Consent and anaesthetic risk

2016 ◽  
Author(s):  
Kath Jenkins
Keyword(s):  
Informed Consent ◽  
Real Life ◽  
Adverse Outcomes ◽  
Risk Patient ◽  
Good Knowledge ◽  
Perioperative Mortality ◽  
Mortality And Morbidity ◽  
Anaesthetic Practice

This chapter describes the importance of obtaining informed consent for anaesthesia. It covers some ethical points to guide this process. Informed consent requires good knowledge of the risks of anaesthetic practice and their likelihood. The chapter contains a detailed table of perioperative adverse outcomes, linked to real-life examples to aid clarity of communication to the patient. There are detailed suggestions of how to identify the higher-risk patient and estimate their risk of perioperative mortality and morbidity.

Consent and anaesthetic risk

2018 ◽  
Author(s):  
Kath Jenkins
Keyword(s):  
Informed Consent ◽  
Real Life ◽  
Adverse Outcomes ◽  
Risk Patient ◽  
Good Knowledge ◽  
Perioperative Mortality ◽  
Mortality And Morbidity ◽  
Anaesthetic Practice

This chapter describes the importance of obtaining informed consent for anaesthesia. It covers some ethical points to guide this process. Informed consent requires good knowledge of the risks of anaesthetic practice and their likelihood. The chapter contains a detailed table of perioperative adverse outcomes, linked to real-life examples to aid clarity of communication to the patient. There are detailed suggestions of how to identify the higher-risk patient and estimate their risk of perioperative mortality and morbidity.

Prevalence and predictors of adverse outcomes in neonatal seizures

2021 ◽  
pp. 1-7
Author(s):  
K. Famra ◽  
P. Barta ◽  
A. Aggarwal ◽  
B.D. Banerjee
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Birth Asphyxia ◽  
Adverse Outcomes ◽  
Neonatal Seizures ◽  
Clinical Practices ◽  
Inborn Errors ◽  
Mortality And Morbidity ◽  
Low Birth Weight Babies

OBJECTIVES: Neonatal seizures are significant cause of neonatal mortality and morbidity. Current study was planned to study prevalence of adverse outcomes in neonatal seizures and identify its predictors. METHODS: This observational descriptive study was carried out on 220 neonates with seizures. Neonates who succumbed to illness/ death before investigations, or whose maternal records were incomplete were excluded. Blood sugar, serum calcium, serum electrolytes, and USG skull were done in all patients. CT scan, MRI and inborn errors of metabolism profile were done as and when indicated. Adverse outcomes were defined as death, phenobarbitone non responders, or abnormal examination at discharge. Antenatal, perinatal and neonatal predictors of adverse outcomes in neonatal seizures were evaluated. RESULTS: Out of 220 neonates with seizures 76(34.5%) had adverse outcomes. Very low birth weight babies (≤1500 gm) [OR 1.27(CI 0.57–2.84)], microcephaly [OR 5.93 (CI 0.55–64.41)], Apgar score≤3 at 5 minutes [OR 11.28(CI 14.18–30.45)], seizure onset within 24 hours [OR 5.99(CI 12.43–14.78)], meningitis [OR 2.63(CI 0.08–6.39)], septicemia [OR1.22(CI 0.45–3.31)] and abnormal cranial USG [OR 7.95(CI 12.61–24.22)] were significant predictors of adverse outcomes in neonates with seizures. CONCLUSION: Prematurity, very low birth weight, birth asphyxia, meningitis, septicemia and abnormal USG could predict adverse outcomes in neonatal seizures. Improved antenatal and neonatal clinical practices may help reduce adverse outcomes in these patients.

To err is system; a comparison of methodologies for the investigation of adverse outcomes in healthcare

2021 ◽  
pp. 251604352199026
Author(s):  
Peter Isherwood ◽  
Patrick Waterson
Keyword(s):  
Patient Safety ◽  
System Performance ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Real Life ◽  
Adverse Outcomes ◽  
System Level ◽  
Future Performance ◽  
System A ◽  
Regulatory Bodies

Patient safety, staff moral and system performance are at the heart of healthcare delivery. Investigation of adverse outcomes is one strategy that enables organisations to learn and improve. Healthcare is now understood as a complex, possibly the most complex, socio-technological system. Despite this the use of a 20th century linear investigation model is still recommended for the investigation of adverse outcomes. In this review the authors use data gathered from the investigation of a real life healthcare near incident and apply three different methodologies to the analysis of this data. They compare both the methodologies themselves and the outputs generated. This illustrates how different methodologies generate different system level recommendations. The authors conclude that system based models generate the strongest barriers to improve future performance. Healthcare providers and their regulatory bodies need to embrace system based methodologies if they are to effectively learn from, and reduce future, adverse outcomes.

