scholarly journals 3025 Individual Anesthesia Provider Performance Assessment

2019 ◽  
Vol 3 (s1) ◽  
pp. 147-147
Author(s):  
Stephan Maman ◽  
Michael Andreae
Keyword(s):  
Risk Factors ◽  
Graphical Representation ◽  
Regression Line ◽  
Healthcare Delivery ◽  
Individual Performance ◽  
Risk Category ◽  
Provider Performance ◽  
Antiemetic Prophylaxis ◽  
Increased Risk ◽  
Individual Provider

OBJECTIVES/SPECIFIC AIMS: We developed a multilevel hierarchical statistical model which describes the association of prophylactic interventions to patient PONV risk, and provides an intuitive summary for anesthesiologists to understand how well they are adhering to PONV guidelines. METHODS/STUDY POPULATION: Accepted PONV risk factors as well as preventative interventions to reduce the PONV risk, (e.g. total intravenous anesthesia or pharmacological prophylaxis) are retrieved from the electronic medical record (EMR). Risk is regressed against interventions. Fig 1, Panel A visualizes adherence for an individual provider by plotting anesthesia cases, with PONV risk in the x-axis and the number of interventions in the y-axis. Fig 1, Panel B shows a “Jitterplot”, jittering individual cases, which would otherwise plot onto the same coordinates (Panel A). The distribution of the number of interventions in each risk category is better summarized in Fig 1 Panel C by overlaying a violin plot onto the “Jitterplot”. Finally, a fitted regression line provides a summary measure for the individual provider’s risk-adjusted utilization of PONV prophylaxis in Fig 1, Panel D. The model can control for confounders and interactions, such as patient or procedure characteristics, such as supervision by attending physicians, institutional culture, and surgical procedure. RESULTS/ANTICIPATED RESULTS: Fig. 2, Panel A demonstrates good adherence. The provider responded to increased risk with additional interventions leading to a steep regression line. Less discriminate administration of prophylaxis is shown in Fig 2, Panel B. The graphical representation of our proposed measure of individual provider performance is intuitive, allowing us to compare adherence of two distinct groups of providers (light lines) and institutional averages (dark lines) as shown in Fig 2, Panel C. Controlling for known risk factors and potential confounders renders the assessment irrepudiable. The rigorous statistical approach allows for multi-level modeling and comparative effectiveness research, realistically evaluating process changes and interventions like CDS in the hierarchical structure of contemporary healthcare delivery. DISCUSSION/SIGNIFICANCE OF IMPACT: The strength of our novel measure of individual provider performance is its generalizability to other care settings, as well as the intuitive graphical representation of risk-adjusted individual performance. However, accuracy, precision and validity, sensitivity to system perturbations (like the implementation of CDS), and acceptance among providers remain to be evaluated. Fig 1. Risk-Adjusted Utilization of Antiemetic Prophylaxis Fig 2. Comparing Performance between Provider Groups

scholarly journals Seroprevalence and Risk Factors of SARS CoV-2 in Health Care Workers of Tertiary-Care Hospitals in the Province of Khyber Pakhtunkhwa, Pakistan

2020 ◽  
Author(s):  
Mohsina Haq ◽  
Asif Rehman ◽  
Muhammad Noor ◽  
Jawad Ahmed ◽  
Junaid Ahmad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Developed Countries ◽  
Protective Measure ◽  
Special Importance ◽  
Khyber Pakhtunkhwa ◽  
Increased Risk ◽  
Tertiary Care Hospitals

