293 Enhancing Your Recovery: A Mobile Application for Patients Undergoing Vascular Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Hodge ◽  
K Pattabathula ◽  
J Jenkins ◽  
M Ogg
Keyword(s):  
Vascular Surgery ◽  
Mobile Application ◽  
Outpatient Appointment ◽  
Healthcare Settings ◽  
System A ◽  
University Of Technology ◽  
Operative Complications ◽  
Remote Consultations ◽  
Healthcare Assessment

Abstract Aim: With increasing demands on the healthcare system, a central (and currently essential) push for remote consultations, and an increasing number of co morbidities in the surgical population, the aim was to create an application that placed the focus on pre-hospital optimisation, education and autonomy – addressing these sector trends to enhance outcomes for patients and ease the burden on healthcare settings. Method After obtaining baseline data, I worked alongside students from the Queensland University of Technology to produce an application suitable for both iOS and android platforms. Results The application has four facets which mirror a patient’s journey from their initial outpatient appointment through to recovery. The application is easy to use, free to download and readily accessible. On opening the application, the user can select their planned operation and navigate along a personalised decision tree. Conclusions The application has been designed to educate and empower a patient to become an active participant in their care, leading to long-term changes in healthcare. Assessment is ongoing but early indications suggest that this will be a valuable tool in optimising outcomes for patients undergoing vascular surgery – leading to fewer post-operative complications and earlier restoration of functional status.

Sex Differences in Perioperative and Long-term Cardiac Event–Free Survival in Vascular Surgery Patients

Circulation ◽  
1995 ◽  
Vol 91 (4) ◽  
pp. 1044-1051 ◽  
Author(s):  
Robert C. Hendel ◽  
Ming Hui Chen ◽  
Gilbert J. L’Italien ◽  
John B. Newell ◽  
Sumita D. Paul ◽  
...  
Keyword(s):  
Sex Differences ◽  
Vascular Surgery ◽  
Cardiac Event ◽  
Event Free Survival ◽  
Free Survival

scholarly journals Candida auris and Carbapenemase-Producing Organism Prevalence in an Extended Stay Pediatric Hospital, Chicago, Illinois, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s145-s146
Author(s):  
Kelly Walblay ◽  
Tristan McPherson ◽  
Elissa Roop ◽  
David Soglin ◽  
Ann Valley ◽  
...  
Keyword(s):  
The United States ◽  
Multidrug Resistant ◽  
Pediatric Hospital ◽  
Mechanical Ventilators ◽  
Candida Auris ◽  
Term Care ◽  
Healthcare Settings ◽  
High Acuity ◽  
Gastrostomy Tubes

Background:Candida auris and carbapenemase-producing organisms (CPO) are multidrug-resistant organisms that can colonize people for prolonged periods and can cause invasive infections and spread in healthcare settings, particularly in high-acuity long-term care facilities. Point-prevalence surveys (PPSs) conducted in long-term acute-care hospitals in the Chicago region identified median prevalence of colonization to be 31% for C. auris and 24% for CPO. Prevalence of C. auris colonization has not been described in pediatric populations in the United States, and limited data exist on CPO colonization in children outside intensive care units. The Chicago Department of Public Health (CDPH) conducted a PPS to assess C. auris and CPO colonization in a pediatric hospital serving high-acuity patients with extended lengths of stay (LOS). Methods: CDPH conducted a PPS in August 2019 in a pediatric hospital with extended LOS to screen for C. auris and CPO colonization. Medical devices (ie, gastrostomy tubes, tracheostomies, mechanical ventilators, and central venous catheters [CVC]) and LOS were documented. Screening specimens consisted of composite bilateral axillae and groin swabs for C. auris and rectal swabs for CPO testing. The Wisconsin State Laboratory of Hygiene tested all specimens. Real-time polymerase chain reaction (PCR) assays were used to detect C. auris DNA and carbapenemase genes: blaKPC, blaNDM, blaVIM, blaOXA-48, and blaIMP (Xpert Carba-R Assay, Cepheid, Sunnyvale, CA). All axillae and groin swabs were processed by PCR and culture to identify C. auris. For CPO, culture was only performed on PCR-positive specimens. Results: Of the 29 patients hospitalized, 26 (90%) had gastrostomy tubes, 24 (83%) had tracheostomies, 20 (69%) required mechanical ventilation, and 3 (10%) had CVCs. Also, 25 (86%) were screened for C. auris and CPO; 4 (14%) lacked parental consent and were not swabbed. Two rectal specimens were unsatisfactory, producing invalid CPO test results. Median LOS was 35 days (range, 1–300 days). No patients were positive for C. auris. From CPO screening, blaOXA-48 was detected in 1 patient sample, yielding a CPO prevalence of 3.4% (1 of 29). No organism was recovered from the blaOXA-48 positive specimen. Conclusions: This is the first documented screening of C. auris colonization in a pediatric hospital with extended LOS. Despite a high prevalence of C. auris and CPOs in adult healthcare settings of similar acuity in the region, C. auris was not identified and CPOs were rare at this pediatric facility. Additional evaluations in pediatric hospitals should be conducted to further understand C. auris and CPO prevalence in this population.Funding: NoneDisclosures: None

