scholarly journals The impact of the acute surgical assessment unit on the management of acute appendicitis: a single-centre review

2021 ◽  
Author(s):  
Enda Hannan ◽  
Sherif El-Masry
Keyword(s):  
Acute Appendicitis ◽  
Emergency General Surgery ◽  
Conversion To Open Surgery ◽  
Assessment Unit ◽  
The Mean ◽  
Negative Appendicectomy ◽  
The Impact ◽  
Mean Time ◽  
Surgical Condition

Abstract Background Acute surgical assessment units (ASAUs) aim to optimise management of surgical patients compared to the traditional ‘on-call’ emergency department (ED) system. Acute appendicitis (AA) is the most common acute surgical condition requiring emergency surgery. Aim We set out to assess if the ASAU improved care provided to patients with AA compared to those managed through the ED. Methods Patients admitted via the ED with AA in the 6 months prior to opening the ASAU were compared to those admitted via the ASAU in the first six months following its implementation. Relevant data was collected on key performance indicators from their charts. Results In the ASAU cohort, the mean time to be seen was one hour less than the ED cohort (21 min vs 74 min). The mean time to surgery was also 8.8 h shorter. Most patients in the ASAU group (78.6%) underwent surgery during the day, compared to 40.3% of ED patients. The ASAU patients also had a lower postoperative complication rate (0.9% vs 3.9%), as well as a lower negative appendicectomy rate (14.2% vs 18.6%) and lower conversion-to-open surgery rate. Greater consultant supervision and presence was observed. Conclusions The ASAU has resulted in better outcomes for patients with AA than those admitted via ED. More operations were performed in safer daytime hours with greater consultant presence, allowing for improved senior support for trainee surgeons. Our study supports the role of the ASAU in improving the quality and efficiency of emergency general surgery.

scholarly journals The Role of Oncofertility Clinics in Facilitating Access to Reproductive Specialists

2016 ◽  
Vol 3 (4) ◽  
pp. 131-136 ◽  
Author(s):  
Eduardo Hariton ◽  
Pietro Bortoletto ◽  
Eden R Cardozo ◽  
Ephraim P Hochberg ◽  
Mary E Sabatini
Keyword(s):  
Massachusetts General Hospital ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Cancer Center ◽  
The Mean ◽  
Reproductive Aged Women ◽  
The Impact ◽  
Patient Referrals ◽  
Mean Time

Purpose: To determine the impact of the establishment of a dedicated oncofertility clinic on the frequency of patient referrals for fertility preservation (FP) consultation and the time from patient referral to consultation. Methods: A retrospective chart review of all women aged 21 to 44 years with an active cancer diagnosis who were referred for FP consultation from 2011 to 2015. Results: A total of 6895 female patients eligible for FP were seen at the Massachusetts General Hospital (MGH) Cancer Center. Of those eligible, a total of 209 patients were referred for FP consultation with 150 included in the final analysis. Since the establishment of the oncofertility clinic, the mean time to nonemergent consultation with a reproductive endocrinologist decreased by 27%, from 10.4 to 7.6 days ( P = .03). Furthermore, the proportion of reproductive-aged females seen at the MGH Cancer Center referred for FP consultation increased from 1.7% to 3.0% ( P < .01). Conclusion: A dedicated oncofertility clinic increases physician referrals for FP and decreases the mean time to consultation, improving access to FP consultation for reproductive-aged women with cancer.

scholarly journals The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽  
2021 ◽  
pp. 146040862094972
Author(s):  
Ahmed Fadulelmola ◽  
Rob Gregory ◽  
Gavin Gordon ◽  
Fiona Smith ◽  
Andrew Jennings
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Hospital Admissions ◽  
The Elderly ◽  
Primary Outcome Measure ◽  
Time To Death ◽  
Significant Difference ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

scholarly journals Early Neuromuscular Blockade in Children with Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
Vol 09 (03) ◽  
pp. 201-206
Author(s):  
Surabhi Chandra ◽  
Sahil Goel ◽  
Ritika Dawra
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Neuromuscular Blockade ◽  
Distress Syndrome ◽  
Control Group ◽  
Case Group ◽  
The Mean ◽  
Mean Time