Background: High number of SARS CoV2 infected patients has overburdened healthcare delivery system, particularly in low-income countries. In the recent past many studies from the developed countries have been published on the prevalence of SARS CoV2 antibodies and the risk factors of COVID 19 in healthcare-workers but little is known from developing countries. Methods: This cross-sectional study was conducted on prevalence of SARS CoV2 antibody and risk factors for seropositivity in HCWs in tertiary care hospitals of Peshawar city, Khyber Pakhtunkhwa province Pakistan. Findings: The overall seroprevalence of SARS CoV2 antibodies was 30.7% (CI, 27.8 to 33.6) in 1011 HCWs. Laboratory technicians had the highest seropositivity (50.0%, CI, 31.8 to 68.1). Risk analysis revealed that wearing face-mask and observing social-distancing within a family could reduce the risk (OR:0.67. p<0.05) and (OR:0.73. p<0.05) while the odds of seropositivity were higher among those attending funeral and visiting local-markets (OR:1.83. p<0.05) and (OR:1.66. p<0.01). In Univariable analysis, being a nursing staff and a paramedical staff led to higher risk of seropositivity (OR:1.58. p< 0.05), (OR:1.79. p< 0.05). Fever (OR:2.36, CI, 1.52 to 3.68) and loss of smell (OR:2.95, CI: 1.46 to 5.98) were significantly associated with increased risk of seropositivity (p<0.01). Among the seropositive HCWs, 165 (53.2%) had no symptoms at all while 145 (46.8%) had one or more symptoms. Interpretation: The high prevalence of SARS CoV2 antibodies in HCWs warrants for better training and use of protective measure to reduce their risk. Early detection of asymptomatic HCWs may be of special importance because they are likely to be potential threat to others during the active phase of viremia. Funding: Prime Foundation Pakistan.

Risk prediction models and scores in hypertrophic cardiomyopathy

2021 ◽  
Vol 27 ◽  
Author(s):  
Thomas D. Gossios ◽  
Konstantinos Savvatis ◽  
Thomas Zegkos ◽  
Despina Parcharidou ◽  
Haralambos I Karvounis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hypertrophic Cardiomyopathy ◽  
Risk Stratification ◽  
Prediction Models ◽  
Risk Category ◽  
Predictive Capacity ◽  
European Guidelines ◽  
Device Implantation ◽  
Increased Risk ◽  
Risk Stratum

: Hypertrophic cardiomyopathy (HCM) has historically been linked with sudden cardiac death (SCD). Currently, it is well established that only a subset of patients is at the highest risk stratum for such a catastrophic event. Detection of patients belonging to this high-risk category can allow for timely defibrillator implantation, changing the natural history of HCM. Inversely, device implantation in patients deemed at low risk leads to an unnecessary burden of device complications with no apparent protective benefit. Previous studies have identified a series of markers, now considered as established risk factors, with genetic testing and newer imaging allowing for the detection of novel, highly promising indices of increased risk for SCD. Despite the identification of a number of risk factors, there is noticeable discrepancy on the utility of such factors for risk stratification between the current American and European guidelines. We sought to systematically review the data available on these two approaches, presenting their rationale and respective predictive capacity, also discussing the potential of novel markers to augment the precision of currently used risk stratification models for SCD in HCM.

scholarly journals Mucormycosis: An unanticipated progeny of COVID-19

2021 ◽  
Vol 59 (241) ◽  
pp. 965-967
Author(s):  
Gentle Sunder Shrestha ◽  
Sabin Bhandari ◽  
Ritesh Lamsal ◽  
Urmila Gurung
Keyword(s):  
Risk Factors ◽  
Delivery System ◽  
Low Income ◽  
Clinical Presentation ◽  
Healthcare Delivery ◽  
Low Income Countries ◽  
Risk Of Infection ◽  
Healthcare Delivery System ◽  
Increased Risk ◽  
Second Wave

The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.

ABO Group As a Thrombotic Risk Factor In Children With Acute Lymphoblastic Leukemia: A Retrospective Study Of 523 Pediatric Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2370-2370
Author(s):  
Terry Mizrahi ◽  
Jean-Marie Leclerc ◽  
Michele David ◽  
Thierry Ducruet ◽  
Nancy Robitaille
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Acute Lymphoblastic Leukemia ◽  
High Risk ◽  
Blood Group ◽  
Lymphoblastic Leukemia ◽  
Blood Groups ◽  
Risk Category ◽  
Abo Blood Group ◽  
Increased Risk

