approach, respectively, to avoid any selection bias. Retrospectively, epidemiological data, complications and perioperative data were documented and statistically analyzed. A total of 491 patients met the inclusion criteria. Open surgery procedure was carried out on 169 patients, and percutaneous surgery procedure was carried out on 322 patients. Fracture level ranged from T1 to L5, and fractures were classified types A, B, and C. In 91.4% of all patients, no complication occured following dorsal stabilization after traumatic spine fracture during their hospital stay. However, 42 complications related to dorsal stabilization have been documented during the hospital stay. The complication rate was 14.8% if open surgical approach has been used and was significantly reduced to 5.3% using percutaneous surgical approach. Post-operative hospital stay was also reduced significantly using the percutaneous surgical approach. According to the current study, percutaneous dorsal stabilization of the spine could also be safely used in trauma cases and is not restricted to degenerative spinal surgery.

The role of hemostatic agents in preventing complications in laparoscopic partial nephrectomy

PubMed Central

y Gregorio, Sergio Alonso; Rivas, Juan Gómez; Bazán, Alfredo Aguilera; Sebastián, Jesús Díez; Martínez-Piñeiro, Luis

2017-01-01

Introduction Nephron-sparing surgery is currently the treatment of choice for renal cell carcinoma stage T1a. During the past years, several hemostatic agents (HA) have been developed in order to reduce surgical complications. We present the results of our series and the impact of the use of HA in the prevention of surgical complications in laparoscopic partial nephrectomies (LPNs). Material and methods We retrospectively analyzed all LPN performed in our center from 2005 to 2012. A total of 77 patients were included for analysis. Patients were divided into two groups: Group A (no use of HA) and Group B (use of HA). HA used included gelatin matrix thrombin (FloSeal) and oxidized regenerated cellulose (Surgicel). Demographics, perioperative variables, and complications were analyzed with a special interest in postoperative bleeding and urinary leakage. Results Median age was 57.17 years old (±12.1), 72.7% were male, most common comorbidities were hypertension (33.8%) and diabetes mellitus (18.2%). All patients had one solitary tumor, and 87% had a tumor ≤4 cm. Renal cell carcinoma was found in 79.2% of cases, and 78.7% were stage pT1a. and were used in 36 cases (46.8%). No differences were found in demographics, perioperative variables, and complications between groups. No conversions to open surgery or perioperative mortality were reported. Conclusions We conclude that in our series the use of a hemostatic agent did not offer benefit in reducing the complication rate over sutures over a bolster. PMID:29410886

Ocular complications and loss of vision due to herpes zoster ophthalmicus in patients with HIV infection and a comparison with HIV-negative patients.

PubMed

Nithyanandam, S; Joseph, M; Stephen, J

2013-02-01

The aim of the work is to describe the occurrence of ocular complications and loss of vision due to herpes zoster ophthalmicus (HZO) in HIV-positive patients who received early antiviral therapy for HZO.This is a post hoc analysis of prospectively collected data.Twenty-four HIV-positive patients with HZO were included in this report; male to female ratio was 3.8:1; mean age was 33.5 (±14.9) years. The visual outcome was good, with 14/24 patients having 6/6 vision; severe vision loss (≤6/60) occurred in only 2/24. There was no statistical difference in the visual outcome between the HIV-positive and -negative patients (P = 0.69), although severe vision loss was more likely in HIV-infected patients. The ocular complications of HZO in HIV-infected patients were: reduced corneal sensation (17/24), corneal epithelial lesions (14/24), uveitis (12/24), elevated intraocular pressure (10/24) and extra-ocular muscle palsy (3/24). The severity of rash was similar in the two groups but multidermatomal rash occurred only in HIV-infected patients (4/24). There was no difference in the occurrence of ocular complications of HZO between HIV-positive and HIV-negative patients. HZO associated ocular complications and visual loss is low in HIV-infected patients if treated with HZO antiviral therapy and was comparable with HIV-negative patients. Early institution of HZO antiviral therapy is recommended to reduce ocular complication and vision loss.

Nonverbal and Language-Reduced Measures of Cognitive Ability: A Review and Evaluation

ERIC Educational Resources Information Center

Drevon, Daniel D.; Knight, Rachel M.; Bradley-Johnson, Sharon

2017-01-01

With the number of new and revised nonverbal and language-reduced tests of cognitive ability, selection and interpretation of appropriate measures can be complicated. Seven nonverbal or language-reduced tests with normative data collected within the last 15 years were evaluated. Besides evaluating technical adequacy, other variables affecting test…

[COMPLICATED URINARY TRACT INFECTIONS IN THE ELDERLY].

PubMed

Ćosić, I; Ćosić, V

2016-12-01

Urinary tract infections (UTI) are the most common bacterial infections involving lower (cystitis, prostatitis) or upper (pyelonephritis, renal abscess, perinephric abscess) urinary tract. Differentiation of complicated and uncomplicated UTI is usually based on the presence of structural or functional urinary tract abnormalities, which can increase the risk of treatment failure and development of serious complications. Factors that increase the risk are foreign bodies, stones, obstruction, neurogenic bladder, kidney transplantation, immunosuppression, and pregnancy. Complicated UTI includes a spectrum of conditions that increase the risk of treatment failure, as well as of serious complications such as bacteremia and sepsis, perinephric abscess, renal impairment and emphysematous pyelonephritis. To avoid the potentially devastating outcomes, appropriate diagnostic procedures, antibiotic and surgical treatment, and appropriate follow-up are required. The incidence of complicated UTI will grow in the future due to general aging of the population, increasing incidence of diabetes, and ever growing number of immunocompromised and immunosuppressed patients. It is of key importance to recognize complicated UTI on time, and treat it wisely and aggressively to reduce duration of the disease and the risk of antibiotic resistance.

XGlycScan: An Open-source Software For N-linked Glycosite Assignment, Quantification and Quality Assessment of Data from Mass Spectrometry-based Glycoproteomic Analysis.

PubMed

Aiyetan, Paul; Zhang, Bai; Zhang, Zhen; Zhang, Hui

2014-01-01

Mass spectrometry based glycoproteomics has become a major means of identifying and characterizing previously N-linked glycan attached loci (glycosites). In the bottom-up approach, several factors which include but not limited to sample preparation, mass spectrometry analyses, and protein sequence database searches result in previously N-linked peptide spectrum matches (PSMs) of varying lengths. Given that multiple PSM scan map to a glycosite, we reason that identified PSMs are varying length peptide species of a unique set of glycosites. Because associated spectra of these PSMs are typically summed separately, true glycosite associated spectra counts are lost or complicated. Also, these varying length peptide species complicate protein inference as smaller sized peptide sequences are more likely to map to more proteins than larger sized peptides or actual glycosite sequences. Here, we present XGlycScan. XGlycScan maps varying length peptide species to glycosites to facilitate an accurate quantification of glycosite associated spectra counts. We observed that this reduced the variability in reported identifications of mass spectrometry technical replicates of our sample dataset. We also observed that mapping identified peptides to glycosites provided an assessment of search-engine identification. Inherently, XGlycScan reported glycosites reduce the complexity in protein inference. We implemented XGlycScan in the platform independent Java programing language and have made it available as open source. XGlycScan's source code is freely available at https://bitbucket.org/paiyetan/xglycscan/src and its compiled binaries and documentation can be freely downloaded at https://bitbucket.org/paiyetan/xglycscan/downloads. The graphical user interface version can also be found at https://bitbucket.org/paiyetan/xglycscangui/src and https://bitbucket.org/paiyetan/xglycscangui/downloads respectively.

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

PubMed

Compostella, Leonida; Compostella, Caterina; Russo, Nicola; Setzu, Tiziana; Iliceto, Sabino; Bellotto, Fabio

2017-09-01

During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

Theory-based self-management educational interventions on patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Zhao, Fang-Fang; Suhonen, Riitta; Koskinen, Sanna; Leino-Kilpi, Helena

2017-04-01

To synthesize the effects of theory-based self-management educational interventions on patients with type 2 diabetes (T2DM) in randomized controlled trials. Type 2 diabetes is a common chronic disease causing complications that put a heavy burden on society and reduce the quality of life of patients. Good self-management of diabetes can prevent complications and improve the quality of life of T2DM patients. Systematic review with meta-analysis of randomized controlled trials following Cochrane methods. A literature search was carried out in the MEDLINE, EMBASE, CINAHL, PSYCINFO, and Web of Science databases (1980-April 2015). The risk of bias of these eligible studies was assessed independently by two authors using the Cochrane Collaboration's tool. The Publication bias of the main outcomes was examined. Statistical heterogeneity and random-effects model were used for meta-analysis. Twenty studies with 5802 participants met the inclusion criteria. The interventions in the studies were based on one or more theories which mostly belong to mid-range theories. The pooled main outcomes by random-effects model showed significant improvements in HbA1c, self-efficacy, and diabetes knowledge, but not in BMI. As for quality of life, no conclusions can be drawn as the pooled outcome became the opposite with reduced heterogeneity after one study was excluded. No significant publication bias was found in the main outcomes. To get theory-based interventions to produce more effects, the role of patients should be more involved and stronger and the education team should be trained beyond the primary preparation for the self-management education program. © 2016 John Wiley & Sons Ltd.

Intraocular pressure control of a novel glaucoma drainage device - in vitro and in vivo studies

PubMed Central

Cui, Li-Jun; Li, Di-Chen; Liu, Jian; Zhang, Lei; Xing, Yao

2017-01-01

AIM To evaluate the intraocular pressure (IOP) control of an artificial trabeculum drainage system (ATDS), a newly designed glaucoma drainage device, and postoperative complications in normal rabbit eyes. METHODS Pressure drops in air and fluid of 30 ATDS were measured after being connected to a closed manometric system. Twenty of them were then chosen and implanted randomly into the eyes of 20 rabbits. Postoperative slit-lamp, gonioscopic examination and IOP measurements were recorded periodically. Ultrasound biomicroscopy and B-scan ultrasonography were also used to observe the complications. Eyes were enucleated on day 60. RESULTS Pressure drops of 4.6-9.4 mm Hg were obtained at physiological aqueous flow rates in the tests in vitro. The average postoperative IOP of the experimental eyes (11.6-12.8 mm Hg) was lower than the controls significantly (P<0.05) at each time point. Complications of hemorrhage (n=1), cellulosic exudation (two cases) and local iris congestion (two cases) were observed. The lumina of the devices were devoid of obstructions in all specimens examined and a thin fibrous capsule was found around the endplate. CONCLUSION ATDS reduce IOP effectively. However, further studies on the structure are needed to reduce complications. PMID:28944192

Complications of hypospadias surgery: Experience in a tertiary hospital of a developing country

PubMed Central

Appeadu-Mensah, William; Hesse, Afua Adwo Jectey; Glover-Addy, Hope; Osei-Nketiah, Samuel; Etwire, Victor; Sarpong, Pokua Ama

2015-01-01

Background: Over 300 different operations have been described for the management of hypospadias. In recent times, the numbers of operations used in various centres have gradually reduced as the principles necessary to ensure adequate cosmetic and functional results with minimum complications are better understood. The aim of this article was to review the different types of operations used for managing hypospadias in a tertiary hospital in a developing country, to analyse the complications of surgery and discuss the factors that contribute to complications. Materials and Methods: Patient folders, theatre, and ward records were used to obtain the required information. The age at surgery, types of hypospadias at presentation, types of operations done and complications were analysed. Results and Conclusion: With three main types of operations, tubularised incised plate urethroplasty and meatal advancement and glanuloplasty incorporated for anterior hypospadias (glanular, coronal, subcoronal, distal, midpenile), and lateral based flap urethroplasty for posterior hypospadias (proximal penile, penoscrotal, scrotal, perineal), most hypospadias were corrected with acceptable complication rates. PMID:26712282

Complications of thoracentesis: incidence, risk factors, and strategies for prevention.

