scholarly journals 925 Maintenance of Elective Surgical Care During Covid-19 Pandemic

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Digne-Malcolm ◽  
A Kanwal ◽  
P Puventhiranathan ◽  
L Phelan ◽  
M Hamid ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Elective Surgery ◽  
Surgical Care ◽  
Patient Transfers ◽  
Level 3 ◽  
The Mean ◽  
Further Development ◽  
Level 2

Abstract Introduction Recent publications demonstrate significant morbidity in surgical patients with concurrent COVID-19 infection. This, combined with the redistribution of resources to support the pandemic, led to abrupt cessation in planned operating. COVID-19-free ‘cold’ sites were established to enable elective surgery to resume with reduced risk. We evaluate the outcomes and limitations of a newly established cold site. Method Data were collected retrospectively for all patients operated between June and September 2020 by either General Surgery or Urology. Primary outcomes were 30-day COVID-19 infection and 30-day mortality. Secondary outcomes included length of stay, 30-day complications, and need for transfer to ‘hot’ hospital sites. Results 881 patients were included. No patients had a positive COVID-19 test within 30 days of their operation. 30-day mortality was 0.01% (n = 1). The mean (+/-SD) length of stay was 1.69+/-3.42 days. 12.15% (n = 107) of patients experienced a complication within 30 days and 11.7% (n = 103) were readmitted within 30 day of discharge. 3.3% (n = 29) of patients required transfer to a ‘hot’ hospital site. 44.8% of these were admitted to level 2 or level 3 care, 17.2% required total parenteral nutrition, and 20.7% returned to theatre. Conclusions ‘Cold’ surgical sites are effective in preventing peri-operative COVID-19 infection. Elective surgery can therefore continue safely through the pandemic with such precautions. Further development of on-site resources, including provision for total parenteral nutrition and access to higher level care, will help to minimise the need for patient transfers to COVID-19 exposed sites.

Home Parenteral Nutrition in Patients with Systemic Sclerosis: A Retrospective Review of 12 Cases

2012 ◽  
Vol 39 (5) ◽  
pp. 1004-1007 ◽  
Author(s):  
HANI JAWA ◽  
GAIL FERNANDES ◽  
OLIVIA SAQUI ◽  
JOHANNE P. ALLARD
Keyword(s):  
Body Mass Index ◽  
Systemic Sclerosis ◽  
Nutritional Status ◽  
Parenteral Nutrition ◽  
Functional Status ◽  
Total Parenteral Nutrition ◽  
Retrospective Review ◽  
Karnofsky Score ◽  
The Mean ◽  
The University

Objective.To evaluate the effect of home total parenteral nutrition (HTPN) on the nutritional and functional status of patients with systemic sclerosis (SSc).Methods.Retrospective review of SSc patients from the HTPN database at the University Health Network, Toronto, Canada, from 1998 to 2010.Results:In total 12 subjects (9 females, 3 males) with SSc were identified. At initiation of HTPN, the age was 48.75 ± 3.94 years and the median body mass index was 16.8 kg/m2 (range 12.3–21.3). This significantly increased to 18.3 kg/m2 (17.0–21.7) at 6 months and to 19.7 kg/m2 (17.0–24.6) at 12 months. The mean Karnofsky score at baseline was 58.00 ± 3.27, and the score at 12 months of 39.00 ± 13.29 did not change significantly.Conclusion.HTPN improved the nutritional status of these patients with SSc but it did not improve their functional status.

scholarly journals Total Parenteral Nutrition Successfully Treating Black Esophagus Secondary to Hypovolemic Shock

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Tony S. Brar ◽  
Richard Helton ◽  
Zareen Zaidi
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Complete Resolution ◽  
Hypovolemic Shock ◽  
Successful Outcome ◽  
Multimodal Approach ◽  
Black Esophagus ◽  
Area Of Interest ◽  
Noncompliant Patient ◽  
Further Development

We present a patient who developed black esophagus secondary to hypovolemic shock and was placed on total parenteral nutrition for three weeks after hospital discharge. The area of interest is the multimodal approach used in treatment of this noncompliant patient. Even with a high mortality rate, this case illustrates a successful outcome of a patient who responded to appropriate immediate therapy resulting in complete resolution of the necrosis with no further development of complications.

Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

2020 ◽  
Vol 30 (6) ◽  
pp. 761-768
Author(s):  
Daniel M. Pasternack ◽  
Manal AlQahtani ◽  
Rafael Zonana Amkie ◽  
Lisa J. Sosa ◽  
Marcelle Reyes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Extracorporeal Membrane Oxygenation ◽  
Total Parenteral Nutrition ◽  
Morbidity And Mortality ◽  
Prolonged Length ◽  
Conjugated Hyperbilirubinaemia ◽  
Neonates And Infants

AbstractIntroduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.

Unification of the "Burst" and "Linear" Theories of Periodontal Disease Progression: A Multilevel Manifestation of the Same Phenomenon

2003 ◽  
Vol 82 (3) ◽  
pp. 200-205 ◽  
Author(s):  
M.S. Gilthorpe ◽  
A.T. Zamzuri ◽  
G.S. Griffiths ◽  
I.H. Maddick ◽  
K.A. Eaton ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
Disease Progression ◽  
Repeated Measures ◽  
Regression To The Mean ◽  
Random Coefficient Models ◽  
Linear Change ◽  
New Approach ◽  
Level 3 ◽  
The Mean ◽  
Level 2

Previously, burst and linear theories for periodontal disease progression were proposed based on different but limited statistical methods of analysis. Multilevel modeling provides a new approach, yielding a more comprehensive model. Random coefficient models were used to analyze longitudinal periodontal data consisting of repeated measures (level 1), sites (level 2), teeth (level 3), and subjects (level 4). Large negative and highly significant correlations between random linear and quadratic time coefficients indicated that subjects and teeth with greater-than-average linear change experienced decelerated variation. Conversely, subjects and teeth with less-than-average linear change experienced accelerated variation. Change therefore exhibited a dynamic regression to the mean at the tooth and subject levels. Since no equilibrium was attained throughout the study, changes were cyclical. When considered as a multilevel system, the "linear" and "burst" theories of periodontal disease progression are a manifestation of the same phenomenon: Some sites improve while others progress, in a cyclical manner.

scholarly journals Assessment of the Level-3 MODIS daily aerosol optical depth in the context of surface solar radiation and numerical weather modeling

2013 ◽  
Vol 13 (2) ◽  
pp. 675-692 ◽  
Author(s):  
J. A. Ruiz-Arias ◽  
J. Dudhia ◽  
C. A. Gueymard ◽  
D. Pozo-Vázquez
Keyword(s):  
Solar Radiation ◽  
Aerosol Optical Depth ◽  
Optical Depth ◽  
Surface Solar Radiation ◽  
Numerical Weather ◽  
Modis Aod ◽  
Level 3 ◽  
Weather Modeling ◽  
The Mean ◽  
Level 2

Abstract. The daily Level-3 MODIS aerosol optical depth (AOD) product is a global daily spatial aggregation of the Level-2 MODIS AOD (10-km spatial resolution) into a regular grid with a resolution of 1° × 1°. It offers interesting characteristics for surface solar radiation and numerical weather modeling applications. However, most of the validation efforts so far have focused on Level-2 products and only rarely on Level 3. In this contribution, we compare the Level-3 Collection 5.1 MODIS AOD dataset from the Terra satellite available since 2000 against observed daily AOD values at 550 nm from more than 500 AERONET ground stations around the globe. Overall, the mean error of the dataset is 0.03 (17%, relative to the mean ground-observed AOD), with a root mean square error of 0.14 (73%, relative to the same), but these errors are also found highly dependent on geographical region. We propose new functions for the expected error of the Level-3 AOD, as well as for both its mean error and its standard deviation. Additionally, we investigate the role of pixel count vis-à-vis the reliability of the AOD estimates, and also explore to what extent the spatial aggregation from Level 2 to Level 3 influences the total uncertainty in the Level-3 AOD. Finally, we use a radiative transfer model to investigate how the Level-3 AOD uncertainty propagates into the calculated direct normal and global horizontal irradiances.