scholarly journals Cholinesterase activity in serum during general anesthesia in patients with or without vascular disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yitzhak Brzezinski-Sinai ◽  
Ester Zwang ◽  
Elena Plotnikova ◽  
Ester Halizov ◽  
Itzhak Shapira ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
General Anesthesia ◽  
Vascular Disease ◽  
Cholinesterase Activity ◽  
Serum Cholinesterase ◽  
Hemodynamic Support ◽  
System A ◽  
Lower Baseline ◽  
Increased Risk ◽  
A Prospective Study

AbstractMaintaining hemodynamic stability during the induction and maintenance of anesthesia is one of the challenges of the anesthesiologist. Patients with vascular disease are at increased risk of instability due to imbalance between the sympathetic and parasympathetic parts of the autonomic nervous system, a balance accessible by serum cholinesterase activity. We aim to characterize the dynamics of cholinesterase activity in patients undergoing general anesthesia (GA) and surgery. This was a prospective study of 57 patients undergoing ambulatory or vascular surgery under GA. Cholinesterase activity was measured before the induction of anesthesia, after 15 min and at the end of surgery by calculating the capacity of serum acetylcholinesterase (AChE) and butyrylcholinesterase to hydrolyze AcetylThioCholine. Data on atherosclerotic disease, anesthesia management were analyzed. Both AChE and total cholinergic status (CS) decreased significantly after GA induction at 15 min and even more so by the end of surgery. Vascular surgery patients had lower baseline cholinesterase activity compared to ambulatory surgery patients. Patients requiring intraoperative administration of phenylephrine for hemodynamic support (21.1%) had a significantly lower level of AChE and CS compared to untreated patients. Our findings serve as a mirror to the sympathetic/parasympathetic imbalance during GA, with a marked decrease in the parasympathetic tone. The data of a subgroup analysis show a correlation between low cholinesterase activity and an increase in the need for hemodynamic support.

Is the water permit system a panacea or a bed of inefficiency? The case of South Africa

Water Policy ◽  
2013 ◽  
Vol 15 (4) ◽  
pp. 570-584 ◽  
Author(s):  
Devi Datt Tewari ◽  
Saidou Baba Oumar
Keyword(s):  
South Africa ◽  
Water Distribution ◽  
Water Markets ◽  
Water Management System ◽  
Administrative Costs ◽  
System A ◽  
Access To Water ◽  
License System ◽  
Institutional Efficiency

Although South Africa has adopted a very modern permit/license system to control access to water as a resource, the attainment of the lofty objectives (efficiency, equity and sustainability) of the National Water Act of 1998 depends on two critical factors: (1) the institutional efficiency of the water management system; and (2) the development of water markets and their efficient functioning. This study lists a number of concerns that the Act is not geared to resolve efficiently or in a timely manner. These concerns include the high administrative costs of implementation, poor incentives for long-term investments, bureaucratic inefficiency, practical problems in water pricing and adaptability to climate change threat. There is a need to re-think the ways and means with which to make water distribution more efficient in the country. One possible solution would be to develop water markets in the country.

Commentary: The Broader Context of Long-Term Care Ethics

2016 ◽  
Vol 25 (3) ◽  
pp. 554-556
Author(s):  
Jason Lesandrini ◽  
Carol O’Connell
Keyword(s):  
Care Setting ◽  
Long Term Care ◽  
Ethical Issues ◽  
Term Care ◽  
Ethical Concerns ◽  
Healthcare Settings ◽  
Care Facilities ◽  
Ethics Program ◽  
Made In

Ethical issues in long-term care settings, although having received attention in the literature, have not in our opinion received the appropriate level they require. Thus, we applaud the Cambridge Quarterly for publishing this case. We can attest to the significance of ethical issues arising in long-term care facilities, as Mr. Hope’s case is all too familiar to those practicing in these settings. What is unique about this case is that an actual ethics consult was made in a long-term care setting. We have seen very little in the published literature on the use of ethics structures in long-term care populations. Our experience is that these healthcare settings are ripe for ethical concerns and that providers, patients, families, and staff need/desire ethics resources to actively and preventively address ethical concerns. The popular press has begun to recognize the ethical issues involved in long-term care settings and the need for ethics structures. Recently, in California a nurse refused to initiate CPR for an elderly patient in a senior residence. In that case, the nurse was quoted as saying that the facility had a policy that nurses were not to start CPR for elderly patients.1 Although this case is not exactly the same as that of Mr. Hope, it highlights the need for developing robust ethics program infrastructures in long-term care settings that work toward addressing ethical issues through policy, education, and active consultation.

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