PubMed

Cantey, Eric P; Walter, James M; Corbridge, Thomas; Barsuk, Jeffrey H

2016-07-01

Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. In this article, we review the risk factors and prevention of the most common complications of thoracentesis including pneumothorax, bleeding (chest wall hematoma and hemothorax), and re-expansion pulmonary edema. Recent data support the importance of operator expertise and the use of ultrasound in reducing the risk of iatrogenic pneumothorax. Although coagulopathy or thrombocytopenia and the use of anticoagulant or antiplatelet medications have traditionally been viewed as contraindications to thoracentesis, new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk. Re-expansion pulmonary edema, a rare complication of thoracentesis, is felt to result in part from the generation of excessively negative pleural pressure. When and how to monitor changes in pleural pressure during thoracentesis remains a focus of ongoing study. Major complications of thoracentesis are uncommon. Clinician awareness of risk factors for procedural complications and familiarity with strategies that improve outcomes are essential components for safely performing thoracentesis.

Clinical profiles, comorbidities and complications of type 2 diabetes mellitus in patients from United Arab Emirates.

PubMed

Jelinek, Herbert F; Osman, Wael M; Khandoker, Ahsan H; Khalaf, Kinda; Lee, Sungmun; Almahmeed, Wael; Alsafar, Habiba S

2017-01-01

To assess clinical profiles of patients with type 2 diabetes in the United Arab Emirates (UAE), including patterns, frequencies, and risk factors of microvascular and macrovascular complications. Four hundred and ninety patients with type 2 diabetes were enrolled from two major hospitals in Abu Dhabi. The presence of microvascular and macrovascular complications was assessed using logistic regression, and demographic, clinical and laboratory data were collected. Significance was set at p<0.05. Hypertension (83.40%), obesity (90.49%) and dyslipidemia (93.43%) were common type 2 diabetes comorbidities. Most of the patients had relatively poor glycemic control and presented with multiple complications (83.47% of patients had one or more complication), with frequent renal involvement. The most frequent complication was retinopathy (13.26%). However, the pattern of complications varied based on age, where in patients <65 years, a single pattern presented, usually retinopathy, while multiple complications was typically seen in patients >65 years old. Low estimated glomerular filtration rate in combination with disease duration was the most significant risk factor in the development of a diabetic-associated complication especially for coronary artery disease, whereas age, lipid values and waist circumference were significantly associated with the development of diabetic retinopathy. Patients with type 2 diabetes mellitus in the UAE frequently present with comorbidities and complications. Renal disease was found to be the most common comorbidity, while retinopathy was noted as the most common diabetic complication. This emphasizes the need for screening and prevention program toward early, asymptomatic identification of comorbidities and commence treatment, especially for longer disease duration.

Vacuum-assisted drainage in cardiopulmonary bypass: advantages and disadvantages.

PubMed

Carvalho Filho, Elio Barreto de; Marson, Fernando Augusto de Lima; Costa, Loredana Nilkenes Gomes da; Antunes, Nilson

2014-01-01

Systematic review of vacuum assisted drainage in cardiopulmonary bypass, demonstrating its advantages and disadvantages, by case reports and evidence about its effects on microcirculation. We conducted a systematic search on the period 1997-2012, in the databases PubMed, Medline, Lilacs and SciELO. Of the 70 selected articles, 26 were included in the review. Although the vacuum assisted drainage has significant potential for complications and requires appropriate technology and professionalism, prevailed in literature reviewed the concept that vacuum assisted drainage contributed in reducing the rate of transfusions, hemodilutions, better operative field, no significant increase in hemolysis, reduced complications surgical, use of lower prime and of smaller diameter cannulas.

Reducing patient drug acquisition costs can lower diabetes health claims.

PubMed

Mahoney, John J

2005-08-01

Concerned about rising prevalence and costs of diabetes among its employees, Pitney Bowes Inc recently revamped its drug benefit design to synergize with ongoing efforts in its disease management and patient education programs. Specifically, based on a predictive model showing that low medication adherence was linked to subsequent increases in healthcare costs in patients with diabetes, the company shifted all diabetes drugs and devices from tier 2 or 3 formulary status to tier 1. The rationale was that reducing patient out-of-pocket costs would eliminate financial barriers to preventive care, and thereby increase adherence, reduce costly complications, and slow the overall rate of rising healthcare costs. This single change in pharmaceutical benefit design immediately made critical brand-name drugs available to most Pitney Bowes employees and their covered dependents for 10% coinsurance, the same coinsurance level as for generic drugs, versus the previous cost share of 25% to 50%. After 2 to 3 years, preliminary results in plan participants with diabetes indicate that medication possession rates have increased significantly, use of fixed-combination drugs has increased (possibly related to easier adherence), average total pharmacy costs have decreased by 7%, and emergency department visits have decreased by 26%. Hospital admission rates, although increasing slightly, remain below the demographically adjusted Medstat benchmark. Overall direct healthcare costs per plan participant with diabetes decreased by 6%. In addition, the rate of increase in overall per-plan-participant health costs at Pitney Bowes has slowed markedly, with net per-plan-participant costs in 2003 at about 4000 dollars per year versus 6500 dollars for the industry benchmark. This recent moderation in overall corporate health costs may be related to these strategic changes in drug benefit design for diabetes, asthma, and hypertension and also to ongoing enhancements in the company's disease management and wellness programs.

Family planning is reducing abortions.

PubMed

Clinton, H R

1997-01-01

This news brief presents the US President's wife's statement on the association between use of family planning and a decline in abortions worldwide. Hillary Rodham Clinton attended the Sixth Conference of Wives of Heads of State and Government of the Americas held in La Paz, Bolivia. The conference was suitably located in Bolivia, a country with the highest rates of maternal mortality in South America. Bolivia has responded by launching a national family planning campaign coordinated between government, nongovernmental, and medical organizations. Half of Bolivian women experience pregnancy and childbirth without the support of trained medical staff. Mortality from abortion complications account for about half of all maternal deaths in Bolivia. Voluntary family planning workers teach women about the benefits of child spacing, breast feeding, nutrition, prenatal and postpartum care, and safe deliveries. Bolivia has succeeded in increasing its contraceptive use rates and decreasing the number of safe and unsafe abortions. Bolivia's program effort was supported by USAID. USAID provided technical assistance and funds for the establishment of a network of primary health care clinics. Mrs. Clinton visited one such clinic in a poor neighborhood in La Paz, which in its first six months of operation provided 2200 consultations, delivered 200 babies, registered 700 new family planning users, and immunized 2500 children. Clinics such as this one will be affected by the US Congress's harsh cuts in aid, which reduce funding by 35% and delay program funding by 9 months. These US government cuts in foreign aid are expected to result in an additional 1.6 million abortions, over 8000 maternal deaths, and 134,000 infant deaths in developing countries. An investment in population assistance represents a sensible, cost-effective, and long-term strategy for improving women's health, strengthening families, and reducing abortion.

Pediatric American College of Surgeons National Surgical Quality Improvement Program: feasibility of a novel, prospective assessment of surgical outcomes.

PubMed

Raval, Mehul V; Dillon, Peter W; Bruny, Jennifer L; Ko, Clifford Y; Hall, Bruce L; Moss, R Lawrence; Oldham, Keith T; Richards, Karen E; Vinocur, Charles D; Ziegler, Moritz M

2011-01-01

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) provides validated assessment of surgical outcomes. This study reports initiation of an ACS NSQIP Pediatric at 4 children's hospitals. From October 2008 to June 2009, 121 data variables were prospectively collected for 3315 patients, including 30-day outcomes and tailoring the ACS NSQIP methodology to children's surgical specialties. Three hundred seven postoperative complications/occurrences were detected in 231 patients representing 7.0% of the study population. Of the patients with complications, 175 (75.7%) had 1, 39 (16.9%) had 2, and 17 (7.4%) had 3 or more complications. There were 13 deaths (0.39%) and 14 intraoperative occurrences (0.42%) detected. The most common complications were infection, 105 (34%) (SSI, 54; sepsis, 31; pneumonia, 13; urinary tract infection, 7); airway/respiratory events, 27 (9%); wound disruption, 18 (6%); neurologic events, 8 (3%) (nerve injury, 4; stroke/vascular event, 2; hemorrhage, 2); deep vein thrombosis, 3 (<1%); renal failure, 3 (<1%); and cardiac events, 3 (<1%). Current sampling captures 17.5% of cases across institutions with unadjusted complication rates ranging from 6.8% to 10.2%. Completeness of data collection for all variables exceeded 95% with 98% interrater reliability and 87% of patients having full 30-day follow-up. These data represent the first multiinstitutional prospective assessment of specialty-specific surgical outcomes in children. The ACS NSQIP Pediatric is poised for institutional expansion and future development of risk-adjusted models. Copyright © 2011 Elsevier Inc. All rights reserved.

[Treatment of inflammatory complications of colic diverticular disease at the emergency surgical care hospital].

PubMed

Reznitsky, P A; Yartsev, P A; Shavrina, N V

To assess an effectiveness of minimally invasive and laparoscopic technologies in treatment of inflammatory complications of colic diverticular disease. The study included 150 patients who were divided into control and main groups. Survey included ultrasound, X-ray examination and abdominal computerized tomography. In the main group standardized treatment algorithm including minimally invasive and laparoscopic technologies was used. In the main group 79 patients underwent conservative treatment, minimally invasive (ultrasound-assisted percutaneous drainage of abscesses) and laparoscopic surgery that was successful in 78 (98.7%) patients. Standardized algorithm reduces time of treatment, incidence of postoperative complications, mortality and the risk of recurrent inflammatory complications of colic diverticular disease. Also postoperative quality of life was improved.

Impact of resident training on operative time and safety in hemithyroidectomy.

