scholarly journals 1037 Early Detection and Management of Preoperative Anaemia in An Elective Vascular Surgery Cohort

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Tanna ◽  
J Walker
Keyword(s):  
Vascular Surgery ◽  
Adverse Outcomes ◽  
Major Surgery ◽  
Surgical Patient ◽  
Post Intervention ◽  
Early Management ◽  
The Mean ◽  
The Impact ◽  
Major Vascular Surgery ◽  
Preoperative Anaemia

Abstract Introduction Iron deficiency anaemia is the most common cause of anaemia in the surgical population. Patients receiving transfusions during major surgery encounter more adverse outcomes compared to those that do not, indicating the early management of pre-operative anemia is likely to reduce major surgical patient morbidity and mortality. Previous studies have demonstrated that 33% of patients undergoing major vascular surgery operations are anaemic (haemaglobin, Hb, <130g/L). Aim We aim to reduce the proportion of anaemic patients undergoing major vascular surgery by 50%. Method A point-of-care HemoCue machine was used to measure Hb in patients who were referred for elective major surgery in 11 vascular clinics. Patients with Hb < 130g/L were prescribed a 1-month course of Ferrous Sulfate (200mg TDS), and a letter was sent to their GP requesting iron function tests. Post-intervention Hb levels were rechecked following the preoperative anaesthetics review. Results 11 patients were referred for major surgery, of which 4 were identified as anaemic (36%). The mean Hb concentration was 121.3g/L, which increased to 137.3g/L following oral iron therapy. The mean duration of follow up was 36 days (range 0-94 days). Conclusions The implementation of a HemoCue machine to identify and manage preoperative anaemia was successful in our pilot study. Further work should include full integration of our pathway into current vascular clinics without student support. This will enable evaluation of the impact of our intervention on a wider scale.

scholarly journals Daily Medical Liaison Is Associated with Reduced Length of Stay and Complications in Selected Patients Admitted to a Regional Vascular Surgery Service

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 78
Author(s):  
Emma Mitchell ◽  
Roisin Coary ◽  
Paul White ◽  
Emily Farrow ◽  
Amy Crees ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vascular Surgery ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Primary Outcome Measure ◽  
Adverse Outcomes ◽  
Mean Difference ◽  
Post Intervention ◽  
Randomised Controlled ◽  
The Impact

Older adults undergoing vascular surgery are particularly vulnerable to adverse outcomes by virtue of their vascular risk factors and medical comorbidities. This study aimed to determine the impact of daily medical liaison for patients aged 65 years and older admitted to a regional vascular surgery centre. This was a descriptive before-and-after study concerning 375 patients. The primary outcome measure was length of stay (LOS). Following intervention, we identified a reduction in mean LOS in the sample from 10.75 to 7.95 days (p = 0.635, 95% Confidence Interval [CI] 0–5 days) with a statistically significant reduction in mean LOS for “stranded” patients admitted for more than seven days (mean 7.84 days reduction, p = 0.025, 95% CI for mean difference, 1.5 to 14 days). These patients did not display elevated 30-day readmission rates (12/60 to 8/72, p = 0.156, 95% CI −3% to 21%). A non-significant reduction in postoperative complications was seen in all patients in the post-intervention cohort (1.09 to 0.86 per person, p = 0.181, 95% CI −0.11 to 0.56), reaching statistical significance in emergency vascular admissions (1.81 to 0.97 complications per person, p = 0.01, mean difference = 0.84, 95% CI 0.21–1.46). This study demonstrated reduced LOS and complications in selected older patients admitted under vascular surgery after the introduction of a daily medical liaison model. These data are amongst the first to reproduce randomised controlled trial findings in a non-trial setting. Subgroup analysis indicates that patients admitted with acute pathology and those with long LOS may benefit most from medical liaison where resources are finite.

scholarly journals The Impact of COVID-19 on Risky Behaviors and Health Changes in African-American Smokers Who Are Eligible for LDCT Screening