scholarly journals A Two-Stage Mutation Stochastic Model of Carcinogenesis Driven by a Three Level Environmental Process

2020 ◽  
Vol 5 (6) ◽  
pp. 1468-1487
Author(s):  
V. S. S. Yadavalli ◽  
S. Udayabaskaran ◽  
C. T. Dora Pravina ◽  
S. Sreelakshmi
Keyword(s):  
Random Environment ◽  
Normal Cell ◽  
Malignant Cell ◽  
Intermediate Cell ◽  
Malignant Cells ◽  
Level 3 ◽  
Environmental Process ◽  
The Mean ◽  
Intermediate Cells ◽  
Level 2

A two-mutation model of carcinogenesis which evolves under the influence of three level random environment on the production process is formulated and analyzed. A random environment occupies one of the levels 1, 2 and 3 at any time t according to a Markov process. When the environment is in level 1, a normal cell either divides into two normal cells or dies; and an intermediate cell divides into two intermediate cells or dies. When the environment is in level 2, a normal cell either divides into one normal cell and one intermediate cell or dies and an intermediate cell either divides into one intermediate cell and one malignant cell or dies. When the environment is in level 3, a normal cell either divides into two intermediate cells or dies and an intermediate cell either divides into two malignant cells or dies. It is assumed that, once a malignant cell is produced, it generates a malignant tumor with probability 1. We obtain the mean numbers of normal, intermediate and malignant cells at any time t.

Human Skeletal Muscle Protein: Effect of Malnutrition, Elective Surgery and Total Parenteral Nutrition

1995 ◽  
Vol 88 (4) ◽  
pp. 479-484 ◽  
Author(s):  
Benny Petersson ◽  
Eric Hultman ◽  
Kerstin Andersson ◽  
Jan Wernerman
Keyword(s):  
Weight Loss ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Soluble Protein ◽  
Protein Concentration ◽  
Elective Surgery ◽  
Muscle Protein ◽  
Glutamine Supplementation ◽  
Dna And Rna ◽  
Weight Loss Group

1. The concentration of alkali-soluble protein, DNA and RNA in percutaneous muscle biopsy specimens was analysed. Tissue alkali-soluble protein/DNA ratio is a measure of muscle protein concentration, while tissue RNA/DNA ratio may reflect the capacity for protein synthesis. 2. Patients with weight loss due to cancer (n = 6) were compared with metabolically healthy patients before elective surgery (n = 7). Alkali-soluble protein/DNA and RNA/DNA ratios in the weight loss group were 248 (14) g/g and 1.3 (0.1) g/g respectively as compared with 404 (13) g/g and 2.1 (0.1) g/g in otherwise healthy patients. All of the alkali-soluble protein/DNA ratios and 5/6 of the RNA/DNA ratios in the weight loss group were below the 95% confidence interval for the healthy control subjects. 3. Patients undergoing elective open cholecystectomy (n = 7) were studied preoperatively and on days 3, 10, 20 and 30 post-operatively. The alkali-soluble protein/DNA ratio remained unchanged on postoperative day 3 but decreased by 8.7% (P < 0.01), 9.6% (P < 0.05) and 20.4% (P < 0.01) on days 10, 20 and 30 respectively in patients eating at will after the operation. No significant post-operative changes in alkali-soluble protein/DNA ratio were seen in patients given post-operative total parenteral nutrition with (n = 9) or without (n = 7) glycyl-glutamine supplementation for 3 days after surgery. 4. In conclusion, patients with weight loss due to malignant disease have a low muscle protein concentration. Elective surgery of medium magnitude results in a decrease in muscle protein lasting for more than 30 days. This is in contrast to patients receiving post-operative total parenteral nutrition, in whom no significant reduction in muscle protein was noted following surgery regardless of whether or not the total parenteral nutrition was supplemented with glutamine.