PubMed

Folsom, Craig; Serbousek, Kimberly; Lydiatt, William; Rieke, Katherine; Sayles, Harlan; Smith, Russell; Panwar, Aru

2017-06-01

The purpose of this study was to present our assessment of the impact of resident participation on operative duration and outcomes after hemithyroidectomy, which may identify opportunities for optimization of educational programs, reduction in cost of healthcare delivery, and maximizing patient safety, while continuing to train a competent physician workforce for the future. The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) dataset from 2006 to 2012 identified 13,151 adult patients who underwent hemithyroidectomy. Differences in operative duration, postoperative complications, reoperation, and readmission rates were assessed based on stratification by resident participation in surgery. Compared with operations performed by attending surgeons alone, resident participation with attending supervision prolonged the operative duration by 10.5% (82.5 minutes vs 91.2 minutes; p < .0001). The incidence of readmission and wound complications was higher for patients who underwent surgery with resident participation. Resident participation in hemithyroidectomy may be associated with increased operative duration, higher incidence of wound complications, and readmission. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1212-1217, 2017. © 2017 Wiley Periodicals, Inc.

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.

PubMed

Boockvar, Kenneth S; Teresi, Jeanne A; Inouye, Sharon K

2016-05-01

Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Antibiotic complications during the treatment of Mycobacterium ulcerans disease in Australian patients.

PubMed

O'Brien, Daniel P; Friedman, Deborah; Hughes, Andrew; Walton, Aaron; Athan, Eugene

2017-09-01

Antibiotics are the recommended first-line treatment for Mycobacterium ulcerans disease. Antibiotic toxicity is common in Australian patients, yet antibiotic complication rates and their risk factors have not been determined. To determine the incidence rate and risk factors for antibiotic toxicity in Australian patients treated for M. ulcerans disease. An analysis of severe antibiotic complications was performed using data from a prospective cohort of M. ulcerans cases managed at Barwon Health from 1 January 1998 to 30 June 2016. A severe antibiotic complication was defined as an antibiotic adverse event that required its cessation. Antibiotic complication rates and their associations were assessed using a Poisson regression model. A total of 337 patients was included; 184 (54.6%) males and median age 57 years (interquartile range (IQR) 36-73 years). Median antibiotic treatment duration was 56 days (IQR 49-76 days). Seventy-five (22.2%) patients experienced severe antibiotic complications after a median 28 days (IQR 17-45 days) at a rate of 141.53 per 100 person-years (95% confidence interval (CI) 112.86-177.47). Eleven (14.7%) patients required hospitalisation. Compared with rifampicin/clarithromycin combinations, severe complication rates were not increased for rifampicin/ciprofloxacin (rate ratio (RR) 1.49, 95% CI 0.89-2.50, P = 0.13) or rifampicin/moxifloxacin (RR 2.54, 95% CI 0.76-8.50, P = 0.13) combinations, but were significantly increased for 'other' combinations (RR 2.53, 95% CI 1.13-5.68, P = 0.03). In a multivariable analysis, severe complication rates were significantly increased with reduced estimated glomerular filtration rates (EGFR) (adjusted rate ratio (aRR) 2.65, 95% CI 1.24-5.65 for EGFR 60-89 mL/min and aRR 1.31, 95% CI 0.49-3.53 for EGFR 0-59 mL/min compared with EGFR ≥90 mL/min, P < 0.01) and female gender (aRR 2.15, 95% CI 1.38-3.30, P < 0.01). Severe antibiotic complications during M. ulcerans treatment are high with increased rates independently associated with reduced renal function and female gender. © 2017 Royal Australasian College of Physicians.

Do Newborns Have More Complications When Mom Has Asthma?

MedlinePlus

... Center Fellows-in-Training Grants & Awards Program Directors Practice Resources ASTHMA IQ Consultation and Referral Guidelines Practice Management Tips Practice Management Workshop Practice Tools Running ...

[A transparent, internal complication management concept: results and consequences].

PubMed

Wagner, G; Gritzbach, B; Frank, J; Marzi, I

2010-09-01

The acquisition of data and public discussion of complications after therapeutic procedures and surgeries is a sensitive subject, which is mostly avoided even in department meetings. However, it is evident that the broad discussion and the expression of different opinions and aspects provide useful information for continuous improvements. Therefore, we established a system for the transparent acquisition of complications in our department. Since January 2005, we systematically register operative and non-operative complications at our department, evaluate them and therefore gain a great benefit. All the complications are presented, discussed and evaluated within the weekly morbidity and mortality conferences. In 2005 and 2006, among a total number of 2730 and, respectively, 3124 operations, 102 (3.7 %) and 71 (2.3 %) complications have been registered and analysed according to different criteria. We have distinguished between complications which required surgery and complications which only required conservative treatment. There was a higher number of complications which needed surgery. In this group, the most common complications have been found in vertebral spine surgery. The groups of complications with conservative treatment were mostly related to nerve lesions and deep venous thrombosis. With the aid of the internal department evaluation of the registered data, especially the number of complications in vertebral spine surgery could be clearly reduced in 2006. The described method has created a transparency of occurring complications because each colleague is informed as well as involved in the solution process. Furthermore, it is planned to evaluate the impact of risk factors on the various performed surgeries. © Georg Thieme Verlag KG Stuttgart · New York.

Impact of an Event Reporting System on Resident Complication Reporting in Plastic Surgery Training: Addressing an ACGME and Plastic Surgery Milestone Project Core Competency.

PubMed

Parikh, Rajiv P; Snyder-Warwick, Alison; Naidoo, Sybill; Skolnick, Gary B; Patel, Kamlesh B

2017-11-01

The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program. This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons. There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001). An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.

Perioperative complications of sleeve gastrectomy: Review of the literature.

PubMed

Iannelli, Antonio; Treacy, Patrick; Sebastianelli, Lionel; Schiavo, Luigi; Martini, Francesco

2018-05-04

Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.

Yield and complications in percutaneous renal biopsy. A comparison between ultrasound-guided gun-biopsy and manual techniques in native and transplant kidneys.

PubMed

Nyman, R S; Cappelen-Smith, J; al Suhaibani, H; Alfurayh, O; Shakweer, W; Akhtar, M

1997-05-01

To compare the yield and complications of ultrasound-guided gun-biopsy and manual Tru-Cut techniques in percutaneous renal biopsy. A total of 448 biopsies were reviewed. They comprised 124 manual and 131 gun-biopsies in native kidneys, and 111 manual and 82 gun-biopsies in transplant kidneys. The gun-biopsies were performed under real-time ultrasound (US) guidance. The manual technique used US mainly for marking the position of the kidney. There was a significantly higher diagnostic yield and fewer complications in the gun-biopsy group. A total of 8 major complications were found, all in the manual group. Provided that the operator is experienced in US scanning, a switch from the manual technique to real-time US-guided gun-biopsy will result in the improvement of diagnostic accuracy together with a reduced risk of complications.

Foot care education in patients with diabetes at low risk of complications: a consensus statement

PubMed Central

McInnes, A; Jeffcoate, W; Vileikyte, L; Game, F; Lucas, K; Higson, N; Stuart, L; Church, A; Scanlan, J; Anders, J

2011-01-01

Aims To define and agree a practical educational framework for delivery by all healthcare professionals managing patients with diabetes, particularly those at low risk of developing foot complications. Methods A consensus meeting of a multidisciplinary expert panel. Prior to the meeting, relevant clinical papers were disseminated to the panel for review. The consensus was largely based upon the experts’ clinical experience and judgement. Results Four main health behaviours were identified for those at low risk of developing foot complications, namely:, control of blood glucose levels; attendance at annual foot screening examination; reporting of any changes in foot health immediately; and the engagement in a simple daily foot care routine. Conclusion There is currently little evidence-based literature to support specific foot care practices. Patients with diabetes at low risk of developing complications should be encouraged to undertake a basic foot care regimen to reduce their likelihood of developing complications. PMID:21219423

[Peripheral Regional Anesthesia Without Any Complications - a Dream Comes True?!

PubMed

Wiesmann, Thomas; Döffert, Jens; Steinfeldt, Thorsten

2018-04-01

Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade ("bleeding/infection/nerve damage"), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus. In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages. Georg Thieme Verlag KG Stuttgart · New York.

Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality.

PubMed

Etzioni, David A; Wasif, Nabil; Dueck, Amylou C; Cima, Robert R; Hohmann, Samuel F; Naessens, James M; Mathur, Amit K; Habermann, Elizabeth B

2015-02-03

Programs that analyze and report rates of surgical complications are an increasing focus of quality improvement efforts. The most comprehensive tool currently used for outcomes monitoring in the United States is the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). To compare surgical outcomes experienced by patients treated at hospitals that did vs did not participate in the NSQIP. Data from the University HealthSystem Consortium from January 2009 to July 2013 were used to identify elective hospitalizations representing a broad spectrum of elective general/vascular operations in the United States. Data on hospital participation in the NSQIP were obtained through review of semiannual reports published by the ACS. Hospitalizations at any hospital that discontinued or initiated participation in the NSQIP during the study period were excluded after the date on which that hospital's status changed. A difference-in-differences approach was used to model the association between hospital-based participation in NSQIP and changes in rates of postoperative outcomes over time. Hospital participation in the NSQIP. Risk-adjusted rates of any complications, serious complications, and mortality during a hospitalization for elective general/vascular surgery. The cohort included 345,357 hospitalizations occurring in 113 different academic hospitals; 172,882 (50.1%) hospitalizations were in NSQIP hospitals. Hospitalized patients were predominantly female (61.5%), with a mean age of 55.7 years. The types of procedures performed most commonly in the analyzed hospitalizations were hernia repairs (15.7%), bariatric (10.5%), mastectomy (9.7%), and cholecystectomy (9.0%). After accounting for patient risk, procedure type, underlying hospital performance, and temporal trends, the difference-in-differences model demonstrated no statistically significant differences over time between NSQIP and non-NSQIP hospitals in terms of likelihood of complications (adjusted odds ratio, 1.00; 95% CI, 0.97-1.03), serious complications (adjusted odds ratio, 0.98; 95% CI, 0.94-1.03), or mortality (adjusted odds ratio, 1.04; 95% CI, 0.94-1.14). No association was found between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time within a large cohort of patients undergoing elective general/vascular operations at academic hospitals in the United States. These findings suggest that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.

Using a standardised protocol was effective in reducing hospitalisation and treatment use in children with newly diagnosed immune thrombocytopenia.

PubMed

Labrosse, R; Vincent, M; Nguyen, U-P; Chartrand, C; Di Liddo, L; Pastore, Y

2017-10-01

Childhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use. A retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded. The protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94-7.61) and 2.3 times less likely to receive treatment (95% CI 1.2-4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70). Our ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Does omental pedicle flap reduce anastomotic leak and septic complications after rectal cancer surgery?

