scholarly journals Patient Predictors of Surgical Candidacy in Elective Spine Disorders

2018 ◽  
Vol 46 (1) ◽  
pp. 96-101
Author(s):  
Michael M.H. Yang ◽  
Godefroy Hardy St-Pierre ◽  
Stephan DuPlessis
Keyword(s):  
Walking Distance ◽  
Degenerative Spine ◽  
Random Forest Method ◽  
Age Related ◽  
History Of ◽  
Patient Variables ◽  
Observational Cohort ◽  
Spine Disorders ◽  
Preoperative Patient

AbstractBackgroundThe expansion of age-related degenerative spine pathologies has led to increased referrals to spine surgeons. However, the majority of patients referred for surgical consultation do not need surgery, leading to inefficient use of healthcare resources. This study aims to elucidate preoperative patient variables that are predictive of patients being offered spine surgery.MethodsWe conducted an observational cohort study on patients referred to our institution between May 2013 and January 2015. Patients completed a detailed preclinic questionnaire on items such as history of presenting illness, quality-of-life questionnaires, and past medical history. The primary end point was whether surgery was offered. A multivariable logistical regression using the random forest method was used to determine the odds of being offered surgery based on preoperative patient variables.ResultsAn analysis of 1194 patients found that preoperative patient variables that reduced the odds of surgery being offered include mild pain (odds ratio [OR] 0.37,p=0.008), normal walking distance (OR 0.51,p=0.007), and normal sitting tolerance (OR 0.58,p=0.01). Factors that increased the odds of surgery include radiculopathy (OR 2.0,p=0.001), patient’s belief that they should have surgery (OR 1.9,p=0.003), walking distance <50 ft (OR 1.9,p=0.01), relief of symptoms when bending forward (OR 1.7,p=0.008) and sitting (OR 1.6,p=0.009), works more slowly (OR 1.6p=0.01), aggravation of symptoms by Valsalva (OR 1.4,p=0.03), and pain affecting sitting/standing (OR 1.1,p=0.001).ConclusionsWe identified 11 preoperative variables that were predictive of whether patients were offered surgery, which are important factors to consider when screening outpatient spine referrals.

332 Factors that Predict Surgical Candidacy in Degenerative Spine Disorders: a Clinical Prediction Model

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 273-274
Author(s):  
Michael M H Yang ◽  
Godefroy Hardy St-Pierre ◽  
Stephan DuPlessis ◽  
Keyword(s):  
Predictive Value ◽  
Walking Distance ◽  
Degenerative Spine ◽  
Presenting Symptoms ◽  
Co Morbidity ◽  
Spine Diseases ◽  
Patient Variables ◽  
Logistical Regression ◽  
Morbidity Index ◽  
Spine Disorders

Abstract INTRODUCTION Referrals to spine surgeons typically have low surgical yields between 10–20%. In this study, pre-operative patient variables predictive of patients being offered surgery for degenerative spine diseases were examined METHODS We performed retrospective analysis of prospectively collected data of patients referred to the spine clinic at Foothills Medical Centre, Calgary, Canada between May 2013 and January 2015. Variables collected include basic patient demographics, presenting symptoms, SF-12, perceived deficit questionnaire, McGill pain index, Charlson Co-morbidity index, VAS, alleviating/aggravating factors, medications, occupational variables and previous surgeries/injections were collected. A multivariate logistical regression using the Random Forest method was used to determine the odds of being offered surgery or not based on pre-operative variables. RESULTS >1184 patients were included in the analysis. The multivariate logistical regression showed factors that reduce the likelihood of surgery being offered include mild pain (OR 0.37), normal walking distance (OR 0.51), sitting tolerance of 30–60 min (OR 0.58). Factors that increased likelihood of surgery being offered include radiculopathy (OR 2.0), walking distance <50ft (OR 1.9), Relief when bending forward (OR 1.7) and sitting (OR 1.6), aggravation of symptoms by valsalva (OR 1.44), pain affects sit/stand (OR 1.1). The model's overall accuracy was 75% with a negative predictive value of 77% and positive predictive value of 50% CONCLUSION Direct functional metrics dominate the decision-making process overshadowing traditional scales such as the VAS, PDQ-9 and SF-12. This model does not predict which patients would be offered surgery. However, the model is able to identify patients who are non-surgical and thereby improve the surgical yield in spine surgery clinics.