scholarly journals Canadian Home Total Parenteral Nutrition Registry: Preliminary Data on the Patient Population

2007 ◽  
Vol 21 (10) ◽  
pp. 643-648 ◽  
Author(s):  
Maitreyi Raman ◽  
Leah Gramlich ◽  
Scott Whittaker ◽  
Johane P Allard
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Population Sample ◽  
Intestinal Failure ◽  
Care Utilization ◽  
Future Research ◽  
Karnofsky Score ◽  
Cross Sectional ◽  
Primary Indication ◽  
The Mean

BACKGROUND: Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed.OBJECTIVES: To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population.METHODS: This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis.RESULTS: One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63.CONCLUSIONS: In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and future research.

scholarly journals Effect of a Comprehensive Total Parenteral Nutrition Training Program on Knowledge and Practice of Nurses in NICU

2016 ◽  
Vol 8 (10) ◽  
pp. 135 ◽  
Author(s):  
Zahra Daneshvar Ameri ◽  
Ali Vafaee ◽  
Tahere Sadeghi ◽  
Zhila Mirlashari ◽  
Djavad Ghoddoosi-Nejad ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Training Program ◽  
Total Parenteral Nutrition ◽  
Preterm Neonates ◽  
Multiple Choice Questions ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
Knowledge And Practice ◽  
Nurses Knowledge

<p><strong>Background: </strong>Parenteral nutrition is a lifesaving therapy for many infants who are unable to tolerate enteral feedings. It fulfils preterm neonates’ needs for growth and development when their sizes or conditions preclude enteral feeding. Virtuous nursing care and close biochemical monitoring are absolutely essential for successful parenteral nutrition therapy. Since poor knowledge in parenteral nutrition can causes severe impairment to neonatal infants, the conduction of this study is essential.</p><p><strong>Aims: </strong>The present study aims to: (1) examine the knowledge and practice of nurses in total parenteral nutrition (TPN); (2) employ training programs for improving knowledge and practice in management of TPN in new-borns.<strong></strong></p><p><strong>Method: </strong>A quasi-experimental study was carried out in Sarem Maternity Hospital in Tehran, Iran. The study population included nurses working in Neonatal Intensive Care Unit (NICU) who were included in the study using headcount census method (n=30). A two-part questionnaire including demographic information; 20 multiple choice questions on the nurses’ knowledge of TPN therapy and 19-item 3-point Likert-type checklist on administration of TPN completed by observing the nurses’ practice. To examine the reliability of the practice part, Cronbach's alpha method was used (α=0.78). Study interventions were mentoring education by the researcher and researcher-developed training manual and educational video and guidelines about neonatal parenteral nutrition. Before and after intervention data were collected and compared using paired t-test.<strong></strong></p><p><strong>Results: </strong>The mean scores of nurses' knowledge before and afterward parenteral nutrition (PN) training program were 11.93±1.91 and 17.56±1.59, respectively. The mean scores of the nurses' practice earlier and after training program were 38.84±2.96 and 40.15±3.02, respectively. Comparing the mean scores of the nurses' familiarity, before and after taking the training course, demonstrated a significant difference (p&lt;0.0001). The knowledge of the nurses in all areas of parenteral nutrition prescription was significantly improved after the employment of mentoring method (p&lt;0.05). Despite an increase in the post-intervention total score, the nurses’ practice, before and after, the intervention was not statistically significant (p&lt;0.05).<strong></strong></p><p><strong>Conclusion: </strong>There is a breach between nursing knowledge and practice in prescribing parenteral nutrition. The gap between knowledge and practice in this area can lead to more morbidity and negative influences on the infant. Therefore, it is required that the gap between knowledge and practice is known as the infant gets less damage.</p>

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