PubMed

Ozben, Volkan; Aytac, Erman; Liu, Xiaobo; Ozuner, Gokhan

2016-03-01

Whether creation of omental pedicle flap (OPF) to reinforce bowel anastomosis can reduce septic outcomes remains controversial. The aim of this study was to investigate the role of this technique on anastomotic leak and septic complications after rectal cancer surgery. Patients who underwent rectal cancer surgery from 01/2008 to 12/2013 were identified and categorized into two groups based on OPF creation versus no-OPF creation. Clinical, operative characteristics and postoperative anastomotic leak and surgical site infections within 30 days after surgery were compared between the groups. There were 65 (14%) and 403 (86%) patients in OPF and no-OPF group, respectively. In multivariate analysis, OPF was not found to be associated with anastomotic leak (p = 0.35), organ/space infections (p = 0.99) and overall surgical site infections (p = 0.65). Three hundred and sixty eight (78.6%) patients underwent diversion. OPF did not reduce septic complications irrespective of the stoma status (p > 0.05). There were no differences between the two groups in terms of operative (p = 0.46) and non-operative management (p = 0.14). OPF neither reduced the incidence of anastomotic leak and surgical site infections nor had any impact on the management of anastomotic leak. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Acute neurorehabilitation: does a neurosensory and coordinated interdisciplinary programme reduce tracheostomy weaning time and weaning failure?

PubMed

Berney, Loric; Wasserfallen, Jean-Blaise; Grant, Kathleen; Levivier, Marc; Simon, Christian; Faouzi, Mohamed; Paillex, Roland; Schweizer, Valérie; Diserens, Karin

2014-01-01

A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency. This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care). Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003). This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments.

Postoperative blood salvage versus allogeneic blood transfusion in total knee and hip arthroplasty: a literature review.

PubMed

Leigheb, Massimiliano; Pogliacomi, Francesco; Bosetti, Michela; Boccafoschi, Francesca; Sabbatini, Maurizio; Cannas, Mario; Grassi, Federico

2016-04-15

We aimed to compare Postoperative Blood Salvage (PBS) with Allogeneic Blood Transfusion (ABT) in patients undergoing Total Hip and Knee Arthroplasty (THA, TKA).  A bibliographic research was carried out in order to review the literature dedicated to postoperative blood salvage in major orthopaedic surgery, excluding papers dealing exclusively with preoperative autologous donation, intraoperative blood salvage and ABT. PBS and ABT were compared according to complications, costs and duration of hospitalization. PBS effectiveness in reducing ABT was also assessed. PBS system is useful for reducing the complication rate and the length of hospital stay if compared to ABT. Costs for the reinfusion of unwashed shed blood, washed blood, and allogeneic transfusion are controversial among the different authors. Several papers demonstrate that PBS significantly reduces the need of postoperative ABT in both THA and TKA, while there is low evidence that PBS does not affect the risk of surgical wound complications. To reduce potential risks related to PBS, including non-hemolytic febrile reaction, the reinfusion of saved blood should begin within 4-6 hours after the start of collection through the wound drainage. According to literature, PBS appears to be a valid alternative to ABT, which is the standard treatment for postoperative anemia in THA and TKA. Contraindications to PBS must be ruled out before recommending it to patients undergoing major orthopaedic procedures.

Rigid Plate Fixation Versus Wire Cerclage for Sternotomy After Cardiac Surgery: A Meta-Analysis.

PubMed

Tam, Derrick Y; Nedadur, Rashmi; Yu, Monica; Yanagawa, Bobby; Fremes, Stephen E; Friedrich, Jan O

2018-03-22

Traditionally, wire cerclage has been used to reapproximate the sternum after sternotomy. Recent evidence suggests that rigid plate fixation for sternal closure may reduce the risk of sternal complications. The Medline and Embase databases were searched from inception to February 2017 for studies that compared rigid plate fixation with wire cerclage for cardiac surgery patients undergoing sternotomy. Random effects meta-analysis compared rates of sternal complications (primary outcome, defined as deep or superficial sternal wound infection, or sternal instability), early mortality, and length of stay (secondary outcomes). Three randomized controlled trials (n = 427) and five unadjusted observational studies (n = 1,025) met inclusion criteria. There was no significant difference in sternal complications with rigid plate fixation at a median of 6 months' follow-up (incidence rate ratio 0.51, 95% confidence interval [CI]: 0.20 to 1.29, p = 0.15) overall, but a decrease when including only patients at high risk for sternal complications (incidence rate ratio 0.23, 95% CI: 0.06 to 0.89, p = 0.03; two observational studies). Perioperative mortality was reduced favoring rigid plate fixation (relative risk 0.40, 95% CI: 0.28 to 0.97, p = 0.04; four observational studies and one randomized controlled trial). Length of stay was similar overall (mean difference -0.77 days, 95% CI: -1.65 to +0.12, p = 0.09), but significantly reduced with rigid plate fixation in the observational studies (mean difference -1.34 days, 95% CI: -2.05 to -0.63, p = 0.0002). This meta-analysis, driven by the results of unmatched observational studies, suggests that rigid plate fixation may lead to reduced sternal complications in patients at high risk for such events, improved perioperative survival, and decreased hospital length of stay. More randomized controlled trials are required to confirm the potential benefits of rigid plate fixation for primary sternotomy closure. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study.

PubMed

Hwee, Jeremiah; Cauch-Dudek, Karen; Victor, J Charles; Ng, Ryan; Shah, Baiju R

2014-05-09

Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling. With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups. Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39). Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.

Reduced thrombin formation and excessive fibrinolysis are associated with bleeding complications in patients with dengue fever: a case–control study comparing dengue fever patients with and without bleeding manifestations

PubMed Central

2013-01-01

Background Dengue cases have been classified according to disease severity into dengue fever (DF) and dengue hemorrhagic fever (DHF). Although DF is considered a non-severe manifestation of dengue, it has been recently demonstrated that DF represents a heterogeneous group of patients with varied clinical complications and grades of severity. Particularly, bleeding complications, commonly associated to DHF, can be detected in half of the patients with DF. Although a frequent complication, the causes of bleedings in DF have not been fully addressed. Thus, the aim of this study was to perform a comprehensive evaluation of possible pathophysiological mechanisms that could contribute to the bleeding tendency observed in patients with DF. Methods This is a case–control study that enrolled adults with DF without bleeding and adults with DF and bleeding complications during the defervescence period. Healthy controls were also included. Peripheral blood counts, inflammatory, fibrinolysis and endothelial cell activation markers, and thrombin generation were evaluated in patients and controls. Results We included 33 adults with DF without complications, 26 adults with DF and bleeding and 67 healthy controls. Bleeding episodes were mild in 15 (57.6%) and moderate in 11 (42.4%) patients, 8 (30.7%) patients had bleedings in multiple sites. Patients with DF and bleedings had lower platelet counts than DF without bleeding (median = 19,500 vs. 203,500/mm3, P < 0,0001). Levels of TNF-α, thrombomodulin and VWF were significantly increased in the two dengue groups than in healthy controls, but similar between patients with and without bleedings. Plasma levels of tPA and D-dimer were significantly increased in patients with bleedings (median tPA levels were 4.5, 5.2, 11.7 ng/ml, P < 0.0001 and median D-dimer levels were 515.5, 1028 and 1927 ng/ml, P < 0.0001). The thrombin generation test showed that patients with bleeding complications had reduced thrombin formation (total thrombin generated were 3753.4 in controls, 3367.5 in non-bleeding and 2274.5nM in bleeding patients, P < 0.002). Conclusions DF can manifest with spontaneous bleedings, which are associated with specific coagulation and fibrinolysis profiles that are not significantly present in DF without this complication. Particularly, thrombocytopenia, excessive fibrinolysis and reduced thrombin formation may contribute to the bleeding manifestations in DF. PMID:23890510

Reduced thrombin formation and excessive fibrinolysis are associated with bleeding complications in patients with dengue fever: a case-control study comparing dengue fever patients with and without bleeding manifestations.

PubMed

Orsi, Fernanda A; Angerami, Rodrigo N; Mazetto, Bruna M; Quaino, Susan K P; Santiago-Bassora, Fernanda; Castro, Vagner; de Paula, Erich V; Annichino-Bizzacchi, Joyce M

2013-07-28

Dengue cases have been classified according to disease severity into dengue fever (DF) and dengue hemorrhagic fever (DHF). Although DF is considered a non-severe manifestation of dengue, it has been recently demonstrated that DF represents a heterogeneous group of patients with varied clinical complications and grades of severity. Particularly, bleeding complications, commonly associated to DHF, can be detected in half of the patients with DF. Although a frequent complication, the causes of bleedings in DF have not been fully addressed. Thus, the aim of this study was to perform a comprehensive evaluation of possible pathophysiological mechanisms that could contribute to the bleeding tendency observed in patients with DF. This is a case-control study that enrolled adults with DF without bleeding and adults with DF and bleeding complications during the defervescence period. Healthy controls were also included. Peripheral blood counts, inflammatory, fibrinolysis and endothelial cell activation markers, and thrombin generation were evaluated in patients and controls. We included 33 adults with DF without complications, 26 adults with DF and bleeding and 67 healthy controls. Bleeding episodes were mild in 15 (57.6%) and moderate in 11 (42.4%) patients, 8 (30.7%) patients had bleedings in multiple sites. Patients with DF and bleedings had lower platelet counts than DF without bleeding (median = 19,500 vs. 203,500/mm3, P < 0,0001). Levels of TNF-α, thrombomodulin and VWF were significantly increased in the two dengue groups than in healthy controls, but similar between patients with and without bleedings. Plasma levels of tPA and D-dimer were significantly increased in patients with bleedings (median tPA levels were 4.5, 5.2, 11.7 ng/ml, P < 0.0001 and median D-dimer levels were 515.5, 1028 and 1927 ng/ml, P < 0.0001). The thrombin generation test showed that patients with bleeding complications had reduced thrombin formation (total thrombin generated were 3753.4 in controls, 3367.5 in non-bleeding and 2274.5nM in bleeding patients, P < 0.002). DF can manifest with spontaneous bleedings, which are associated with specific coagulation and fibrinolysis profiles that are not significantly present in DF without this complication. Particularly, thrombocytopenia, excessive fibrinolysis and reduced thrombin formation may contribute to the bleeding manifestations in DF.

A Cataract Surgery Training Program: 2-Year Outcome After Launching.

PubMed

Yu, A-Yong; Wang, Qin-Mei; Li, Jin; Huang, Fang; Golnik, Karl

2016-01-01

To investigate whether a short-term training program can produce competent cataract surgeons. This observational pilot study enrolled 12 trainees who could not perform phacoemulsification independently. The training consisted of 2 phases. During the first 3-month phase, trainees were taught phacoemulsification through wet laboratory exposure and deliberate practice in patients at the training center in the Eye Hospital of Wenzhou Medical University in China. The second phase consisted of performing 50 cases at the trainees׳ home institution with supports from instructors of the first phase. Trainees׳ surgical results were followed-up. The surgical skill as measured by the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) and surgical outcomes were analyzed. During the first phase trainees performed 193.3 ± 95.4 wet laboratory cases and 557 eyes in patients. The complication rate was 0.54%. The OSCAR scores improved significantly (p < 0.01) in the first phase. At the second phase, all the trainees could carry out phacoemulsification at their home hospital and the complication rate was 1.87%. During the long-term follow-up, 4936 cases of phacoemulsification were performed and the complication rate was 0.87%. Trainees succeeded in performing phacoemulsification safely and skillfully through a limited short period of training by wet laboratory exposure, deliberate practice in patients, and frequent formative feedback provided by the OSCAR tool. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Challenges in adult vaccination.

