scholarly journals P-OGC89 Peri-operative blood use in Upper GI surgery

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Alexandra Mercer ◽  
Martin Houston ◽  
Andrew Harris ◽  
Steven Millen
Keyword(s):  
Baseline Data ◽  
Post Intervention ◽  
Upper Gi ◽  
Number Of Patients ◽  
Group A ◽  
Made In

Abstract Background One group and hold sample costs approximately £18 to process whilst it costs £170 to prepare and administer 1 unit of cross matched blood. We aimed to quantify the amount of blood cross-matched for elective oesophagectomy and gastrectomy cases and compare this to the number of units transfused in the peri-operative setting (within 24 hours of surgery). Current unit guidance required all patients to be cross matched for 2 units of blood pre-operatively.  Methods Baseline data was collected retrospectively over a 10 week period (08/07/19-16/09/19). A new blood ordering protocol, made in agreement with oesophago-gastric and anaesthetic consultants was produced. Blood was only to be requested if: antibodies on group and hold, pre-op Hb < 120g/l, operative team concerns or previous radiotherapy. Data was recollected using the same parameters post -intervention over a 10 week period (23/12/19-08/03/20).  Results Before implementation of the protocol 24 patients were included, mean age 67 (range 40-84). All patients were cross matched between 2 and 4 units, with a total of 52 units requested and only 1 transfused. After implementation of the protocol 27 patients were included, mean age 69 (range 51-87). 36 units were ordered for 15 patients and 3 units were transfused. The new protocol was correctly implemented in 19 patients (70%). If implemented correctly in all patients in this group a saving of approximately £6120 could have been made. This could equate to a saving of as much as £20,400 per year based on 90 OG operative cases. Conclusions Patients were cross-matched far in excess of their transfusion needs. There was significant reduction in the number of patients being cross-matched post intervention. Rationalising this is important to reduce waste, reduce cost and cut down on delays to maximise theatre time.

1622 Peri-Operative Blood Use in Upper GI Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Mercer
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Baseline Data ◽  
Post Intervention ◽  
Upper Gi ◽  
Number Of Patients ◽  
Made In

Abstract Aim One group and hold sample costs approximately £18 to process while it costs £170 to prepare and administer 1 unit of cross matched blood. We aimed to quantify the amount of blood cross-matched for elective oesophagectomy and gastrectomy cases and compare this to the number of units transfused. Method Retrospective cohort study comparing number of crossmatched blood units requested. Baseline data collected over a 10-week period (08/07/19-16/09/19). A new blood ordering protocol made in agreement with oesophago-gastric and anaesthetic consultants with criteria for blood ordering. Blood was only to be requested if: antibodies on group and hold, pre-op Hb < 120g/l, operative team concerns or previous radiotherapy. Data recollected using the same parameters post -intervention over a 10-week period (23/12/19-08/03/20). Results Pre-intervention 24 patients were included, mean age 67. 47 units were requested with only 1 transfused. Post intervention 27 patients were included, mean age 69. 36 units were ordered and 3 transfused. The new protocol was correctly implemented in 19 patients (70%) therefore saving a potential of 24 units and approximately £4080. Conclusions Patients were cross matched far in excess of their transfusion needs. There was significant reduction in the number of patients being cross-matched post intervention. Rationalising this is important to reduce waste, reduce cost and cut down on delays to maximise theatre time.

Study About the Precision of Surgical Guides Used in Implantology

2018 ◽  
Vol 69 (3) ◽  
pp. 660-664
Author(s):  
Ionut Daniel Mihai ◽  
Roxana Mihai ◽  
Claudiu Vartolomei ◽  
Raluca Monica Comaneanu ◽  
Stefania Coman ◽  
...  
Keyword(s):  
Dental Implants ◽  
Future Studies ◽  
Surgical Guide ◽  
Surgical Guides ◽  
Number Of Patients ◽  
Group A ◽  
Dental Offices ◽  
Group B ◽  
Made In