2021 ◽  
Vol 9 ◽  
Author(s):  
Tung-Sung Tseng ◽  
Mirandy Li ◽  
Yu-Hsiang Kao ◽  
Lei-Shih Chen ◽  
Hui-Yi Lin
Keyword(s):  
African American ◽  
Risky Behaviors ◽  
Adverse Outcomes ◽  
Health Changes ◽  
The Us ◽  
The Mean ◽  
Vegetables And Fruits ◽  
Control And Management ◽  
Low Dose Computed Tomography ◽  
The Impact

The COVID-19 pandemic has disrupted much of day-to-day life in the US and around the world. Smokers have a higher risk of adverse outcomes due to COVID-19. This study investigated the impact of COVID-19 on risky behaviors and health changes in lower income African-American smokers eligible for Low dose computed tomography (LDCT) screening, who may be more adversely impacted by the COVID-19 pandemic. A total of 22 African-American daily smokers who were eligible for LDCT screening participated in this study. The mean age of participants was 61.2 years old (SD = 4.7), 77.3% of the smokers were female, all participants had an income below $20,000, and 63.6% were on Medicaid. Descriptive statistics were used to provide summary information on demographics, COVID-19, and health status. Results showed that participants increased cigarette smoking, spent more time on screens, increased sugary drink consumption, consumed more vegetables and fruits, and engaged in more gardening activities during the COVID-19 pandemic. However, participants also decreased physical activity time and slept less during the pandemic. In general, more than one-third of participants gained more body weight and reported increased stress and anxiety. Our results suggest that African-American smokers who qualify for LDCT screening should be encouraged to consider strategies not only for smoking cessation, but also risky behavior control and management.

scholarly journals Preoperative Anemia Is A Predictor of Cacoethic Postoperative Outcomes Following Open Pancreatoduodenectomy – A Propensity Score-Based Analysis

2021 ◽  
Author(s):  
Jing-Yong Xu ◽  
Xiao-Dong Tian ◽  
Yin-Mo Yang ◽  
Jinghai Song ◽  
Jun-Min Wei
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Situation ◽  
Postoperative Outcomes ◽  
Ductal Adenocarcinoma ◽  
Major Surgery ◽  
Before And After ◽  
Open Pancreaticoduodenectomy ◽  
The Impact ◽  
Preoperative Anaemia

Abstract Background: Preoperative anaemia is a common clinical situation that was proved to be associated with severe outcomes in major surgery but not pancreatic surgery alone. We aimed to study the impact of preoperative anaemia on morbidity and mortality in patients undergoing open pancreaticoduodenectomy by using propensity score matching (PSM) to balance the basal data and reduce bias. Methods: Consecutive patients undergoing open pancreaticoduodenectomy with complete record of preoperative haemoglobin at two pancreatic centers in China between 2015 to 2019 were analysed. Haemoglobin less than 12g/dl for male and 11g/dl for female were defined as anaemia in Chinese population. Clinical and economic outcomes were compared before and after propensity score matching (PSM). Logistic regression analysis was used to assess correlation between variables and anaemia. Results: The unmatched initial cohort consist of 517 patients. 148 cases (28.6%) were diagnosed as anaemia at admission, and no case received preoperative blood transfusion or anti-anaemia therapy. After PSM, 126 cases were in each group. The rate of severe postoperative complications was significantly higher in anaemia group than in normal group (43.7% versus 27.0%, P=0.006), among which prevalence of clinically relevant postoperative pancreatic fistula (31.0% versus 15.9%, P=0.005) and cardiac and cerebrovascular events (4.0% versus 0.0%, P=0.024) were most significant. It costed more in the anaemia group (26958.2±21671.9 versus 20987.7±10237.9 USD, P=0.013). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [OR 1.813, 95%CI (1.206-2.725), P=0.004] and pancreatic ductal adenocarcinoma [OR 1.861, 95%CI (1.178-2.939), P=0.008] were predictors of anaemia. Among paired patients, preoperative anaemia [OR 2.593, 95%CI (1.481-5.541), P=0.001] and malignant pathology [OR 4.266, 95%CI (1.597-11.395), P=0.004] were predictors of postoperative severe complications.Conclusions: Preoperative anaemia is a predictor of cacoethic postoperative outcomes following open pancreatoduodenectomy and needs identified and treated.