PubMed

de Gomensoro, Eduardo; Del Giudice, Giuseppe; Doherty, T Mark

2018-05-01

Life-long primary prevention interventions beginning and continuing throughout an individual's lifetime are increasingly seen as key to meeting the global healthcare challenges that accompany demographic changes - a concept referred to as "Healthy aging". In this perspective, vaccination is seen as part of a triad, together with healthy diet and exercise. Current adult vaccine coverage is lower than target vaccination rates in most developed countries, and so vaccine preventable diseases continue to present a substantial burden on health and healthcare resources, especially in older individuals. In part, this is due to lack of knowledge and understanding of the benefits of vaccination, inconsistent recommendations by providers and uncertainties about cost benefits. However, lower vaccine effectiveness in older adults plays a part, and new vaccines with novel characteristics to improve effectiveness in older adults are required. A life-course immunization approach to ensure optimal vaccine uptake across adults of all ages can be expected to reduce morbidity and mortality in later life. To achieve this, greater emphasis on public and healthcare provider education is necessary, based on appropriate economic analyses that demonstrate the overall value of vaccination. This article introduces the technical, economic, political and demographic issues that make establishing effective adult vaccination programs such a difficult, but pressing issue, and outlines some of the steps that are now being taken to address them. Key messages Life-long preventive activities that start and continue throughout life are essential, especially as the world's population is "getting older". This "Healthy aging" approach includes not only healthy diet and physical exercise; vaccination is critical in reducing some infectious diseases and their complications. Many adults, especially older adults (who have lower immunity than younger people) develop infections such as influenza and shingles that could potentially be prevented through vaccination. This review provides a perspective on the challenges in delivering a life-course immunization program. While some vaccines are less effective in older people, newer vaccines have been developed which provide stronger and longer protection in older patients than standard existing vaccines. However, the benefits of vaccination can only be realized if the vaccines are recommended and used. For that purpose, greater education of patients and their healthcare providers is necessary. Better knowledge of vaccines and making sure that all adults are up to date with all their recommended vaccines is an essential part of "Healthy aging". This should prevent not only vaccine-preventable diseases but also reduce the risk of complications in later life.

Social work role in developing and managing employee assistance programs in health care settings.

PubMed

Foster, Z; Hirsch, S; Zaske, K

1991-01-01

The hospital setting presents special needs for an Employee Assistance Program and special complications for sponsorship, development, and maintenance. What has been learned, how certain problems can be solved or avoided, how responsibility and accountability can be negotiated are presented by a team that has successfully established such a program at a large metropolitan medical center. In addition to successes, some unsolved problems are identified for further study.

Changing Landscape for Peritoneal Dialysis: Optimizing Utilization.

PubMed

Schreiber, Martin J

2017-03-01

The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications. © 2017 Wiley Periodicals, Inc.

In-patient international normalized ratio self-testing instruction after mechanical heart valve implantation.

PubMed

Thompson, Jess L; Sundt, Thoralf M; Sarano, Maurice E; Santrach, Paula J; Schaff, Hartzell V

2008-06-01

Patient self-testing of the international normalized ratio (INR) has been shown to improve management of anticoagulation with warfarin and reduce risks of thromboembolism and bleeding. Self-testing instruction usually begins several weeks after hospital discharge. We evaluated the feasibility of in-hospital INR self-testing instruction in patients recovering from valve replacement. We instituted an education program on a self-testing device before hospital discharge in 50 adult patients (median age, 54 years; 66% men) undergoing cardiac valve replacement with mechanical prostheses. Patients were monitored for 1 month to assess their ability to self-test and the accuracy of the INR measurements. Self-testing instruction began on postoperative day 4 (range, 1 to 8 days). Each patient had an average of 3.5 teaching sessions; each session lasted approximately 20 minutes. One month after discharge, all patients (98%) but 1 were able to self-test. No patient required interval instruction. One bleeding episode occurred in a patient whose INR exceeded the therapeutic range. Once warfarin doses were stabilized, 5 patients had subtherapeutic INR values on self-testing. The mean INR test result obtained from the coagulometer correlated well with values obtained by laboratory determination (r = 0.79). This evaluation of an in-hospital education program demonstrates that patients are able to learn INR self-testing and that most will continue to use the method without the need for interval instruction. Improved anticoagulation management by early introduction of INR self-testing should reduce thromboembolic and hemorrhagic complications after valve replacement.

Utilizing Physiological Principles of Motor Unit Recruitment to Reduce Fatigability of Electrically-Evoked Contractions: A Narrative Review.

PubMed

Barss, Trevor S; Ainsley, Emily N; Claveria-Gonzalez, Francisca C; Luu, M John; Miller, Dylan J; Wiest, Matheus J; Collins, David F

2018-04-01

Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20 and 40Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is in large part because of the nonphysiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by using physiological principles that help minimize fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced, and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described that were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimize MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Using the theoretical domains framework to guide the development of a self-management program for individuals with spinal cord injury: Results from a national stakeholder advisory group.

PubMed

Munce, Sarah E P; Allin, Sonya; Wolfe, Dalton L; Anzai, Karen; Linassi, Gary; Noonan, Vanessa K; Jaglal, Susan B

2017-11-01

To determine the implementation considerations for a targeted self-management program for individuals with spinal cord injury (SCI) from the perspective of a national stakeholder advisory group using the Theoretical Domains Framework (TDF) as a guide. Qualitative descriptive approach. Two focus groups held at the 6 th National Spinal Cord Injury Conference (October 2-4 th , 2014) in Toronto, Ontario, Canada. A total of 25 stakeholders from across Canada participated in focus groups or "brainstorming sessions". The stakeholders included 5 clinicians, 14 researchers, 3 policy makers, and 3 individuals with SCI. Not applicable. Not applicable. All 14 theoretical domains were identified in the brainstorming sessions. No new themes or domains were identified. The need to consider the theoretical domains of Knowledge, Skills, Reinforcement, Intentions, Goals (e.g. the readiness of the individual with SCI), Environmental Context and Resources (e.g. considerations for governance and ownership of the program and a business model for sustainability), as well as Social Influences (e.g. issues of privacy and security in the context of on-line delivery) was identified. The current study provides complementary results to our previous series of studies on the implementation considerations for the development of a targeted self-management program for individuals with SCI by emphasizing the health care professional/health policy perspective. It is anticipated that such a program could not only reduce secondary complications and subsequent inappropriate health care use but it may also improve the quality of life for individuals with SCI and their caregivers.

Enhancing Diabetes Self-care Among Rural African Americans With Diabetes

PubMed Central

Williams, Ishan C.; Utz, Sharon W.; Hinton, Ivora; Yan, Guofen; Jones, Randy; Reid, Kathryn

2015-01-01

Purpose The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the “Taking Care of Sugar” DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. Results From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high. Conclusions A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans. PMID:24478047

Redevelopment Ready Communities: Best Practices and Scoring System

EPA Pesticide Factsheets

This report discusses the Redevelopment Ready Communities program in southeast Michigan, which encourages mature suburbs to bolster their competitiveness by making development more efficient and less complicated.

Team Training and Institutional Protocols to Prevent Shoulder Dystocia Complications.

PubMed

Smith, Samuel

2016-12-01

Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance.

Interventional radiology procedures in adult patients who underwent liver transplantation

PubMed Central

Miraglia, Roberto; Maruzzelli, Luigi; Caruso, Settimo; Milazzo, Mariapina; Marrone, Gianluca; Mamone, Giuseppe; Carollo, Vincenzo; Gruttadauria, Salvatore; Luca, Angelo; Gridelli, Bruno

2009-01-01

Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT. PMID:19222091

Older females are at higher risk for medical complications during 21 km road race running: a prospective study in 39 511 race starters--SAFER study III.

PubMed

Schwabe, Karen; Schwellnus, Martin P; Derman, Wayne; Swanevelder, Sonja; Jordaan, Esme

2014-06-01

The half-marathon (21 km) race is a very popular mass community-based distance running event. It is important to determine risk factors for medical complications during these events, so that prevention programmes can be developed. To determine risk factors associated with medical complications during 21 km road running events. Prospective study. Two Oceans half-marathon (21 km) races. 39 511 starters in the 21 km race. Medical complications (defined as any runner requiring assessment by a doctor at the race medical facility or a local hospital on race day) were recorded over a 4-year study period. Medical complications were subdivided according to the system affected and by final diagnosis. A Poisson regression model was used to determine risk factors for any medical complication and more common specific complications. Independent risk factors for medical complication during 21 km running were older female runners (women >50 vs  ≤50 years; p<0.0001) and year of observation (2008 vs 2011; p=0.0201: 2009 vs 2011: p=0.0019; 2010 vs 2011: p=0.0096). Independent risk factors for specific common medical complications were: postural hypotension (women, slow running pace), musculoskeletal complications (less running experience, slower running pace) and dermatological complications (women). Older female runners are at higher risk of developing medical complications during 21 km road running races. Environmental conditions in a particularly cold climate may also play a role. Less running experience and slower running pace are associated with specific medical complications. Medical staff can now plan appropriate care on race days, and interventions can be developed to reduce the risk of medical complications in 21 km races.

Should laparoscopic cholecystectomy be practiced in the developing world?: the experience of the first training program in Afghanistan.

PubMed

Manning, Richard G; Aziz, Abdul Qayoume

2009-05-01

We address the controversial issue of whether or not it is wise to perform and train laparoscopic cholecystectomy (LC) in a developing nation by reviewing the results of the first large series done in Afghanistan. Afghanistan has been devastated by 3 decades of war leaving it with deficiencies in training programs, medical technologies, and overall medical infrastructure that are among the worst in the developing world. We retrospectively reviewed 137 consecutive cholecystectomies, 102 laparoscopic and 35 open, performed by 4 senior and 3 junior surgeons trained at our hospital in Kabul from July 2005 until February 2008. Deaths, complications, conversion rate, operative time, and hospital length of stay were compared. Unrecognized major operative injuries occurred in 4 LC patients, 3 bile leaks, and 1 duodenal perforation, although there were no such injuries in the open cholecystectomy group. Complication rates were much higher for patients operated on for acute cholecystitis for both surgeon groups. Even though junior surgeons converted to open cholecystectomy more frequently than senior surgeons, they had a higher major complication rate. Hospital length of stay was 28% shorter for the laparoscopic group. The high rate of major unrecognized intraoperative complications during LC in our series underscores the difficulties inherent in performing and training LC in developing nations. Practical changes are suggested to make LC more efficient and safer in a developing world hospital.