Abstract Introduction Children with acute lymphoblastic leukemia (ALL) are at high risk of thrombotic complications, resulting from multiple risk factors (including malignancy, medications, central venous access devices (CVADs) and inherent host characteristics). Several studies have investigated the role of ABO blood groups in the occurrence of thromboembolic events in adults. Non-O blood group has been associated with an increased risk of venous thromboembolism (VTE), with a compounding effect in the presence of thrombophilia or cancer. We hypothesized that among children with ALL receiving a standardized protocol, there would be an increased risk of thrombotic events in non-O blood group compared to O group patients. Methods We retrospectively reviewed medical charts of all children with ALL treated in our tertiary care center between 1995 and 2013 and identified those with an objectively confirmed VTE. Children were included in 3 different, but similar multiagent protocols (DFCI 95-01, 00-01 and 05-01). Patients were classified into O and non-O blood groups. Leukemia phenotype, risk category, age, gender, timing of thrombosis, localisation and thrombotic workup were also collected. Statistical analysis Risk factor for VTE was defined as a prevalence. Univariate and multivariate logistic regression models were applied to assess the association between potential risk factors and the occurrence of VTE. Results are presented as adjusted OR and 95% confidence intervals. All statistical tests were two-sided. Results Of 523 children with ALL, 50 (9.6%) had thrombosis. Blood group distribution showed 38 (76%) patients in the non-O and 12 (24%) in the O group, compared to 302 (58%) non-O and 221 (42%) O in the total cohort. Except for gender, univariate predictors of VTE were all significant (age ≥ 10 years, P = 0.023, high risk category, P = 0.001, T phenotype, P = <0.001, non-O blood group, P = 0.006, male, P = 0.79). In multivariate analysis, non-O blood group, phenotype and risk category remained significant, but not age nor gender: age ≥ 10 years, OR 1.12 [95% CI 0.53,2.34]; high risk, OR 2.45 [95% CI 1.13,5.34]; T phenotype, OR 2.48 [95% CI 1.11,5.55]; non-O blood group, OR 2.93 [95% CI 1.46, 5.87]; male, OR 0.83[ 95% CI 0.45, 1.54] (table I). The vast majority of VTE occurred at an upper limb CVAD site (64%). Other sites were lower limb (14%), cerebral venous sinus thrombosis (14%), pulmonary embolism (6%), intracardiac (6%) and multiple sites (10%). VTE mainly occurred during the induction (18%) and consolidation (72%) phases of therapy. Thrombotic workup was done in 33/50 patients, with 11 abnormal results (mostly non-diagnostic low Protein C or S levels and positive lupus anticoagulants). Positive family history was found in 2 cases, but not consistently explored. No patients had Factor V Leiden or II G20210A mutation. Discussion The estimated prevalence of VTE in children with cancer is 8% (compared with 0.7-1.4/100 000 in the general pediatric population (Athale and Chan, 2003). A large number of studies have evaluated the epidemiology and risk factors of thrombotic events in children with ALL (Caruso et al 2006, Farinasso et al, 2007, Grace et al, 2011), confirming the multifactorial etiology of VTE in these children. Significant associations between ABO blood group and VTE have been reported in several studies (Dentali et al, 2012, T.Ohira et al, 2006 and 2007, Wu O et al, 2008, Wiggins KL et al, 2009). A few studies have investigated ABO blood group as a risk factor for VTE in adult malignancies (Streiff et al, 2004,). To date, none have explored it in childhood cancer. Our results clearly identify non-O blood group as a significant independent risk factor for VTE in children with ALL. Prospective studies are needed to confirm these data. The mechanisms underlying the increased risk of VTE in non-O blood group patients remain to be elucidated. Disclosures: No relevant conflicts of interest to declare.

Abstract 4565: Optimal Timing Of Stage-2 Palliation For Hypoplastic Left Heart Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Edward J Hickey ◽  
Christopher A Caldarone ◽  
Eugene H Blackstone ◽  
Thomas Yeh ◽  
Christian Pizarro ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Survival Models ◽  
Optimal Timing ◽  
Risk Category ◽  
Cumulative Hazard ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage 1 ◽  
High Risk Children