AbstractPediatric acute respiratory distress syndrome (PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having PARDS and development of associated complications, if any. This was a prospective, case–control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24–48) for case group patients, significantly lower (p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90–126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower (p < 0.0001; 95% confidence interval: 5.9129–9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.

scholarly journals PRE- and POST-STORM LiDAR SURVEYS FOR ASSESSMENT OF IMPACT ON COASTAL EROSION

2019 ◽  
Vol XLII-3/W8 ◽  
pp. 261-266
Author(s):  
A.-L. Montreuil ◽  
M. Chen ◽  
A. Esquerré ◽  
R. Houthuys ◽  
R. Moelans ◽  
...  
Keyword(s):  
Management Practices ◽  
Morphological Changes ◽  
Storm Surges ◽  
High Water ◽  
Water Levels ◽  
Airborne Lidar ◽  
Coastline Change ◽  
The Mean ◽  
The Impact

<p><strong>Abstract.</strong> Sustainable management of the coastal resources requires a better understanding of the processes that drive coastline change. The coastline is a highly dynamic sea-terrestrial interface. It is affected by forcing factors such as water levels, waves, winds, and the highest and most severe changes occur during storm surges. Extreme storms are drivers responsible for rapid and sometimes dramatic changes of the coastline. The consequences of the impacts from these events entail a broad range of social, economic and natural resource considerations from threats to humans, infrastructure and habitats. This study investigates the impact of a severe storm on coastline response on a sandy multi-barred beach at the Belgian coast. Airborne LiDAR surveys acquired pre- and post-storm covering an area larger than 1 km<sup>2</sup> were analyzed and reproducible monitoring solutions adapted to assess beach morphological changes were applied. Results indicated that the coast retreated by a maximum of 14.7 m where the embryo dunes in front of the fixed dunes were vanished and the foredune undercut. Storm surge and wave attacks were probably the most energetic there. However, the response of the coastline proxies associated with the mean high water line (MHW) and dunetoe (DuneT) was spatially variable. Based on the extracted beach features, good correlations (r>0.73) were found between coastline, berm and inner intertidal bar morphology, while it was weak with the most seaward bars covered in the surveys. This highlights the role of the upper features on the beach to protect the coastline from storm erosion by reducing wave energy. The findings are of critical importance in improving our knowledge and forecasting of coastline response to storms, and also in its translation into management practices.</p>

scholarly journals THE LUCK IN “TALENT VERSUS LUCK” MODELING

2020 ◽  
Vol 23 (03) ◽  
pp. 2050007
Author(s):  
SEAN ELVIDGE
Keyword(s):  
Mean Value ◽  
Maximum Amount ◽  
Random Numbers ◽  
Individual Parameter ◽  
Input Parameters ◽  
The Mean ◽  
Model Variability ◽  
The Impact ◽  
The Relationship

This paper further investigates the Talent versus Luck (TvL) model described by [Pluchino et al. Talent versus luck: The role of randomness in success and failure, Adv. Complex Syst. 21 (2018) 1850014] which models the relationship between ‘talent’ and ‘luck’ on the impact of an individuals career. It is shown that the model is very sensitive to both random sampling and the choice of value for the input parameters. Running the model repeatedly with the same set of input parameters gives a range of output values of over 50% of the mean value. The sensitivity of the inputs of the model is analyzed using a variance-based approach based upon generating Sobol sequences of quasi-random numbers. When using the model to look at the talent associated with an individual who has the maximum capital over a model run it has been shown that the choice for the standard deviation of the talent distribution contributes to 67% of the model variability. When investigating the maximum amount of capital returned by the model the probability of a lucky event at any given epoch has the largest impact on the model, almost three times more than any other individual parameter. Consequently, during the analysis of the model results one must keep in mind the impact that only small changes in the input parameters can have on the model output.

