scholarly journals Correlation between Intraoperative Fluid Administration and Outcomes of Pancreatoduodenectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Xuefeng Cao ◽  
Xixiu Wang ◽  
Baolei Zhao ◽  
Lingqun Kong ◽  
Lei Zhou ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Postoperative Morbidity ◽  
Multivariable Analysis ◽  
Bowel Function ◽  
University Hospital ◽  
Respiratory Complications ◽  
Liberal Group ◽  
Abdominal Infections ◽  
Medical University

Background. Intraoperative fluid (IOF) administration plays an important role during major abdominal surgery although increased fluid intake can adversely influence postoperative outcomes. However, the effect of the IOF rate on the outcomes of pancreatoduodenectomy (PD) is unclear. Methods. 151 patients, who underwent PD at Binzhou Medical University Hospital between January 2010 and May 2017, were categorized into three groups according to IOF rates (ml/kg/hr): restricted (<10, n=47), standard (10–15, n=76), and liberal (>15, n=28). Results. The overall postoperative morbidity was 56.95%. The incidence of postoperative pancreatic fistula (POPF) was 11.26%. The in-hospital mortality rate was 7.28% with the most common cause being grade C POPF and secondary intra-abdominal infections. The patients in the liberal group had significantly higher incidences of POPF (25%) and respiratory complications (21.43%). The other outcome parameters such as recovery of bowel function, hospital stay, and postoperative daily drainage were similar among the groups. Multivariable analysis confirmed the IOF rate to be most strongly associated with POPF (odds ratio: 5.195, confidence interval: 1.142–23.823, P=0.023) and respiratory complications (odds ratio: 7.302, confidence interval: 0.676–58.231, P=0.025). Conclusions. The IOF rate significantly affects the incidence of POPF and respiratory complications after PD. Careful patient-oriented fluid therapy may help to prevent these complications.

scholarly journals The Frequency of Use and Harm Perception of Heated Tobacco Products (HTPs): The 2019 Cross-Sectional Survey among Medical Students from Poland

2021 ◽  
Vol 18 (7) ◽  
pp. 3381
Author(s):  
Paulina Majek ◽  
Mateusz Jankowski ◽  
Bartłomiej Nowak ◽  
Maksymilian Macherski ◽  
Maciej Nowak ◽  
...  
Keyword(s):  
Medical Students ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Response Rate ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Cigarette Smokers ◽  
Tobacco Products ◽  
Frequency Of Use ◽  
Medical University

Heated tobacco products (HTPs) are devices for generating a nicotine aerosol by heating the tobacco sticks. This study aimed to assess (1) the prevalence of HTP and tobacco cigarette usage among medical students, (2) to characterize smoking habits and (3) to assess students’ awareness and opinions about HTPs. A cross-sectional survey on the frequency and attitudes toward cigarettes, e-cigarettes and HTP use was performed between 2019–2020 at the Medical University of Silesia in Katowice (Poland). The data were obtained from 1344 students aged 21.8 ± 1.9 years (response rate: 66.9%). Current traditional tobacco use was 13.2%, e-cigarettes use 3.5%, and HTP use 2.8% of students. Duration of use was shorter among HTPs users comparing to cigarette smokers (p < 0.001) although the number of tobacco sticks used daily was similar (p = 0.1). Almost 30% of respondents have ever tried HTPs. HTPs were considered safe by 5.3% of respondents (43.2% of HTP users vs. 3.9% of non-HTP users, p < 0.001). HTP users were more likely to report that heating tobacco is not addictive (odds ratio (OR) = 8.9, 95% confidence interval (CI): 1.8–45.8) and disagreed with a public ban on HTP use (OR = 4.9, 95%CI: 2.5–9.8). Among students, HTP use was less popular than cigarette smoking, but awareness of their presence is widespread.