scholarly journals The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 714
Author(s):  
Elisabeta Bădilă ◽  
Cristina Japie ◽  
Emma Weiss ◽  
Ana-Maria Balahura ◽  
Daniela Bartoș ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renin Angiotensin System ◽  
Drug Regimen ◽  
Secondary Hypertension ◽  
Adverse Outcomes ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Mineralocorticoid Receptor Antagonist ◽  
Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

scholarly journals Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1704
Author(s):  
Rahul Soangra ◽  
Thurmon Lockhart
Keyword(s):  
Cardiovascular Disease ◽  
Older Adults ◽  
Cardiac Surgery ◽  
Regression Model ◽  
Mobile Phone ◽  
Gait Speed ◽  
Adverse Outcomes ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

C125 A critical analysis of perioperative mortality and morbidity from radical cystectomy

2009 ◽  
Vol 8 (8) ◽  
pp. 699 ◽  
Author(s):  
B. Braticevici ◽  
V. Ambert ◽  
D. Damian ◽  
S. Andrei ◽  
I. Chira ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Critical Analysis ◽  
Perioperative Mortality ◽  
Mortality And Morbidity

Glucocorticosteroids effects on brain development in the preterm infants: a role for microglia?

2021 ◽  
Vol 19 ◽  
Author(s):  
Zinni Manuela ◽  
Pansiot Julien ◽  
Elodie Billion ◽  
Baud Olivier ◽  
Mairesse Jérôme
Keyword(s):  
Brain Development ◽  
Preterm Infants ◽  
Adverse Outcomes ◽  
Mortality And Morbidity ◽  
Respiratory Problems ◽  
Neurodevelopmental Impairment ◽  
Short And Long Term ◽  
Abnormal Brain

: Prematurity, observed in 15 million births worldwide each year, is a clinical condition that is a major cause of neonatal mortality and morbidity in short and long term. Preterm infants are at high risk for developing respiratory problems, sepsis, and other morbidities leading to neurodevelopmental impairment and neurobehavioral disorders. Perinatal glucocorticosteroids have been widely used for the prevention and treatment of adverse outcomes linked to prematurity. However, despite their shortterm benefits due to their maturational properties, some clinical trials have shown an association between steroids exposure and abnormal brain development in infants born preterm. Neuroinflammation has emerged as a preeminent factor for brain injury in preterm infants, and the major role of microglia, the brain resident immune cells, has been recently highlighted. Considering the role of microglia in the modulation of brain development, the aim of this review is to summarize the effects of endogenous and exogenous glucocorticosteroids on brain development and discuss the possible role of microglia as a mediator of these effects.

scholarly journals Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

2020 ◽  
Vol 105 (4) ◽  
pp. 449-454
Author(s):  
Emily J J Horn-Oudshoorn ◽  
Ronny Knol ◽  
Arjan B Te Pas ◽  
Stuart B Hooper ◽  
Suzan C M Cochius-den Otter ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Management Strategies ◽  
Fetal Surgery ◽  
Adverse Outcomes ◽  
Delivery Room ◽  
Treatment Modalities ◽  
Mortality And Morbidity ◽  
Early Predictors ◽  
Stabilisation Period

Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.

Acoustic neuroma (schwannoma) surgery 1978–1990

1991 ◽  
Vol 105 (3) ◽  
pp. 165-173 ◽  
Author(s):  
J. E. M. Dutton ◽  
R. T. Ramsden ◽  
R. H. Lye ◽  
K. Morris ◽  
A. O. Keith ◽  
...  
Keyword(s):  
Tumour Size ◽  
Hearing Preservation ◽  
Royal Infirmary ◽  
Perioperative Mortality ◽  
Neurophysiological Mechanism ◽  
Mortality And Morbidity ◽  
Number Of Patients ◽  
Normal Functional ◽  
Unusual Type ◽  
The Ideal

AbstractA series of 151 patients with 154 acoustic schwannomas have been operated upon in Manchester Royal Infirmary by a joint Otological and Neurosurgical team, employing either the translabynnthine or the sub-occipital approach. The perioperative mortality rate was 3 per cent. Anatomical preservation of the facial nerve was achieved in 89 per cent of tumour removals and a good to normal functional result in 79 per cent of cases. Attempts at hearing preservation have been unsuccessful, largely because of the small number of patients in the series in whom useful hearing was present preoperatively. Complications included major brain stem ischaemia (1.2 per cent), CSF fistula (5 per cent) and facial dysaesthesia (7 per cent). The incidence of mortality and morbidity is directly related to tumour size and to the experience of the surgeons. A number of patients experienced an unusual type of post-operative dreamlike state which appeared to be a form of hypnagogic hallucination, and the possible neurophysiological mechanism responsible for this phenomenon is discussed. The continuing failure to attain the ideal of early diagnosis is lamented, and the importance of a flexible bidisciplinary surgical approach emphasized.

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