The purpose of this study was to detect the precision of inserting dental implants using 3 types of surgical guides on 3 groups of patients according to the degree of implantologist experience. In this study, 27 patients were taken, in 3 groups of 9 patients, who addressed to dental offices in which were implantologists with 1 year (group A), 6 years (group B) and 11 years (group C) of experience in surgery. Lot A, operated by a 1-year physician with experience in implantology, had the smallest deviation, demonstrating the increased attention that he had to the interventions. Comparing B and C lots, the smallest deviations were recorded for group C, operated by implantologist with greater experience in implantology. By comparing the deviations according to the type of surgical guide used, the smallest deviations at the apex and prosthetic platform were made in patients where the implants were inserted with a bone supported guide, followed by dental-gingival and mucosal guide. In terms of axis of implantation, the lowest values were recorded for the dental-gingival guide, followed by the bone and mucosal guide. The study has a number of limitations (low number of patients undergoing study, low dispensation period), which requires more extensive future studies to validate the results.

Analysis of Deliberate Self-Wrist-Cutting Episodes Presenting to the Emergency Department

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Jin Kim ◽  
Han Joon Kim ◽  
Soo Hyun Kim ◽  
Sang Hoon Oh ◽  
Kyu Nam Park
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Psychiatric Interview ◽  
Clinical Variables ◽  
Completed Suicide ◽  
Number Of Patients ◽  
Group A ◽  
Efficacy Of Treatment

Abstract. Background: Previous suicide attempts increase the risk of a completed suicide. However, a large proportion of patients with deliberate self-wrist cutting (DSWC) are often discharged without undergoing a psychiatric interview. Aims: The aims of this study were to investigate the differences in the characteristics and outcomes of patients with DSWC and those with deliberate self-poisoning (DSP) episodes. The results of this study may be used to improve the efficacy of treatment for DSWC patients. Method: We retrospectively reviewed the medical records of 598 patients with DSWC and DSP who were treated at the emergency department of Seoul Saint Mary's Hospital between 2008 and 2013. We assessed sociodemographic information, clinical variables, the reasons for the suicide attempts, and the severity of the suicide attempts. Results: A total of 141 (23.6%) patients were included in the DSWC group, and 457 (76.4%) were included in the DSP group. A significantly greater number of patients in the DSWC group had previously attempted suicide (p = .014). A total of 63 patients (44.7%) in the DSWC group and 409 patients (89.5%) in the DSP group underwent psychiatric interviews. Conclusion: More DSWC patients had previously attempted suicide, but fewer of them underwent psychiatric interviews compared with the DSP patients.

Imaging of Bacteria: Is there Any Hope for the Future Based on Past Experience?

2018 ◽  
Vol 24 (7) ◽  
pp. 772-786 ◽  
Author(s):  
Thomas Ebenhan ◽  
Elena Lazzeri ◽  
Olivier Gheysens
Keyword(s):  
Clinical Practice ◽  
Sterile Inflammation ◽  
Ageing Population ◽  
Major Health Problem ◽  
Major Health ◽  
Number Of Patients ◽  
Implanted Medical Devices ◽  
Neutropenic Patients ◽  
Socio Economic Impact ◽  
Made In

Infectious diseases remain a major health problem and cause of death worldwide. It is expected that the socio-economic impact will further intensify due to escalating resistance to antibiotics, an ageing population and an increase in the number of patients under immunosuppressive therapy and implanted medical devices. Even though radiolabeled probes and leukocytes are routinely used in clinical practice, it might still be difficult to distinguish sterile inflammation from inflammation caused by bacteria. Moreover, the majority of these probes are based on the attraction of leukocytes which may be hampered in neutropenic patients. Novel approaches that can be implemented in clinical practice and allow for swift diagnosis of infection by targeting the microorganism directly, are posing an attractive strategy. Here we review the current strategies to directly image bacteria using radionuclides and we provide an overview of the preclinical efforts to develop and validate new approaches. Indeed, significant progress has been made in the past years, but very few radiopharmaceuticals (that were promising in preclinical studies) have made it into clinical practice. We will discuss the challenges that remain to select good candidates for imaging agents targeting bacteria.