Spinal Disorders

2015 ◽  
Author(s):  
James Rainville
Keyword(s):  
Health Care Providers ◽  
Leg Pain ◽  
Time Sharing ◽  
Care Providers ◽  
Pain Scores ◽  
Age Related ◽  
History Of ◽  
Radicular Symptoms ◽  
And Function ◽  
Spine Disorders

Physicians of many disciplines encounter patients complaining of neck pain, back pain, and radicular symptoms. Although the prognoses for spinal problems are generally favorable and most patients recover quickly, in many cases, symptoms recur or persist over time. Sharing information with patients can help health care providers develop a rationale for treatment that stresses the role of patients in their recovery. This chapter discusses spine anatomy and function, age-related degeneration of spine structures, the epidemiology and natural history of degenerative spine disorders, the basic neurology of pain, and treatment choices that may optimize recovery. A table describes common patterns of symptoms and signs of radiculopathies. A graph illustrates pain scores for leg pain from acute lumbar radiculopathies. This chapter contains 1 highly rendered figure, 1 table, 323 references, and 5 MCQs.

Probiotics in gastroenterology – from a different angle

2013 ◽  
Vol 154 (8) ◽  
pp. 294-304 ◽  
Author(s):  
György Miklós Buzás
Keyword(s):  
Side Effects ◽  
Beneficial Effect ◽  
Analytical Data ◽  
Well Being ◽  
Gastrointestinal Diseases ◽  
Convincing Evidence ◽  
Probiotic Treatment ◽  
History Of ◽  
Irritable Bowel

After a short overview of the history of probiotics, the author presents the development of human intestinal microflora based on the newest genetic data and the microbiological features of main probiotics. The indications of probiotic administration have been defined and extended in recent years. The author reviews significant results of probiotic treatment in some gastrointestinal diseases based on meta-analytical data. Probiotics are useful in preventing and treating diarrhoea caused by antibiotics and Clostridium difficile caused diarrhoea. In the treatment of Helicobacter pylori infection, preparations containing certain Lactobacillus,Bifidobacterium strains or Saccaromyces boulardii could enhance by 5–10% the rate of successful eradication and reduce the incidence and severity of the side effects. Some symptoms of irritable bowel syndrome and thus the quality of life can be improved by probiotics. Their beneficial effect in ulcerative colitis was proven, while in Crohn’s disease has not yet been defined. The use of probiotics is not included in guidelines, with the exception of the Maastricht IV/Florence consensus. For each disease it is advisable to use probiotics containing strains only with proven beneficial effect. The efficiency of preparations containing mixed strains has not yet been properly investigated. The author reviews the rare but potentially serious side effects of probiotics. In Hungary, there are many probiotic preparations available which can be purchased in pharmacies without prescription: their use is more empirical than evidence-based. The European Food Safety Authority has recently rejected claims for probiotics to be classed as medicines given the lack of convincing evidence on the effects of probiotics on human health and well-being. Clearly, further research is needed to collect evidence which could be incorporated into the international guidelines. Orv. Hetil., 2013, 154, 294–304.