scholarly journals The Impact of an Educational Program Based on the BASNEF Model on Knowledge and Self-Care Behaviors of Patients with Hypertension

Health Scope ◽  
2020 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Sedigheh Abedini ◽  
Farzaneh Pourjalil ◽  
Shokrallah Mohseni
Keyword(s):  
Educational Program ◽  
Intervention Group ◽  
Self Care ◽  
Educational Interventions ◽  
T Test ◽  
Post Intervention ◽  
Enabling Factors ◽  
Significant Difference ◽  
The Mean ◽  
The Impact

Background: Hypertension is an important health problem that can be controlled by self-care. Objectives: The present study aimed to determine the impact of an educational program based (BASNEF) model on knowledge and self-care behaviors for hypertensive patients in Bastak, Iran. Methods: This quasi-experimental study was performed on 180 patients with hypertension who were admitted to health centers of the Bastak city. The participants were randomly assigned to intervention (n = 90) and control (n = 90) groups. Data were collected using a questionnaire that had three sections of demographic information, knowledge, and BASNEF constructs. The questionnaires were completed before the intervention and two months after providing the intervention. After the pre-test, an appropriate educational intervention was designed and implemented only among the intervention group. To analyze the data, paired t-test, independent t-test, and Chi-square tests were run by SPSS version 19. Results: The mean age of the participants was 50.62 ± 7.549 years. The results showed a statistically significant difference in the mean scores of attitudes, subjective norms, enabling factors, and self-care behaviors in the intervention group pre- and post-intervention (P = 0.001). Besides, it was found that enabling factors (0.311) play a significant role in predicting self-care behaviors. Conclusions: The results of this study support the effectiveness of educational interventions in raising awareness and improving self-care behaviors in patients with hypertension using the BASNEF model. Therefore, with an emphasis on enabling factors, the BASNEF model can be used as a framework to develop educational interventions for self-care.

High-Frequency Jet Ventilation in the Early Management of Respiratory Distress Syndrome Is Associated With a Greater Risk for Adverse Outcomes

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1035-1043 ◽  
Author(s):  
Thomas E. Wiswell ◽  
Leonard J. Graziani ◽  
Michael S. Kornhauser ◽  
James Cullen ◽  
Daniel A. Merton ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Premature Infants ◽  
High Frequency ◽  
Distress Syndrome ◽  
Periventricular Leukomalacia ◽  
Adverse Outcomes ◽  
Jet Ventilation ◽  
Early Management ◽  
The Mean

Objective. The objective of this investigation was to determine if high-frequency jet ventilation (HFJV) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes. Study Design. A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, birth weight of more than 500 g, age of less than 24 hours, need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30, and roentgenographic evidence of respiratory distress syndrome) were randomized to either conventional (n = 36) or to high-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes. Results. The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7.3 hours of life, respectively). Their prerandomization ventilator settings and arterial blood gases were nearly identical. There were no differences in pulmonary outcomes (occurrence of air leaks, need for oxygen or ventilation at 36 weeks postconception), and there were no differences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorrhage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .016). Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome. The presence of hypocarbia was not an independently significant predictor of adverse outcomes. Conclusions. With the HFJV treatment strategy that we used, use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.

The Impact of Postoperative Discontinuation or Continuation of Chronic Statin Therapy on Cardiac Outcome After Major Vascular Surgery

2007 ◽  
Vol 104 (6) ◽  
pp. 1326-1333 ◽  
Author(s):  
Yannick Le Manach ◽  
Gilles Godet ◽  
Pierre Coriat ◽  
Claire Martinon ◽  
Mich??le Bertrand ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Statin Therapy ◽  
Cardiac Outcome ◽  
The Impact ◽  
Major Vascular Surgery
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