Primary Uterine Cancer in Maryland: Impact of Distance on Access to Surgical Care at High-Volume Hospitals

2013 ◽  
Vol 23 (7) ◽  
pp. 1244-1251 ◽  
Author(s):  
Camille C. Gunderson ◽  
Ana I. Tergas ◽  
Aimee C. Fleury ◽  
Teresa P. Diaz-Montes ◽  
Robert L. Giuntoli
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Uterine Cancer ◽  
Multivariable Analysis ◽  
Community Setting ◽  
Surgical Care ◽  
High Volume ◽  
High Volume Hospital ◽  
To Receive ◽  
Zip Code

ObjectiveTo evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland.MethodsThe Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient’s zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals.ResultsFrom 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (allP< 0.05). Patients who travel 50 miles or more to the treating hospital are more likely to have surgery at a HVH (odds ratio, 6.03; 95% confidence interval, 4.67–7.79) In contrast, patients, who reside ≥50 miles from a HVH, are less likely to have their surgery at an HVH. (odds ratio, 0.37; 95% confidence interval, 0.32–0.42).ConclusionIn Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

scholarly journals Comparing Telephone Counseling With Reminding to Promote On-Time Repeated Mammography: A Randomized Trial in a Cohort With 4 Years Follow-Up

2019 ◽  
Vol 47 (1) ◽  
pp. 37-46
Author(s):  
Mary E. Costanza ◽  
Roger Luckmann ◽  
Christine Frisard ◽  
Mary Jo White ◽  
Caroline Cranos
Keyword(s):  
Confidence Interval ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Telephone Counseling ◽  
Long Term Effects ◽  
Time Points ◽  
Reminder Call ◽  
Screening Mammograms

Background. Long-term continuous adherence to biennial screening mammograms as guidelines recommend remains low. Limited evidence suggests that reminder calls may increase short-term adherence as much as telephone counseling, but research is needed comparing the long-term effects of these two approaches. Purpose. To compare the impacts of two telephone outreach interventions and mailed reminders on 4-year continuous mammography adherence. Method. A cohort of 3,215 women, age 50 to 81 years, was selected from 30,160 women from a 4-year randomized trial of three interventions to promote biennial mammography: reminder letter only (LO), letter plus reminder call (RC), and two letters plus educational material and a counseling call (CC). Women selected remained eligible for the trial all 4 years and received annual interventions as needed. The proportion with a mammogram in the last 24 months was determined at baseline and four annual time points. Results. Continuous adherence at all four time points was higher in the RC (78.8%) and CC arms (78.8%) than in the LO arm (75.1%; p < .001). Multivariable analysis confirmed this finding: CC (odds ratio = 1.27; 95% confidence interval = [1.01, 1.61]) and RC (odds ratio = 1.23; 95% confidence interval = [0.98, 1.56]). Only 27.8% of women eligible for an initial counseling call actually received counseling. Conclusions. Compared with letters alone, outreach calls can modestly increase continuous mammography adherence among insured women with consistent primary care. Telephone counseling was no more effective than a reminder call, possibly due to limited acceptance of counseling calls by women who may find them unwelcome or unnecessary.

Clinical and socio-economic predictors of work participation in adult CHD patients

2020 ◽  
Vol 30 (8) ◽  
pp. 1081-1085
Author(s):  
Lauren A. Sarno ◽  
Lindsay Cortright ◽  
Tiara Stanley ◽  
Dmitry Tumin ◽  
Jennifer S. Li ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Employment Status ◽  
Heart Defects ◽  
Multivariable Analysis ◽  
Population Based ◽  
Work Participation ◽  
Surveillance Network ◽  
The North ◽  
Economic Predictors

AbstractBackground:Adults with CHD have reduced work participation rates compared to adults without CHD. We aimed to quantify employment rate among adult CHD patients in a population-based registry and to describe factors and barriers associated with work participation.Methods:We retrospectively identified adults with employment information in the North Carolina Congenital Heart Defects Surveillance Network. Employment was defined as any paid work in a given year. Logistic regression was used to examine patients’ employment status during each year.Results:The registry included 1,208 adult CHD patients with a health care encounter between 2009 and 2013, of whom 1,078 had ≥1 year of data with known employment status. Overall, 401 patients (37%) were employed in their most recent registry year. On multivariable analysis, the odds of employment decreased with older age and were lower for Black as compared to White patients (odds ratio = 0.78; 95% confidence interval: 0.62, 0.98; p = 0.030), and single as compared to married patients (odds ratio = 0.50; 95% confidence interval: 0.39, 0.63; p < 0.001).Conclusion:In a registry where employment status was routinely captured, only 37% of adult CHD patients aged 18–64 years were employed, with older patients, Black patients, and single patients being less likely to be employed. Further work is needed to consider how enhancing cardiology follow-up for adults with CHD can integrate support for employment.