CREATING WALKING LED TRANSIT STATIONS FOR WOMEN IN MALAYSIA

2020 ◽  
Vol 7 (1) ◽  
pp. 99
Author(s):  
Yong Adilah Shamsul Harumain ◽  
Nur Farhana Azmi ◽  
Suhaini Yusoff
Keyword(s):  
Quality Of Life ◽  
Developing Countries ◽  
Public Transportation ◽  
Carbon Emission ◽  
The Other ◽  
Walking Distance ◽  
The Road ◽  
On The Road ◽  
Female User

Transit stations are generally well known as nodes of spaces where percentage of people walking are relatively high. The issue is do more planning is actually given to create walkability. Creating walking led transit stations involves planning of walking distance, providing facilities like pathways, toilets, seating and lighting. On the other hand, creating walking led transit station for women uncover a new epitome. Walking becomes one of the most important forms of mobility for women in developing countries nowadays. Encouraging women to use public transportation is not just about another effort to promote the use of public transportation but also another great endeavour to reduce numbers of traffic on the road. This also means, creating an effort to control accidents rate, reducing carbon emission, improving health and eventually, developing the quality of life. Hence, in this paper, we sought first to find out the factors that motivate women to walk at transit stations in Malaysia. A questionnaire survey with 562 female user of Light Railway Transit (LRT) was conducted at LRT stations along Kelana Jaya Line. Both built and non-built environment characteristics, particularly distance, safety and facilities were found as factors that are consistently associated with women walkability. With these findings, the paper highlights the criteria  which are needed to create and make betterment of transit stations not just for women but also for walkability in general.

EXPLORING HEALTHCARE ARCHITECTURE THROUGH THE MEDIUM OF FILM: Motives and Techniques

2014 ◽  
Vol 8 (1) ◽  
pp. 29
Author(s):  
Stephen Verderber
Keyword(s):  
Real World ◽  
The Real ◽  
Healthcare Settings ◽  
Interdisciplinary Field ◽  
Body Of Knowledge ◽  
Behavior Setting ◽  
Physical Environments ◽  
Scant Attention ◽  
History Of

The interdisciplinary field of person-environment relations has, from its origins, addressed the transactional relationship between human behavior and the built environment. This body of knowledge has been based upon qualitative and quantitative assessment of phenomena in the “real world.” This knowledge base has been instrumental in advancing the quality of real, physical environments globally at various scales of inquiry and with myriad user/client constituencies. By contrast, scant attention has been devoted to using simulation as a means to examine and represent person-environment transactions and how what is learned can be applied. The present discussion posits that press-competency theory, with related aspects drawn from functionalist-evolutionary theory, can together function to help us learn of how the medium of film can yield further insights to person-environment (P-E) transactions in the real world. Sampling, combined with extemporary behavior setting analysis, provide the basis for this analysis of healthcare settings as expressed throughout the history of cinema. This method can be of significant aid in examining P-E transactions across diverse historical periods, building types and places, healthcare and otherwise, otherwise logistically, geographically, or temporally unattainable in real time and space.

РАССКАЗЫ В.ШУКШИНА И ПРОБЛЕМЫ ПЕРЕВОДА ИХ НА КЫРГЫЗСКИЙ ЯЗЫК

2020 ◽  
pp. 77-81
Author(s):  
Джээнбүбү Бегеева
Keyword(s):  
Key Words ◽  
Russian Literature ◽  
Main Task ◽  
Stylistic Variation ◽  
Psychological Feature ◽  
Translation Analysis ◽  
History Of ◽  
The Creation ◽  
Problems Of Translation