Background Because optimal timing of stage-2 palliation of HLHS is contentious, we explored associations between length of time between stage-1 and stage-2 (“interstage interval”) and survival. Methods A multi-institutional cohort of neonates (N=703;1994 –2001) who underwent Norwood palliation for HLHS was studied. Survival models were constructed for each of stage-1 and stage-2 and their combined cumulative hazard was defined. Results A constant, persisting hazard for death was prominent ≈2 months after Norwood (“interstage death”). Risk factors for interstage death included: smaller weight at diagnosis, longer DHCA duration, smaller indexed tricuspid annulus, mitral stenosis, older age at Norwood, smaller distal arch dimension and sternal splinting (all P <.01, >50% bootstrap reliability). Following stage-2 palliation (N=404, median interval 5.8 months after Norwood), 32 died before subsequent Fontan completion. Risk factors for these deaths included: earlier stage-2 ( P <.0001, 60% reliability), younger age at Norwood and smaller RV dimensions at diagnosis. Performing stage-2 within 2 months of Norwood conferred exponential increased risk of death. Cumulative hazard exposure (figure ) was minimized with interstage interval ≈ 3 months. For low risk patients intervals >4 months were optimal. For high-risk children survival was optimized with ≈ 2 month interstage interval. Conclusions Optimal timing of stage-2 palliation is dependent on patients’ risk category. High-risk children may have improved survival by early progression to stage-2; no such benefits are seen for lower risk children. The interstage interval will not be safely reduced below 2 months.

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

Stroke in chronic renal failure

2008 ◽  
Vol 149 (15) ◽  
pp. 691-696
Author(s):  
Dániel Bereczki
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Cerebrovascular Diseases ◽  
Lipid Lowering ◽  
Increased Risk ◽  
Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

Hygienic characteristics of the cosmetologists' lifestyle

2020 ◽  
Vol 60 (12) ◽  
pp. 958-963
Author(s):  
Natalia I. Latyshevskaya ◽  
Tatyana L. Yatsyshena ◽  
Elena L. Shestopalova ◽  
Irina Yu. Krainova
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Information And Communication Technologies ◽  
Health Risks ◽  
Healthy Lifestyle ◽  
Personal Hygiene ◽  
Risk Category ◽  
Essential Components ◽  
Group A ◽  
Group B

Modern trends in the deterioration of health and the growth of non-communicable diseases among the adult working-age population, including medical workers, actualize the importance of a healthy lifestyle for maintaining health and professional longevity. There were almost no studies related to cosmetologists' experienced group as representatives of aesthetic medicine. There is no scientific evidence on behavioral risks of this group. It justifies the relevance of this study. The study aims to analyze the essential components of the cosmetologists' lifestyle depending on age and the argumentation of priority behavioral health risk factors for preventive and recreational work justification. Sixty women (practicing cosmetologists in Volgograd at the age of 28-39 years (group A) and 40-53 (group B)) took part in the study. Lifestyle assessment included a modified questionnaire. The questionnaire consists of 5 blocks (block 1 - nutrition; 2 - physical activity, including hardening and active rest; 3 - daily regimen; 4 - personal hygiene; 5 - bad habits). It allows the analysis of the adherence to a healthy lifestyle based on the provision of quantitative data. Statistical data processing was carried out using the Excel package. The authors identified the essential and statistically significant differences in the cosmetologists' lifestyle depending on age. The respondents of group B demonstrated hygienically rational indicators in all blocks of the lifestyle more often. They had a more formed adherence to a healthy lifestyle: 504 answers in the category "insignificant risk" of respondents in group B versus 354 in group A. Distribution of answers in the "high risk" category: 119 responses in group B and 185 in group A. The lifestyle of 46.7% of the respondents in group B refers to a healthy lifestyle. 3.3% of the group B respondents have an anxious lifestyle, 50% have health risks. 10% of Group A respondents' lifestyle refers to a healthy lifestyle. 13.3% of Group A respondents' lifestyle refers to an anxious lifestyle; 76.7% of this group have health risks. There was almost no complex hygienic research profession of medical cosmetologists. Cosmetologists of the older age group (40-53 years old) are more conscious of maintaining a hygienically rational lifestyle. The most significant defects among cosmetologists aged 28-39 years are low physical activity, nutritional defects, insufficient duration of night rest, and excessive use of information and communication technologies for rest, accompanied by manifestations of neurotization and signs of pronounced fatigue. The obtained results argue the need to develop and implement informational and educational measures to prevent risk behavior patterns, taking into account the age of cosmetologists and the priority of the identified behavioral risk factors.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

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