Research on Construction Technology of First Pile in an Urban Expressway under Complicated Conditions

NASA Astrophysics Data System (ADS)

Zhu, Zhi gang

2017-12-01

This paper develops a research method on the construction of the first pile in the process of the construction on an urban expressway under complicated conditions, such as the difference between the underground conditions and the exploration results,the sand formation,the whole weathered and the rich groundwater. We study the relevant technical parameters and construction organization through construction of the first pile. The results show that construction on the first pile is very important under complicated conditions and can provide a basis to continuously improve the level of the whole pile foundation construction technology, and ultimately determine the entire project feasible construction program and the successful completion of the construction project.

Considerations in Forest Growth Estimation Between Two Measurements of Mapped Forest Inventory Plots

Treesearch

Michael T. Thompson

2006-01-01

Several aspects of the enhanced Forest Inventory and Analysis (FIA) program?s national plot design complicate change estimation. The design incorporates up to three separate plot sizes (microplot, subplot, and macroplot) to sample trees of different sizes. Because multiple plot sizes are involved, change estimators designed for polyareal plot sampling, such as those...

Simplification May Not Be So Simple: Gauging State Alignment with the FAFSA

ERIC Educational Resources Information Center

Pingel, Sarah

2017-01-01

Applying for financial aid can be a complicated, time-consuming endeavor for students and their families. Fortunately, many state aid programs have taken strides to align aid applications to the form used for federal aid programs, the Free Application for Federal Student Aid (FAFSA), making state aid more readily accessible. New conversations…

Simplified Calculation Of Solar Fluxes In Solar Receivers

NASA Technical Reports Server (NTRS)

Bhandari, Pradeep

1990-01-01

Simplified Calculation of Solar Flux Distribution on Side Wall of Cylindrical Cavity Solar Receivers computer program employs simple solar-flux-calculation algorithm for cylindrical-cavity-type solar receiver. Results compare favorably with those of more complicated programs. Applications include study of solar energy and transfer of heat, and space power/solar-dynamics engineering. Written in FORTRAN 77.

Program For Optimization Of Nuclear Rocket Engines

NASA Technical Reports Server (NTRS)

Plebuch, R. K.; Mcdougall, J. K.; Ridolphi, F.; Walton, James T.

1994-01-01

NOP is versatile digital-computer program devoloped for parametric analysis of beryllium-reflected, graphite-moderated nuclear rocket engines. Facilitates analysis of performance of engine with respect to such considerations as specific impulse, engine power, type of engine cycle, and engine-design constraints arising from complications of fuel loading and internal gradients of temperature. Predicts minimum weight for specified performance.

Insight in modulation of inflammation in response to diclofenac intervention: a human intervention study

USDA-ARS?s Scientific Manuscript database

Background. Chronic systemic low-grade inflammation in obese subjects is associated with health complications including cardiovascular diseases, insulin resistance and diabetes. Reducing inflammatory responses may reduce these risks. However, available markers of inflammatory status inadequately des...

Laser in situ keratomileusis in 2012: a review.

PubMed

Sutton, Gerard; Lawless, Michael; Hodge, Christopher

2014-01-01

Laser in situ keratomileusis (LASIK) is a safe and effective treatment for refractive error. A combination of technological advances and increasing surgeon experience has served to further refine refractive outcomes and reduce complication rates. In this article, we review LASIK as it stands in late 2012: the procedure, indications, technology, complications and refractive outcomes. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

Chronic kidney disease after hematopoietic stem cell transplantation

PubMed Central

Cohen, Eric P; Pais, Priya; Moulder, John E

2010-01-01

Acute and chronic kidney diseases occur after hematopoietic stem cell transplantation. These are caused by the transplant itself, and the complications of transplant. Recent estimates show that near 15% of subjects undergoing HSCT will develop CKD, which is a complication rate that can affect outcome and reduce survival. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate and treat it. PMID:21146127

SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

PubMed

Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

2016-01-01

The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

Six-month Outcomes of Mobile Phone Application-based Self-management in a Patient with Type 2 Diabetes.

PubMed

Hong, Mi Kyeong; Cho, Young Yun; Rha, Mi Yong; Kim, Jae Hyeon; Lee, Moon-Kyu

2015-07-01

We report the case in order to examine the effect of a mobile application program ("Diabetes & Nutrition") developed in 2011-2012 for self-management in patients with type 2 diabetes and to recommend important considerations when the mobile application program is developed. A 46-year-old man was newly diagnosed with type 2 diabetes in 2013 and had no complications. The height of the patient was 168 cm and the body weight was 75.6 kg. Nutrition education was conducted according to a medical prescription, and follow-up nutrition education was conducted after 3 and 6 months. After nutrition education, the patient was engaged in self-management using "Diabetes & Nutrition" program during 3 months. At 3 months, the body weight had decreased by 4.4 kg (from 75.6 to 71.2 kg), waist circumference by 5 cm (from 88 to 83 cm) and HbA1c level from 7.9% to 6.1%. Also at 3 months, the medication was reduced from from the dose of 850 mg to the dose of 500 mg metformin per twice a day. Since then, the patient did not continue to use the "Diabetes & Nutrition" because the level of blood glucose had stabilized, and the patient felt inconvenient and annoying to use the program. At 6 months, no significant change in the body weight and body composition was observed in comparison with those at 3 months. The present case demonstrates that the early use of "Diabetes & Nutrition" could be helpful for self-management of glycemic control in patients with type 2 diabetes. Developing self-management mobile application programs in the future will require strategies of how to promote continuous use of application program and self-management of type 2 diabetes.

The Application of LOGO! in Control System of a Transmission and Sorting Mechanism

NASA Astrophysics Data System (ADS)

Liu, Jian; Lv, Yuan-Jun

Logic programming of general logic control module LOGO! has been recommended the application in transmission and sorting mechanism. First, the structure and operating principle of the mechanism had been introduced. Then the pneumatic loop of the mechanism had been plotted in the software of FluidSIM-P. At last, pneumatic loop and motors had been control by LOGO!, which makes the control process simple and clear instead of the complicated control of ordinary relay. LOGO! can achieve the complicated interlock control composed of inter relays and time relays. In the control process, the logic control function of LOGO! is fully used to logic programming so that the system realizes the control of air cylinder and motor. It is reliable and adjustable mechanism after application.

Managing chronic inflammation in the aging diabetic patient with CKD by diet or sevelamer carbonate: a modern paradigm shift.

PubMed

Vlassara, H; Cai, W; Chen, X; Serrano, E J; Shobha, M S; Uribarri, J; Woodward, M; Striker, G E

2012-12-01

The maintenance of normal metabolism and body defenses depends on the balance between cellular antioxidant and anti-inflammatory factors. This balance can be disrupted by agents/mechanisms in the extracellular milieu that induce excess reactive oxygen species (ROS) and inflammation. Cytopathic advanced glycation endproducts, present in ever increasing amounts in the modern diet, are one of the major environmental factors that cause excess ROS and/or inflammation at all ages and induce complications in aging, such as chronic kidney disease (CKD) and type 2 diabetes. Increased ROS and/or inflammation are present in both aging and CKD, and are associated with reduced cellular defenses against ROS and/or inflammation. Affected individuals have reduced defenses against further stress and are predisposed to organ failure, now a well-known phenomenon in aging. Thus, new methods are urgently needed to safely reduce ROS and/or inflammation in the aging type 2 diabetes patient with CKD. Studies of both normal aging and diabetic patients with kidney disease underline the fact that increased ROS and/or inflammation can be managed in these conditions by economical, safe, and effective interventions that reduce the uptake of advanced glycation endproducts by either modifying preparation of food or an oral drug. This communication reviews these data and adds new information on the efficacy of a drug, sevelamer carbonate, required to reduce ROS and/or inflammation in the aging type 2 diabetes patient complicated by CKD. If larger and longer studies confirm the hypothesis that one or both of these interventions reduce progression of CKD, it could represent a new paradigm in the management of complications in the type 2 diabetes patient with CKD.

Serious complications within 30 days of screening and surveillance colonoscopy are uncommon

PubMed Central

Ko, Cynthia W.; Riffle, Stacy; Michaels, LeAnn; Morris, Cynthia; Holub, Jennifer; Shapiro, Jean A.; Ciol, Marcia A.; Kimmey, Michael B.; Seeff, Laura C.; Lieberman, David

2009-01-01

Background & Aims The risk of serious complications after colonoscopy has important implications for the overall benefits of colorectal cancer screening programs. We evaluated the incidence of serious complications within 30 days after screening or surveillance colonoscopies in diverse clinical settings and to identify potential risk factors for complications. Methods Patients age 40 and over undergoing colonoscopy for screening, surveillance, or evaluation based an abnormal result from another screening test were enrolled through the National Endoscopic Database (CORI). Patients completed a standardized telephone interview approximately 7 and 30 days after their colonoscopy. We estimated the incidence of serious complications within 30 days of colonoscopy and identified risk factors associated with complications using logistic regression analyses. Results 21,375 patients were enrolled. Gastrointestinal bleeding requiring hospitalization occurred in 34 patients (incidence 1.59/1000 exams; 95% confidence interval [CI] 1.10–2.22). Perforations occurred in 4 patients (0.19/1000 exams; 95% CI 0.05–0.48), diverticulitis requiring hospitalization in 5 patients (0.23/1000 exams; 95% CI 0.08–0.54), and post-polypectomy syndrome in 2 patients (0.09/1000 exams; 95%CI 0.02–0.30). The overall incidence of complications directly related to colonoscopy was 2.01 per 1000 exams (95%CI 1.46–2.71). Two of the four perforations occurred without biopsy or polypectomy. The risk of complications increased with pre-procedure warfarin use and performance of polypectomy with cautery. Conclusions Complications after screening or surveillance colonoscopy are uncommon. Risk factors for complications include warfarin use and polypectomy with cautery. PMID:19850154

Optimal timing of autologous cranioplasty after decompressive craniectomy in children.

PubMed

Piedra, Mark P; Thompson, Eric M; Selden, Nathan R; Ragel, Brian T; Guillaume, Daniel J

2012-10-01

The object of this study was to determine if early cranioplasty after decompressive craniectomy for elevated intracranial pressure in children reduces complications. Sixty-one consecutive cases involving pediatric patients who underwent autologous cranioplasty after decompressive craniectomy for raised intracranial pressure at a single academic children's hospital over 15 years were studied retrospectively. Sixty-one patients were divided into early (< 6 weeks; 28 patients) and late (≥ 6 weeks; 33 patients) cranioplasty cohorts. The cohorts were similar except for slightly lower age in the early (8.03 years) than the late (10.8 years) cranioplasty cohort (p < 0.05). Bone resorption after cranioplasty was significantly more common in the late (42%) than the early (14%) cranioplasty cohort (p < 0.05; OR 5.4). No other complication differed in incidence between the cohorts. After decompressive craniectomy for raised intracranial pressure in children, early (< 6 weeks) cranioplasty reduces the occurrence of reoperation for bone resorption, without altering the incidence of other complications.

Topography-guided photorefractive keratectomy for irregular astigmatism after small incision lenticule extraction.