Feedback based on health advice via tracing bracelet and smartphone in the management of Blood Pressure among hypertensive patients: A Community-based RCT Trial in Chongqing, China (Preprint)

2020 ◽  
Author(s):  
Yong Zhang ◽  
Yang Tao ◽  
Yun Zhong ◽  
Jacqueline Thompson ◽  
Jamal Rahmani ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Control Group ◽  
Community Settings ◽  
Post Intervention ◽  
Attrition Rates ◽  
Hypertensive Patients ◽  
Professional Health ◽  
Group A ◽  
And Control ◽  
Study Intervention

UNSTRUCTURED Lifestyle interventions have been recognised as a line treatment of non-communicable diseases. The aimed of this study was to evaluate a bespoke mHealth approach to delivers personalised feedback to improve blood pressure and weight for hypertensive patients in community settings. A total of 307 participants, 50 from each community, were expected to be in the intervention or control group. A professional health facilitator was assigned for each of the 6 communities. The primary outcomes of the study are the reduction in blood pressure and weight at baseline and post-intervention. Of 307 recruited,192 (62.5%) participants completed the study (intervention: 104 and control: 88). There was no difference in attrition rates between the two groups (33.5%vs41.9%, p=0.291). After 6-months of intensive feedback intervention through mHealth approach, patients had better blood pressure, weight, and BMI compared with control. People who were adherent to the intervention demonstrated a clinical benefit with regards to weight and blood pressure.

scholarly journals Improving TB infection control in a regional hospital in the Eastern Cape, South Africa

2019 ◽  
Vol 8 (1) ◽  
pp. bmjoq-2018-000347 ◽  
Author(s):  
Ilsa Louisa Haeusler ◽  
Felicity Knights ◽  
Vishaal George ◽  
Andy Parrish
Keyword(s):  
South Africa ◽  
Eastern Cape ◽  
Post Intervention ◽  
Hospital Policy ◽  
Staff Members ◽  
Root Cause ◽  
Number Of Patients ◽  
Service Training ◽  
Education And Awareness ◽  
Awareness Raising

This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan-Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 22% were correctly isolated and 12% had an airborne precaution sign. Post-intervention (May 2017), the compliance improved to 17%, 50% and 25%, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.

scholarly journals Evaluating of the association between ABO blood groups and coronavirus disease 2019 (COVID-19) in Iraqi patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali H. Ad’hiah ◽  
Risala H. Allami ◽  
Raghdan H. Mohsin ◽  
Maha H. Abdullah ◽  
Ali J. R. AL-Sa’ady ◽  
...  
Keyword(s):  
Blood Groups ◽  
Abo Blood Groups ◽  
Risk Of Death ◽  
Increased Risk ◽  
Fluorescence Probing ◽  
Group A ◽  
Risk Of Disease ◽  
Novel Coronavirus ◽  
Polymorphic System ◽  
Made In