Urgent Adenotonsillectomy

2003 ◽  
Vol 99 (3) ◽  
pp. 586-595 ◽  
Author(s):  
Karen A. Brown ◽  
Isabelle Morin ◽  
Chantal Hickey ◽  
John J. Manoukian ◽  
Gillian M. Nixon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Medical Intervention ◽  
Control Group ◽  
Respiratory Complications ◽  
Obstructive Sleep ◽  
Postoperative Respiratory Complications

Background The aim of this study was to determine the frequency and type of respiratory complications after urgent adenotonsillectomy (study group) for comparison with a control group of children undergoing a sleep study and adenotonsillectomy for obstructive sleep apnea syndrome. A second aim was to assess risk factors predictive of respiratory complications after urgent adenotonsillectomy. Methods The perioperative course of children who underwent adenotonsillectomy between January 1, 1999, and March 31, 2001, was reviewed. Two groups of children were identified from two different databases: the hospital database for surgical procedures (the study group) and the sleep laboratory database (the control group). The retrospective chart review focused on the preoperative status (including an evaluation for obstructive sleep apnea), anesthetic management, and need for postoperative respiratory interventions. Results A total of 64 consecutive cases for urgent adenotonsillectomy were identified, and 54 children met the inclusion criteria. Thirty-three children (60%) had postoperative respiratory complications necessitating a medical intervention; 11 (20.3%) required a major intervention (reintubation, ventilation, and/or administration of racemic epinephrine or Ventolin), and 22 (40.7%) required a minor intervention (oxygen administration). Six children (11.1%) required reintubation in the recovery room for respiratory compromise. Risk factors for respiratory complications were an associated medical condition (odds ratio, 8.15; 95% confidence interval, 1.81-36.73) and a preoperative saturation nadir less than 80% (odds ratio, 5.54; 95% confidence interval, 1.15-26.72). Sixteen (49%) of the medical interventions were required within the first postoperative hour. Atropine administration, at induction, decreased the risk of postoperative respiratory complications (odds ratio, 0.18; 95% confidence interval, 0.11-1.050. Control Group Of 75 children who underwent a sleep study and adenotonsillectomy, 44 had sleep apnea and were admitted to hospital after elective adenotonsillectomy. Sixteen (36.4%) children had postoperative respiratory complications necessitating a medical intervention. Six percent of the children (n = 3) required a major medical intervention. No child required reintubation for respiratory compromise. Conclusions Severe obstructive sleep apnea syndrome and an associated medical condition are risk factors for postadenotonsillectomy respiratory complications. Risk reductions strategies should focus on their assessment.

Risk Factors for Groin Wound Infection After Femoral Artery Catheterization A Case-Control Study

2006 ◽  
Vol 27 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Philip M. Polgreen ◽  
Daniel J. Diekema ◽  
Jeff VandeBerg ◽  
R. Todd Wiblin ◽  
Yi Yi Chen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Wound Infection ◽  
Femoral Artery ◽  
Odds Ratio ◽  
Case Control Study ◽  
Medical Center ◽  
Case Control ◽  
University Hospital ◽  
Hematoma Formation ◽  
Control Study

Objective.Groin wound infection (GWI) after femoral artery catheterization is unusual. However, several reports of GWI associated with the use of a Perclose device appear in the surgical literature.Design.A case-control study.Setting.We pooled 23 cases and 83 controls from a university hospital and a community medical center.Patients.A case was defined as a patient who developed a GWI after a femoral artery catheterization. At the university hospital, 3 controls were randomly selected from the at-risk population and matched to each case by time of procedure only (within 2 weeks). At the community medical center, 4 controls were selected and matched to each case by time of procedure (within 2 weeks), sex, and age (within 5 years).Results.We considered several covariates, including age, sex, body mass index, medical conditions, Perclose use, hematoma formation, and antithrombotic therapy. In a multivariate model, only hematoma formation (odds ratio, 68.8; 95% confidence interval, 12.1-391.4) and glycoprotein IIb/IIIa platelet inhibitor therapy (odds ratio, 6.1; 95% confidence interval, 1.1-33.6) were statistically significant predictors of GWI; Perclose use (odds ratio, 0.9; 95% confidence interval, 0.2-3.7) was not a statistically significant predictor of GWI. However, most of the hematomas (15/17) formed after procedures during which a Perclose device was used.Conclusion.Perclose use did not have any additional effect on GWI risk beyond the effect that hematoma formation had.

scholarly journals Risk Factors for Exposure of Baerveldt Glaucoma Drainage Implants: A Case-Control Study