PubMed

Ivarsen, Anders; Hjortdal, Jesper Ø

2014-06-01

To report the outcome of topography-guided photorefractive keratectomy (PRK) after complicated small incision lenticule extraction (SMILE). Retrospective case series of 5 eyes with irregular topography and ghost images after complicated SMILE. All eyes received transepithelial topography-guided PRK. Two eyes were treated with 0.02% mitomycin C. Patients were examined after a minimum of 3 months with evaluation of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, Pentacam tomography (Oculus Optikgeräte, Wetzlar, Germany), and whole-eye aberrometry. In 3 eyes, subjective symptoms were diminished and UDVA, CDVA, topography, and corneal wavefront aberrations were improved. The remaining 2 eyes developed significant haze with worsened topography and wavefront aberrations. One eye experienced a two-line reduction in CDVA. Eyes with haze development had not been treated with mitomycin C. Transepithelial topography-guided PRK may reduce visual symptoms after complicated SMILE if postoperative haze can be controlled. To reduce the risk of haze development, application of mitomycin C may be considered. Copyright 2014, SLACK Incorporated.

Impact of operative length on post-operative complications in meningioma surgery: a NSQIP analysis.

PubMed

Karhade, Aditya V; Fandino, Luis; Gupta, Saksham; Cote, David J; Iorgulescu, Julian B; Broekman, Marike L; Aglio, Linda S; Dunn, Ian F; Smith, Timothy R

2017-01-01

Many studies have implicated operative length as a predictor of post-operative complications, including venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)]. We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, to evaluate whether length of operation had a statistically significant effect on post-operative complications in patients undergoing surgical resection of meningioma. Patients were included for this study if they had a post-operative diagnosis of meningioma. Patient demographics, pre-operative comorbidities, and post-operative 30-day complications were analyzed. Of 3743 patients undergoing craniotomy for meningioma, 13.6 % experienced any complication. The most common complications and their median time to occurrence were urinary tract infection (2.6 %) at 10 days postoperatively (IQR 7-15), unplanned intubation (2.5 %) at 3 days (IQR 1-7), failure to wean from ventilator (2.4 %) at 2.0 days (IQR 2-4), and DVT (2.4 %) at 6 days (IQR 11-19). Postoperatively, 3.6 % developed VTE; 2.4 % developed DVT and 1.7 % developed PE. Multivariable analysis identified older age (third and upper quartile), obesity, preoperative ventilator dependence, preoperative steroid use, anemia, and longer operative time as significant risk factors for VTE. Separate multivariable logistic regression models demonstrated longer operative time as a significant risk factor for VTE, all complications, major complications, and minor complications. Meningioma resection is associated with various post-operative complications that increase patient morbidity and mortality risk. this large, multi-institutional patient sample, longer operative length was associated with increased risk for postoperative venous thromboembolisms, as well as major and minor complications.

Comparison of complication rates related to male urethral slings and artificial urinary sphincters for urinary incontinence: national multi-institutional analysis of ACS-NSQIP database.

PubMed

Alwaal, Amjad; Harris, Catherine R; Awad, Mohannad A; Allen, Isabel E; Breyer, Benjamin N

2016-10-01

Male stress urinary incontinence (SUI) can significantly diminish quality of life and lead to embarrassment and social withdrawal. Surgical therapies, such as male urethral slings and artificial urinary sphincters (AUS), are considered effective and safe treatments for male SUI. Our objective is to evaluate 30-day complications in patients undergoing male slings and AUS placement from a national multicenter database. Data from the American College of Surgeons National Surgical Quality of Improvement Program for 2008-2013 were used to identify patients who underwent male slings and AUS implantation. Trained coders abstracted complication data from the patient record independent of the surgical team. We compared 30-day postoperative complications for male slings and AUS. We examined the relationship between patient factors and complication rates for each procedure type. Overall, 1205 incontinence surgeries in men were identified: 597 male sling placements and 608 AUS implantations. Male sling placement had a lower 30-day postoperative complication rate compared to AUS (2.8 vs. 5.1 %, p = 0.046). Compared to AUS, male sling was associated with fewer urinary tract infections (0.3 vs. 2.0 %, p = 0.020) and return trips to the operating room (1.0 vs. 3.0 %, p < 0.001). Patients with higher BMI were more likely to have a complication, while age, race and Charlson comorbidity index were not associated with higher or lower complication rates. Complications rates for both male sling and AUS are low. Male sling is associated with a lower rate of complications than AUS. These findings allow for better patient perioperative counseling regarding 30-day perioperative complications.

Creation of a solid organ transplant program in an underdeveloped country: Mexico's General Hospital transplantation program.

PubMed

García Covarrubias, L; Rossano García, A; Cicero Lebrija, A; Luque Hernández, A; Hinojosa Heredia, H; Fernández Ángel, D; Córdova, J; García Covarrubias, A; Bautista Olayo, R; Diliz Perez, H S

2013-05-01

With a population of >112 million persons, all Mexicans are entitled to receive medical care by the state and more than half have limited access to healthcare. From January 1985 to March 2009, 40 renal transplants were performed from living donors with a high percentage of complications. In April 2009, a new Solid Organ Transplantation Program was started; herein, we present this enterprise to the international community and briefly present a perspective on the Mexican transplant situation. We performed a retrospective chart review of kidney and liver transplant recipients from April 2009 to November 2011, including demographic features, immunosuppression, complications as well as initial and 1 month function. We performed 68 kidney (59 living and 9 deceased donors) and 5 liver transplants (cadaveric donors). The kidney transplant recipients were 73.5% males and showed an overall mean age of 29.77 years (range, 18-60). The donor mean age was 34.08 years. Mean recipient creatinine pretransplant was 13.32 mg/dL, while at day 5 it was 2.33 and at month one, 1.32 mg/dL. Five grafts were lost (7.3%): 4 due to death with a functioning graft and 1 due to acute pyelonephritis. Five patients experienced delayed graft function Basiliximab induction was required in all but one who received thymoglobulin owing to a high panel reactive antibody. Maintenance therapy included a calcineurin inhibitor, mycophenolate mofetil (MMF), and prednisone. Liver transplant recipients were 83.6% women. The etiologies were alcoholic cirrhosis (n = 2), primary billiary cirrhosis (n = 1) and hepatitis C virus infection (n = 2). Complications included: reperfusion syndrome (n = 1), convulsive crisis (medication; n = 1), acute respiratory distress syndrome (n = 1), and death (n = 1). Their Model for End-Stage Liver Disease scopes were 10-21. After basiliximab induction, they had maintenance therapy with tacrolimus, MMF, and steroids. The donor mean age was 26.2 years. All survivors show normal liver function tests currently. From 1985 to 2009, 40 kidney transplants were performed, with multiple complications including donor deaths. Our current results were comparable to international standards, with <15% complication rate. Copyright © 2013 Elsevier Inc. All rights reserved.

Polycystic kidney disease

MedlinePlus

... don't have other diseases may be good candidates for a kidney transplant. Possible Complications Health problems ... www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. ...

Cost-of-Illness Analysis of Type 2 Diabetes Mellitus in Iran

PubMed Central

Javanbakht, Mehdi; Baradaran, Hamid R.; Mashayekhi, Atefeh; Haghdoost, Ali Akbar; Khamseh, Mohammad E.; Kharazmi, Erfan; Sadeghi, Aboozar

2011-01-01

Introduction Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year. Methods This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups. Results The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes's complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million). Conclusions T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority. PMID:22066013

Risk factors for complications in donors at first and repeat whole blood donation: a cohort study with assessment of the impact on donor return.

PubMed

Wiersum-Osselton, Johanna C; Marijt-van der Kreek, Tanneke; Brand, Anneke; Veldhuizen, Ingrid; van der Bom, Johanna G; de Kort, Wim

2014-01-01

First-time donation is among recognised risk factors for vasovagal reactions to blood donation and reactions are known to reduce donor return. We assessed associations between potential risk factors and vasovagal reactions and needle-related complications in first-time whole blood donation in comparison to repeat donation and analysed the impact of complications on donor return. We performed a cohort study on whole blood donations in The Netherlands from 1/1/2010 to 31/12/2010 using data extracted from the blood service information system. Donation data up to 31/12/2011 were used to ascertain donor return. In 2010 28,786 donors made first whole blood donations and there were 522,958 repeat donations. Vasovagal reactions occurred in 3.9% of first donations by males and 3.5% of first donations by females compared to in 0.2% and 0.6%, respectively, of repeat donations. Associations of vasovagal reactions with other factors including age, body weight, systolic and diastolic blood pressure were similar in first-time and repeat donors. Needle-related complications occurred in 0.2% of male and 0.5% of female first-time donations and in 0.1% and 0.3%, respectively, of repeat donations. Among first-time donors, the return rate within 1 year was 82% following an uncomplicated first donation, but 55% and 61% following vasovagal reactions and needle-related complications, respectively; the corresponding percentages among repeat donors were 86%, 58% and 82%. Among first-time donors, females suffered less than males from vasovagal reactions. Other risk factors had similar associations among first-time and repeat donors. Vasovagal reactions and needle-related complications in both first-time and repeat donors are followed by reduced donor return.

Trial Comparing a Combined Regimen of Amikacin and Ciprofloxacin to Ciprofloxacin Alone as Transrectal Prostate Biopsy Prophylaxis in the Era of High Fluoroquinolone-Resistant Rectal Flora.

PubMed

Son, Kyung Chul; Chung, Ho Seok; Jung, Seung Il; Kim, Myung Soo; Hwang, Eu Chang; Kim, Jin Woong; Kwon, Dong Deuk

2018-04-09

To investigate whether addition of amikacin to fluoroquinolone (FQ) antimicrobial prophylaxis reduces infections after transrectal ultrasound-guided prostate biopsy (TRUSPB). A total of 503 patients undergoing rectal swab were divided into three groups. Patients with FQ-sensitive rectal flora (group 1, n = 248) were administered ciprofloxacin before TRUSPB, and patients with FQ-resistant rectal flora were either administered ciprofloxacin (group 2, n = 97) or amikacin and ciprofloxacin (group 3, n = 158) before TRUSPB. Based on the rectal swab, FQ resistance was 54.9%, and extended-spectrum β-lactamase (ESBL) positivity was 17.2%. The incidence of infectious complication in group 1 was 1.6%. Groups 2 and 3, with FQ-resistant rectal flora, tended to have increased infectious complications (5.2% and 4.4%, respectively) but the difference between those results is not statistically significant. The most common pathogens of infectious complications in patients with FQ-resistant rectal flora were FQ-resistant and ESBL-producing Escherichia coli. E. coli pathogens isolated in Group 3 were amikacin-susceptible species. The operation history and ESBL positivity of rectal flora increased the incidence of infectious complications (odds ratio [OR] = 3.68; P = 0.035 and OR = 4.02; P = 0.008, respectively). DM and antibiotics exposure were risk factors for FQ resistance (OR = 2.19; P = 0.002) and ESBL positivity of rectal flora (OR = 2.96; P = 0.005), respectively. Addition of amikacin to ciprofloxacin prophylaxis could not reduce infectious complications in patients with FQ-resistant rectal flora. Despite the amikacin sensitivity of infectious complications, single-dose amikacin addition to ciprofloxacin prophylaxis has limitations. © 2018 The Korean Academy of Medical Sciences.