Abstract Background Susceptibility to the pandemic coronavirus disease 2019 (COVID-19) has recently been associated with ABO blood groups in patients of different ethnicities. This study sought to understand the genetic association of this polymorphic system with risk of disease in Iraqi patients. Two outcomes of COVID-19, recovery and death, were also explored. ABO blood groups were determined in 300 hospitalized COVID-19 Iraqi patients (159 under therapy, 104 recovered, and 37 deceased) and 595 healthy blood donors. The detection kit for 2019 novel coronavirus (2019-nCoV) RNA (PCR-Fluorescence Probing) was used in the diagnosis of disease. Results Mean age was significantly increased in patients compared to controls (49.8 ± 11.7 vs. 28.9 ± 6.6 years; p < 0.001). A similar observation was made in recovered (42.1 ± 10.4 vs. 28.9 ± 6.6 years; p < 0.001) and deceased (53.6 ± 9.7 vs. 28.9 ± 6.6 years; p < 0.001) cases. The mean age was also significantly increased in deceased cases compared to recovered cases (53.6 ± 9.7 vs. 42.1 ± 10.4 years; p < 0.001). There were gender-dependent differences in COVID-19 prevalence. The percentage of COVID-19 was higher in males than in females (all cases: 59.7 vs. 40.3%; recovered cases: 55.8 vs. 44.2%). Such male-gender preponderance was more pronounced in deceased cases (67.6 vs. 32.4%). Logistic regression analysis revealed that groups AB and B + AB were significantly associated with increased risk to develop COVID-19 (OR = 3.10; 95% CI 1.59–6.05; pc = 0.007 and OR = 2.16; 95% CI 1.28–3.63; pc = 0.028, respectively). No ABO-associated risk was observed in recovered cases. On the contrary, groups A (OR = 14.60; 95% CI 2.85–74.88; pc = 0.007), AB (OR = 12.92; 95% CI 2.11–79.29; pc = 0.042), A + AB (OR = 14.67; 95% CI 2.98–72.33; pc = 0.007), and A + B + AB (OR = 9.67; 95% CI 2.02–46.24; pc = 0.035) were associated with increased risk of death in deceased cases. Conclusions The findings of this study suggest that group AB may be a susceptibility biomarker for COVID-19, while group A may be associated with increased risk of death.

scholarly journals AB0782 MONOARTHRITIS: PROBABLE OUTCOMES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1417.1-1417
Author(s):  
M. Osipyan ◽  
M. Efraimidou ◽  
V. Vardanyan ◽  
K. Ginosyan
Keyword(s):  
Joint Distribution ◽  
Complete Blood Count ◽  
Mefv Gene ◽  
Baseline Data ◽  
Mefv Mutations ◽  
Appropriate Treatment ◽  
Number Of Patients ◽  
Female Predominance ◽  
Mediterranean Fever ◽  
Systemic Manifestations

Background:Numerous joint disorders initially produce swelling in a single joint and new onset monoartritis will probably further lead to the involvement of other joint groups and development of extraarticular manifestations. It is essential to take a proper diagnostic approach for organizing appropriate treatment and lowering possibility of disease progression.Objectives:The aim of this study was to investigate joint distribution, determine rheumatological diseases of patients with acute monoarthritis and reveal the development of further systemic manifestations.Methods:100 patients (age 18-75 years) with clinically apparent monoarthritis of less than 6 weeks duration were included in the study. Criteria of exclusion were infection, trauma and crystal induced arthritis. Joint distribution, presence of systemic manifestations and development of chronic inflammatory rheumatic disease were evaluated. Presence of arthritis was proved with help of ultrasound examination. Complete blood count, ESR, CRP, RF, anti-CCP; HLAB27; MEFV mutations and X-ray of swollen joint were performed for all patients. Temperature was also measured.Results:Mean age of patients with acute monoarthritis was 46±13 years. Female predominance was noted (61%). 71% of patients had elevated ESR, 69%- CRP. In 24% of cases homozygous or heterozygous mutations of MEFV gene were revealed. 21% of patients had positive RF and 18% - anti-CCP. 11% patients carried HLA-B27 antigen. 28% of examined patients had subfebril fever. Hepatosplenomegaly was determined in 16%, uveitis in 5%, psoriatic plaque in 4%, interstitial pneumonia in 2% of casesAt the baseline 82 patients were diagnosed with rheumatologically disease. Baseline data is shown in the Table 1 bellow.Table 1.Baseline dataDiagnosis Number of patientsFMF23Osteoarthritis (reactive synovitis)16Rheumatoid arthritis15Reactive arthritis10Ankylosing spondylitis6Psoriatic arthritis4SLE3Schonleyn-Henoch purpura2Sarcoidosis2Behcet diseases1Conclusion:In this study monoarhtritis in majority of cases underlies FMF. Though FMF is not considered as a frequent cause of acute monoarthritis, more attention should be paid on this pathology in focus of monoarthritis, especially in specific for FMF region. Further follow up of acute monoarthritis progression is needed.References:[1]A. Becker, J. Daily, K. Pohlgeers. Acute Monoarthritis: Diagnosis in Adults.Am Fam Physician 2016; 94(10): 810-816[2]S. Camacho-Lovillo, A. García-Martínez. Arthritis as presentation of familial Mediterranean fever. An Pediatr (Barc). 2015; 83(2):130. DOI: 10.1016/j.anpede.2015.07.007[3]J. Ellis. Acute monoarthritis. JAAPA. 2019, 32(3):25-31. doi: 0.1097/01.JAA.0000553379.52389.ebDisclosure of Interests:None declared