Patient Access to Hepatitis C Treatment After Incorporation of Pharmacists in a Hepatology Clinic

2021 ◽  
pp. 001857872110375
Author(s):  
Frank A. Fanizza ◽  
Jennifer Loucks ◽  
Angelica Berni ◽  
Meera Shah ◽  
Dennis Grauer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Medication Adherence ◽  
Hcv Treatment ◽  
Clinical Pharmacists ◽  
The Mean ◽  
Group 2 ◽  
Cure Rates ◽  
The Impact ◽  
Mean Time ◽  
Group 1

Background: Modern hepatitis C virus (HCV) treatment regimens yield cure rates greater than 90%. However, obtaining approval for treatment through the prior authorization (PA) process can be time consuming and require extensive documentation. Lack of experience with this complex process can delay HCV medication approval, ultimately increasing the amount of time before patients start treatment and in some cases, prevent treatment altogether. Objectives: Assess the impact of incorporating clinical pharmacists into specialty pharmacy and hepatology clinic services on medication access, patient adherence, and outcomes in patients being treated for HCV. Methods: We performed a retrospective cohort exploratory study of patients seen in an academic medical center hepatology clinic who had HCV prescriptions filled between 8/1/15 and 7/31/17. Patients were categorized by whether they filled prescriptions prior to (Pre-Group) or after (Post-Group) the implementation of a pharmacist in clinic. The Post-Group was further divided according to whether the patient was seen by a pharmacist in clinic (Post-Group 2) or if the patient was not seen by the pharmacist, but had their HCV therapy evaluated by the pharmacist before seeking insurance approval (Post-Group 1). Results: The mean time from the prescription being ordered to being dispensed was longer in the Pre-Group (50.8 ± 66.5 days) compared to both Post-Groups (22.2 ± 27.8 days in Post-Group 1 vs 18.9 ± 17.7 days in Post-Group 2; P < .05). The mean time from when the prescription was ordered to when the PA was submitted was longer in the Pre-Group (41.6 ± 71.9 days) compared to both Post-Groups (6.3 ± 16 in Post-Group 1 vs 4.1 ± 9.7 in Post-Group 2; P < .05). Rates of medication adherence and sustained virologic response were similar between all groups. Conclusion: Incorporation of clinical pharmacists into a hepatology clinic significantly reduced the time patients waited to start HCV treatment. In addition to improving access to medications, implementation of the model helped to maintain excellent medication adherence and cure rates.

Telephone Calls to an Infectious Diseases Fellow

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 753-754
Author(s):  
Mark F. Cotton
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Time Allocation ◽  
Primary Care Physicians ◽  
First Year ◽  
Educational Value ◽  
The Mean ◽  
Telephone Calls ◽  
The Impact ◽  
Mean Time

Objective. There is no information on the impact and nature of telephone calls directed to subspecialists. The main objective was to document prospectively all calls directed to a first-year infectious diseases fellow, to determine their content, origin, educational value, and time allocation. Results. Three hundred fifty-nine calls were received over a 71-day period from March 24 through May 20, 1992. The mean number of daily calls was 5.1 ± 3.3. Mean time per call was 7 ± 5.4 minutes. Cumulatively, 41.7 hours were spent responding to telephone calls. The subgroup with the most calls (44.3%) was from pediatricians in practice. Seventy percent of calls were for advice about case management. Forty percent of calls were considered educational to the fellow. Conclusions. This study confirms the importance of the infectious disease subspecialist as a resource for primary care physicians.

Cardiovascular Risk After Sepsis: Understanding the Role of Statin Indications and the Impact of Clinical Inertia on Prescribing Patterns

2020 ◽  
Vol 25 (6) ◽  
pp. 541-547
Author(s):  
Vedant A. Gupta ◽  
Talal S. Alnabelsi ◽  
Sandipan Shringi ◽  
Steve W. Leung ◽  
Vincent L. Sorrell
Keyword(s):  
Cohort Analysis ◽  
Prescribing Patterns ◽  
Clinical Inertia ◽  
Major Adverse Cardiovascular Events ◽  
Prescribing Practices ◽  
Retrospective Cohort Analysis ◽  
The Mean ◽  
The Impact ◽  
Statin Use