Аннотация. В статье анализируется качество переводов рассказов В.Шукшина, осуществленных в середине 70-х годов С. Наматбаевым. Переводоведческий анализ вывил многочисленные стилевые расхождения между оригиналом и переводом. При переводе одного из лучших рассказов Шукшина «Чудик» искажения стиля не передали психологические тонкости рассказа. При переводе рассказа «Дядя Ермолай» философский аспект рассказа выпал, так как переводчик исказил жанровую специфику. Перевод рассказа «Два письма» оказался более качественным по сравнению с предыдущими. Переводчик рассказа «Два письма» сумел приблизиться к оригиналу, расшифровать его основную тональность, воспроизвести атмосферу напряженных поисков истины героем рассказа Николаем Иванычем. Этот перевод оказался более качественно выполненным по сравнению с предыдущим рассказом «Дядя Ермолай». Причину переводческого успеха можно объяснить, прежде всего, доступностью содержания рассказа, да и сам герой не столь сложная и глубокая личность, как повествователь в рассказе о дяде Ермолае. В целом, переводы С.Наматбаева являются своеобраз- ным этапом в переводческом деле. В настоящее время необходимо более полное и глубокое восприятие творчества В.Шукшина и создания новых адекватных переводов. Ключевые слова: качество переводов, стилевые расхождения, психологические тонкости, философский аспект, этапом. Аннотация. Макалада В.Шукшиндин аңгемелеринин кыргыз тилине которуудагы сапаты каралат, котормолор 1970-жылдары котормочу С.Наматбаев аркылуу жаралган. Котормонун сапатына талдоо жүргүзгөндө көпчүлүк каталар табылган, алардын эң олуттуусу стилдердин айырмасы, негизги чыгарма менен котормонун ортосунда. Мисалы, “Чудик” деген аңгеменин психологиялык мүнөздөмөсү жоголуп кеткен. “Ермолай байке” деген аңгемеде жанрдын туура эмес берилишинен жазуучунун негизги ою жоголуп кеткен. “Эки кат” деген аңгеме беркилерге караганда сапаттуу которулган. Котормочу " Эки кат" деген аңгемени оригиналга жакындатып которгон. Башкы каарман Николай Иванычтын изденүүлөрүн, ойлорун, чындыкты табууга аракеттерин Шукшинден кем эмес окуучуларга жеткирген. Котормочунун жетишкендиги аңгеменин түшүнүктүү мазмуну менен түшүндүрсө болот, жана Николай Ивановичтин жөнөкөйлүгү менен. С.Наматбаевдын котормолору каталарына карабастан котормочулук иште алдыга жылуу болгон. Бирок, азыркы заманда сапаттуу котормо жаратууда мезгил келди. Түйүндүү сөздөр: которуудагы сапаты, стилдердин айырмасы, психологиялык мүнөздөмөсү, негизги ою жоголуп. Annotation. The quality of translation of the Shukshins stories is analyzed in the Middle 70- years. By S.Namatbaev. The translation analysis had idenh hed numerous style discrepancies between the original and the translation. The psychological feature of the compasihion were not be hansfered by the translation one the bestand famous story by. V.Shukshin due to distorhion of the style. By the translation of the story “The uncle Ermolai” had full a phisichal aspect of the story, because the translator had distorted the genre specifics. The translation of the stories “Two letters” was wade more qualitative comparated with another stories. Generally, the Namatbaevs translation are a sui generis stage in the translatiobs. We need currently more total and profound perception of the creation by V.Shukshin. The create of the new adeavate translation is the main task. The head of the theory and history of Russian literature department. V. Shukshin’s stories and problems of translation them into Kyrgyz language. This article is analysed the quality of translation of V. Shukshin’s stories, which were written in 70 th with S. Namatbaev. Translation analyse deduced many stylistic variations between translated version and original. There is a misrepresentation, was not transmitted psychological subtleties of the story in translation of one of the best V. Shuk- shin’s story “Wierdo”. Metaphysical dimension is disappeared in translation of the story “Uncle Ermolai”, since translator destort the genre specificity. The translation of the story “Two letters” has been more qualitative in comparison with previous translations. In common, S. Namatbaev’s translation is a genius stage in translation. It needs more full and deep comprehension of S. Shukshin’s work and to establish new suitable translation. Key words: Quality of translation, stylistic variation, psychological subtleties, metaphysical dimension, stage.

Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

2020 ◽  
Vol 18 ◽  
Author(s):  
Humberto Guanche Garcell ◽  
Juan José Pisonero Socias ◽  
Gilberto Pardo Gómez
Keyword(s):  
Antimicrobial Stewardship ◽  
Historical Review ◽  
Original Data ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Continuous Quality ◽  
Stewardship Program ◽  
History Of ◽  
Health Organization

Background: During the last 30 years an antimicrobial stewardship program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of the sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributes to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarts in 2008 and decline in 2015, while the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.

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