scholarly journals Outcomes of Ureteroscopy and Laser Stone Fragmentation (URSL) for Kidney Stone Disease (KSD): Comparative Cohort Study Using MOSES Technology 60 W Laser System versus Regular Holmium 20 W Laser

2021 ◽  
Vol 10 (13) ◽  
pp. 2742
Author(s):  
Amelia Pietropaolo ◽  
Thomas Hughes ◽  
Mriganka Mani ◽  
Bhaskar Somani
Keyword(s):  
Operative Time ◽  
Laser System ◽  
Stone Fragmentation ◽  
System Versus ◽  
Number Of Patients ◽  
Higher Power ◽  
Group A ◽  
The Mean ◽  
Laser Group ◽  
Second Procedure

Background: For ureteroscopy and laser stone fragmentation (URSL), the use of laser technology has shifted from low power to higher power lasers and the addition of Moses technology, that allows for ‘fragmentation, dusting and pop-dusting’ of stones. We wanted to compare the outcomes of URSL for Moses technology 60 W laser system versus matched regular Holmium 20 W laser cases. Methods: Prospective data were collected for patients who underwent URSL using a Moses 60 W laser (Group A) and matched to historical control data using a regular Holmium 20 W laser (Group B), performed by a single surgeon. Data were collected for patient demographics, stone location, size, pre- and post-operative stent, operative time, length of stay, complications and stone free rate (SFR). Results: A total of 38 patients in each group underwent the URSL procedure. The stones were matched for their location (17 renal and 11 ureteric stones). The mean single and cumulative stone sizes (mm) were 10.9 ± 4.4 and 15.5 ± 9.9, and 11.8 ± 4.0 and 16.5 ± 11.3 for groups A and B, respectively. The mean operative time (min) was 51.6 ± 17.1 and 82.1 ± 27.0 (p ≤ 0.0001) for groups A and B. The initial SFR was 97.3% and 81.6% for groups A and B, respectively (p = 0.05), with 1 and 7 patients in each group needing a second procedure (p = 0.05), for a final SFR of 100% and 97.3%. While there were 2 and 5 Clavien I/II complications for groups A and B, none of the patients in group A had any infection related complication. Conclusions: Use of Moses technology with higher power was significantly faster for stone lithotripsy and reduced operative time and the number of patients who needed a second procedure to achieve a stone free status. It seems that the use of Moses technology with a mid-power laser is likely to set a new benchmark for treating complex stones, without the need for secondary procedures in most patients.

Dyslexia, an Imbalance in Cerebral Information-Processing Strategies

1978 ◽  
Vol 47 (3) ◽  
pp. 699-706 ◽  
Author(s):  
P. G. Aaron
Keyword(s):  
Reading Ability ◽  
Control Group ◽  
Disabled Children ◽  
Opposite Pattern ◽  
Sequential Processing ◽  
Processing Strategies ◽  
Group A ◽  
Entire Word ◽  
Pattern Of Performance ◽  
Made In

Reading ability seems to involve analytic-sequential processing of selected letters and a holistic-simultaneous perception of the salient features of the entire word. The dyslexic child, being normal in intelligence, is most likely deficient in either one of the two processes while being normal in the other. To test this hypothesis, 28 reading disabled children, on the basis of the nature of errors made in a writing from dictation task, were divided into two groups: analytic-sequential deficient and holistic-simultaneous deficient. Further testing showed that the first group was poor in processing a sequence of digits but normal on holistic-simultaneous memory tasks. The opposite pattern of performance was shown by the second group. A control group of 14 normal readers did not show such an imbalance.

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