2020 ◽  
Author(s):  
Ayaka Edo ◽  
Koji Jian ◽  
Yoshiaki Kiuchi
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
University Hospital ◽  
Implant Surgery ◽  
Implant Exposure ◽  
Patients With Diabetes

Abstract Background: Glaucoma drainage implant exposure is one of the serious complications after glaucoma drainage implant surgery. The purpose of this study is to evaluate the risk factors for exposure of the device after implantation of a Baerveldt glaucoma drainage implant.Methods: This is a retrospective review of the medical records of all patients who underwent Baerveldt glaucoma drainage implant surgery at the Hiroshima University Hospital between April 1, 2012 and October 31, 2016, and who were followed for at least 6 months after surgery. We examined the risk factors for implant exposure based on data obtained from the medical records, with particular focus on the differences in implant models.Results: A total of 80 eyes from 80 patients were identified; all patients were Japanese. In this study, the rate of Baerveldt glaucoma drainage implant exposure was 15.0% (12 of 80). The exposure rate of the BG 102-350 was tended to be higher than that for the BG 101-350 and BG 103-250 (p=0.092; adjusted odds ratio=3.34; 95% confidence interval, 0.82–13.58). In the patients who had diabetic mellitus, the BG 102-350 showed a significant risk of implant exposure (p=0.038; adjusted odds ratio =15.36; 95% confidence interval, 1.17–202.59).Conclusions: In Baerveldt glaucoma drainage implant surgery in patients with diabetes, using the BG 102-350 was associated with greater risk of implant exposure compared with using BG 101-350 or BG 103-250.

scholarly journals Association of hemoglobin with incidence of in-hospital cardiac arrest in patients with acute coronary syndrome complicated by cardiogenic shock

2019 ◽  
Vol 47 (9) ◽  
pp. 4151-4162
Author(s):  
Tiancheng Xu ◽  
Dongjie Liang ◽  
Shengjie Wu ◽  
Xiaodong Zhou ◽  
Ruiyu Shi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Confidence Interval ◽  
Cardiogenic Shock ◽  
Odds Ratio ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
Hemoglobin Concentration ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Objective This study was performed to investigate the association of the admission hemoglobin level with the incidence of in-hospital cardiac arrest (IHCA) in patients with acute coronary syndrome (ACS) complicated by cardiogenic shock (CS). Methods In this retrospective study, we reviewed the medical records of consecutive patients with ACS complicated by CS admitted to the coronary care unit from January 2014 to October 2017. Logistic regression models were carried out to evaluate the association between hemoglobin and the incidence of IHCA. Interaction and subgroup analyses were also performed. Results In total, 211 patients were included in the study, and 61 (28.9%) patients developed IHCA. In the multivariable analysis, hemoglobin was a strong independent predictor of IHCA (odds ratio, 0.971; 95% confidence interval, 0.954–0.989). In the fully adjusted model, patients in the higher hemoglobin tertile were less likely to develop IHCA than patients in the lowest hemoglobin tertile (odds ratio, 0.194; 95% confidence interval, 0.071–0.530). The relationship remained stable in most subgroups except patients aged ≥70 years. Conclusion In patients with ACS complicated by CS, the incidence of IHCA is related to the hemoglobin concentration, and a high hemoglobin concentration is a protective factor against the development of IHCA.

Atrial fibrillation and migraine with aura in young adults with ischemic stroke

Cephalalgia ◽  
2020 ◽  
pp. 033310242097088
Author(s):  
Cédric Gollion ◽  
Julie Gazagnes ◽  
Vincent Fabry ◽  
Marianne Barbieux-Guillot ◽  
Fleur Lerebours ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Migraine With Aura ◽  
Odds Ratio ◽  
Migraine Without Aura ◽  
University Hospital ◽  
Common Cause ◽  
Increased Risk

Background Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated. Methods We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18–54 years treated consecutively in a university hospital stroke center. Results A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24–21.92; p = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05–0.97; p = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00–0.87; p = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup. Conclusion We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.

Gastroenteritis in older people living in the community: results of two Australian surveys

2012 ◽  
Vol 140 (11) ◽  
pp. 2028-2036 ◽  
Author(s):  
M. D. KIRK ◽  
G. V. HALL ◽  
N. BECKER
Keyword(s):  
Food Safety ◽  
Confidence Interval ◽  
Older People ◽  
Elderly People ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
The Elderly ◽  
The State ◽  
National Surveys

SUMMARYWe analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.

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