Central venous catheters: legal issues.

PubMed

Gallieni, Maurizio; Martina, Valentina; Rizzo, Maria Antonietta; Gravellone, Luciana; Mobilia, Francesca; Giordano, Antonino; Cusi, Daniele; Genovese, Umberto

2011-01-01

In dialysis patients, both central venous catheter (CVC) insertion and CVC use during the dialysis procedure pose important legal issues, because of potentially severe, even fatal, complications. The first issue is the decision of the kind of vascular access that should be proposed to patients: an arteriovenous (AV) fistula, a graft, or a CVC. The second issue, when choosing the CVC option, is the choice of CVC: nontunneled versus tunneled. Leaving a temporary nontunneled CVC for a prolonged time increases the risk of complications and could raise a liability issue. Even when choosing a long-term tunneled CVC, nephrologists should systematically explain its potential harms, presenting them as "unsafe for long-term use" unless there is a clear contraindication to an AV native or prosthetic access. Another critical issue is the preparation of a complete, informative, and easy-to-understand consent form. The CVC insertion procedure has many aspects of legal interest, including the choice of CVC, the use of ECG monitoring, the use of ultrasound guidance for cannulation, and the use of fluoroscopy for checking the position of the metal guidewire during the procedure as well as the CVC tip before the end of the procedure. Use of insertion devices and techniques that can prevent complications should obviously be encouraged. Complications of CVC use are mainly thrombosis and infection. These are theoretically expected as pure complications (and not as malpractice effects), but legal issues might relate to inappropriate catheter care (in both the inpatient and outpatient settings) rather than to the event per se. Thus, in the individual case it is indeed very difficult to establish malpractice and liability with a catheter-related infection or thrombosis. In conclusion, we cannot avoid complications completely when using CVCs, but reducing them to a minimum and adopting safe approaches to their insertion and use will reduce legal liability.

Canine total hip replacement using a cementless threaded cup and stem: a review of 55 cases.

PubMed

Denny, H R; Linnell, M; Maddox, T W; Comerford, E J

2018-06-01

To determine the long-term results and complications associated with the Helica ® cementless hip endoprosthesis system. Retrospective study of 55 consecutive Helica total hip replacements performed between January 2010 and February 2015. A total of 55 total hip replacements were performed in 50 dogs; 45 dogs had unilateral hip replacements, and five had staged bilateral replacements. A total of 23 first-generation short femoral stems were implanted in 22 dogs, of which nine cases (39%) experienced complications and 19 (86%) recovered satisfactorily when revisions were included; 31 second-generation femoral stems were implanted in 28 dogs, of which 10 cases (32%) experienced complications, and 26 (93%) made satisfactory recoveries, including revisions. In 36 dogs for which data were available, postoperative Liverpool Osteoarthritis in Dogs scores were significantly reduced compared to preoperative scores. Complications occurred in a total of 19 cases (34·5%; 95% confidence interval: 22 to 47·1%); the most common was aseptic loosening of the femoral stem [11 cases (20%; 95% confidence interval: 9·4 to 30·6%)]. Following multivariable analysis, no risk factors were identified for overall complications, but there was a significant association of implant type (first-generation short stem) with loosening (odds ratio 4·9, 95% confidence interval: 1·1 to 22·1, P=0·034). This study found the Helica hip endoprosthesis system to be effective in the management of hip dysplasia and osteoarthritis in dogs. Aseptic loosening of the femoral stem remains the most common complication but appears to have been significantly reduced with the introduction of the second-generation stem. © 2018 British Small Animal Veterinary Association.

Protective role of sulphoraphane against vascular complications in diabetes.

PubMed

Yamagishi, Sho-Ichi; Matsui, Takanori

2016-10-01

Context Diabetes is a global health challenge. Although large prospective clinical trials have shown that intensive control of blood glucose or blood pressure reduces the risk for development and progression of vascular complications in diabetes, a substantial number of diabetic patients still experience renal failure and cardiovascular events, which could account for disabilities and high mortality rate in these subjects. Objective Sulphoraphane is a naturally occurring isothiocyanate found in widely consumed cruciferous vegetables, such as broccoli, cabbage and Brussels sprouts, and an inducer of phase II antioxidant and detoxification enzymes with anticancer properties. We reviewed here the protective role of sulphoraphane against diabetic vascular complications. Methods In this review, literature searches were undertaken in Medline and in CrossRef. Non-English language articles were excluded. Keywords [sulphoraphane and (diabetes, diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, diabetic complications, vascular, cardiomyocytes, heart or glycation)] have been used to select the articles. Results There is accumulating evidence that sulphoraphane exerts beneficial effects on vascular damage in both cell culture and diabetic animal models via antioxidative properties. Furthermore, we have recently found that sulphoraphane inhibits in vitro formation of advanced glycation end products (AGEs), suppresses the AGE-induced inflammatory reactions in rat aorta by reducing receptor for AGEs (RAGE) expression and decreases serum levels of AGEs in humans. Conclusion These findings suggest that blockade of oxidative stress and/or the AGE-RAGE axis by sulphoraphane may be a novel therapeutic strategy for preventing vascular complications in diabetes.

Structural evaluation of curved stiffened composite panels fabricated using a THERM-Xsm process

NASA Technical Reports Server (NTRS)

Kassapoglou, Christos; Dinicola, Albert J.; Chou, Jack C.; Deaton, Jerry W.

1991-01-01

The use of composites in aircraft structures is often limited by material and manufacturing costs which, for some designs and applications, are prohibitively high. To increase the frequency of application of composites in primary airframe components alternative manufacturing processes are sought that reduce cost and/or enhance structural efficiency. One alternative process involves the use of THERM-Xsm as the pressure transfer medium during autoclave curing. THERM-Xsm, a silicon-based flow able polymer which behaves like a liquid under autoclave presssure, transmits quasi-hydrostatic pressure to all contacting surfaces of the part to be cured. Once the autoclave pressure is relieved, THERM-Xsm reverts back to the powdery solid state and can be reused many times. The THERM-Xsm process to be evaluated is depicted and consists of (1) enclosing the tool and part to be cured by a set of frames that create a box, (2) pouring THERM-Xsm powder onto the part and filling the box, and (3) placing a vacuum bag over the box assembly. In this program, a separating non-porous film (Teflon) was placed between the part to be cured and THERM-Xsm powder to avoid any contamination. The use of THERM-Xsm has two significant advantages over conventional manufacturing procedures. First, it eliminates complicated hard tooling since it guarantees uniform pressure transfer and thus, good compaction at complex structural details (such as frame-stiffener intersections and corners). Second, it greatly simplifies vacuum bagging, since once the part to be cured is covered by THERM-Xsm powder, the vacuum bag need only conform to a relatively flat shape reducing significantly the number of pleats required. A program is on-going at Sikorsky Aircraft to evaluate the structural performance of complex composite fuselage structures made with this THERM-Xsm process and to quantify the impact of THERM-Xsm on manufacturing labor hours and cost. The program involves fuselage panel optimization analysis, a building block test program where structural details representative of the full-scale article are analyzed and tested, and static and fatigue test/analysis of the full-scale test articles. The main results of this program are reported.

To Assess the Effect of Maternal BMI on Obstetrical Outcome

NASA Astrophysics Data System (ADS)

Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan

2012-06-01

AIMS: To assess the effect of maternal BMI on complications in pregnancy, mode of delivery, complications of labour and delivery.METHODS:A crossectional study was carried out in the Obst and Gynae department, Kasturba Hospital, Delhi. The study enrolled 100 pregnant women. They were divided into 2 groups based on their BMI, more than or equal to 30.0 kg/m2 were categorized as obese and less than 30 kg/m2 as non obese respectively. Maternal complications in both types of patients were studied.RESULTS:CONCLUSION: As the obstetrical outcome is significantly altered due to obesity, we can improve maternal outcome by overcoming obesity. As obesity is a modifiable risk factor, preconception counseling creating awareness regarding health risk associated with obesity should be encouraged and obstetrical complications reduced.

Laparoscopic repair of non-complicated lumbar hernia secondary to a latissimus dorsi flap.

PubMed

Obregón, L; Ruiz-Castilla, M; Binimelis, M M; Guinot, A; García, V; Puig, O; Barret, J P

2014-03-01

Lumbar hernia is an unusual complication of the latissimus dorsi flap. Traditionally, it has always been repaired using open-surgery techniques. We present the first description of laparoscopic surgery to treat a non-complicated superior lumbar hernia resulting from the creation of an enlarged latissimus dorsi myocutaneous flap for breast reconstruction following left modified radical mastectomy. The laparoscopic approach substantially reduced the risks associated with open surgery, shortened length of hospital stay and time to recovery and obtained better cosmetic results. Laparoscopic surgery may be considered as a feasible therapeutic option for non-complicated superior lumbar hernias secondary to a latissimus dorsi muscle flap. Therapeutic, V. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

One hundred consecutive cases of pars plana vitrectomy with the vitreous stripper.

PubMed

Syrdalen, P

1979-01-01

The results of 100 consecutive cases of pars plana vitrectomy are reported. Vitrectomy was performed on accunt of complications of diabetic retinopathy (37 eyes), complicated retinal detachment (28 eyes), vitreous haemorrhage of various causes (17 eyes), vitreous haemorrhage and complications secondary to injuries (13 eyes) and secondary cataract or vitreous in the anterior chamber creating corneal dystrophy (5 eyes). With an average follow-up time of 14.2 months, vitrectomy resulted in visual improvement in 55 eyes, unchanged visual acuity in 24 eyes and reduced visual acuity in 21 eyes. The operative and postoperative complications were: secondary vitreous haemorrhage (11 eyes), retinal detachment (8 eyes), haemorrhagic glaucoma (7 eyes), retinal tears (5 eyes), lens injury (4 eyes), corneal dystrophy (2 eyes) and endophthalmitis (1 eye).

[Transrectal magnetotherapy of the prostate from Intramag device in prophylaxis of postoperative complications of transurethral resection of prostatic adenoma].

PubMed

Neĭmark, A I; Snegirev, I V; Neĭmark, B A

2006-01-01

The authors analyse preoperative preparation of 91 patients with benign prostatic hyperplasia (BPH). Two groups of patients received conventional preparation (group 1) and magnetotherapy (group 2) before TUR of the prostate. The examination covered immune system, bacteriological indices of urine and prostatic tissue. Infection of the urinary tract is a main risk factor of complications after TUR. Conventional preoperative preparation fails to correct immunity, to change bacterial urine flora, to improve hemodynamics in the prostate. Transrectal magnetotherapy with running magnetic field eliminates deficiency of T- and B-cell immunity, raises functional activity of B-lymphocytes and phagocytic ability of neutrophils, reduces endogenic intoxication, tissue edema, bacterial contamination, number of thrombohemorrhagic complications. This leads to a decrease in the number of postoperative complications.