Introduction: Patients with sepsis have high rates of major adverse cardiovascular events (MACE) in the literature, but the stratification of those at risk has been limited. Statin indicated groups provides clear criteria for therapy, but the risk of MACE after sepsis based on these groups has never been assessed. Materials and Methods: This was a retrospective cohort analysis conducted on adult patients admitted from January 1, 2013, to December 31, 2013, with suspected or confirmed sepsis and data available on statin use. Patients’ past medical history; statin use prior, during, or at time of discharge; and occurrence of MACE were recorded from electronic health records. Result: A total of 321 patients were screened and 265 were found to have data available on statin use. The mean age of the patients was 59 ± 15 years and 47% were female. Overall, 9% were observed to have a MACE at 1 year, with significantly higher rates in those in a statin indicated group (12.2%). On admission, 174 patients were not taking a statin out of whom 52% were in a statin indicated group. Among those in a statin indicated group who survived to hospital discharge, only 10% not on a statin on admission received a statin on discharge, whereas 89% on a statin on admission received a statin on discharge. Conclusion: There is a high risk of MACE after sepsis especially among those in statin indicated groups with significant clinical inertia in prescribing practices.

Uncut Roux-en-Y Reconstruction in a Laparoscopic Distal Gastrectomy: A Single-Center Study of 228 Consecutive Cases and Short-Term Outcomes

2019 ◽  
Vol 26 (6) ◽  
pp. 698-704 ◽  
Author(s):  
Li Yang ◽  
Hao Xu ◽  
Dian-Cai Zhang ◽  
Feng-Yuan Li ◽  
Wei-Zhi Wang ◽  
...  
Keyword(s):  
Distal Gastrectomy ◽  
Laparoscopic Distal Gastrectomy ◽  
Short Term ◽  
Conversion To Open Surgery ◽  
Operative Duration ◽  
Single Center Study ◽  
Distal Gastric Cancer ◽  
The Mean ◽  
Diet Intake ◽  
Mean Time

Aims. We have established a procedure for uncut Roux-en-Y gastrojejunostomy after laparoscopic distal gastrectomy. This study aimed to evaluate the safety and technical feasibility of the procedure for patients with distal gastric cancer according to the short-term outcomes. Methods. Two hundred and twenty-eight consecutive patients who underwent a laparoscopic distal gastrectomy with uncut Roux-en-Y gastrojejunostomy from September 2014 to August 2018 were reviewed retrospectively. All the laparoscopic operations were performed successfully without conversion to open surgery. Results. The mean operative duration was 178.28 ± 32.82 minutes, the mean anastomotic process duration was 28.22 ± 7.50 minutes, the average blood loss was 48.97 ± 29.16 mL, and the overall number of lymph nodes harvested was 37.16 ± 11.47. The mean time of out-of-bed ambulation, anal exsufflation, liquid-diet intake, and duration of hospital stay were 41.99 ± 18.37 hours, 69.57 ± 23.17 hours, 5.06 ± 1.09 days, and 8.77 ± 2.42 days, respectively. Fifteen patients suffered postoperative complications, and the overall incidence rate was 6.58% (15/228). Seventeen patients experienced afferent recanalization, the mean time of which was 11 months after the operation. Conclusion. The laparoscopic uncut Roux-en-Y reconstruction is safe and technically feasible, and it has inspiring short-term outcomes for patients undergoing distal gastrectomy.

Drivers of biases in the extratropical storm tracks in CMIP6

2020 ◽  
Author(s):  
Matthew Priestley ◽  
Duncan Ackerley ◽  
Jennifer Catto ◽  
Kevin Hodges ◽  
Ruth McDonald ◽  
...  
Keyword(s):  
Large Scale ◽  
Climate Models ◽  
Storm Track ◽  
Storm Tracks ◽  
Extratropical Cyclones ◽  
Ocean Coupling ◽  
Coupled Climate Models ◽  
The Mean ◽  
The Impact

&lt;p&gt;Extratropical cyclones are the leading driver of the day-to-day weather variability and wintertime losses for Europe. In the latest generation of coupled climate models, CMIP6, it is hoped that with improved modelling capabilities come improvements in the structure of the storm track and the associated cyclones. Using an objective cyclone identification and tracking algorithm the mean state of the storm tracks in the CMIP6 models is assessed as well as the representation of explosively deepening cyclones. Any developments and improvements since the previous generation of models in CMIP5 are discussed, with focus on the impact of model resolution on storm track representation. Furthermore, large-scale drivers of any biases are investigated, with particular focus on the role of atmosphere-ocean coupling via associated AMIP simulations and also the influence of large-scale dynamical and thermodynamical features.&lt;/p&gt;

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