Aligning Patient Acuity with Resource Intensity after Major Surgery

SummaryA further case of parahaemophilia is reported. One year after the correct diagnosis had been made the patient had to undergo cholecystectomy which was performed under prophylactic substitutive treatment with fresh plasma at a factor V level of 31 %. A minimal factor V level of 11 to 12% was maintained throughout the first week after operation. There was no abnormal postoperative bleeding. The half disappearance time of factor V was found to be about 12 h. Infusion of equivalent amounts of fresh plasma supplied a higher yield of factor V in the patient’s plasma before operation than postoperatively what may be explained by an increased diffusion of factor V into the intercellular space resulting from a postoperatively increased capillar permeability. The results are compared with those of other authors.

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Breathing training before major surgery may reduce lung complications afterwards

10.3310/signal-000178 ◽

2016 ◽

Author(s):

Keyword(s):

Major Surgery ◽

Breathing Training

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CORTICOTROPIN-BESTIMMUNG ANHAND DES CORTICOSTERONANSTIEGES IM NEBENNIEREN-VENENBLUT HYPOPHYSEKTOMIERTER RATTEN

Acta Endocrinologica ◽

10.1530/acta.0.0410211 ◽

1962 ◽

Vol 41 (2) ◽

pp. 211-218 ◽

Cited By ~ 12

Author(s):

K. Retiene ◽

H. Ditschuneit ◽

M. Fischer ◽

K. Kopp ◽

E. F. Pfeiffer

Keyword(s):

Peripheral Blood ◽

Single Injection ◽

Venous Blood ◽

Corticosterone Level ◽

The Other ◽

Adrenal Vein ◽

Major Surgery ◽

Other Hand ◽

Hypophysectomized Rats

ABSTRACT Corticotrophin has been measured by using the corticotrophin-induced increase of corticosterone in adrenal venous blood of rats, the corticotrophin secretion of which has been blocked by preliminary injection of dexamethasone. Sensitivity and precision of this technique have not been higher than in the simpler procedure using corticosterone increase in peripheral blood. Single injection of dexamethasone on the other hand did not prevent release of endogenous corticotrophin following major surgery, required for canulation of the adrenal vein. In hypophysectomized rats corticotrophin can be measured by using adrenal venous blood. 0.05 mU corticotrophin (US-P-Standard) has been determined with an index of precision of λ = 0.13. The consistent relation between initial and elevated corticosterone level following corticotrophin in both peripheral and adrenal venous blood makes it highly unlikely that other modifications of this kind of assay will increase sensitivity.

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IMITATION OF THE ADRENO-CORTICAL RESPONSE TO SURGERY BY INTRAVENOUS INFUSION OF SYNTHETIC HUMAN ACTH

Acta Endocrinologica ◽

10.1530/acta.0.0720075 ◽

1973 ◽

Vol 72 (1) ◽

pp. 75-80

Author(s):

Henrik Kehlet ◽

Christian Binder ◽

Christen Engbæk

Keyword(s):

Intravenous Infusion ◽

Time Course ◽

Cortical Response ◽

Secretion Rate ◽

Major Surgery ◽

Acth Secretion ◽

Dose Rates

ABSTRACT The concentration of plasma corticosteroids was followed during major surgery and during the infusion of synthetic human ACTH at dose rates varying from 2400 ng to 15 000 ng per hour. The results showed that the time course of plasma corticosteroids during major surgery was intermediate between that obtained during the infusion of 7500 and 15 000 ng synthetic human ACTH per hour. This gives an estimated ACTH secretion rate during major surgery of between 7500 ng and 15 000 ng per hour.

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PLASMA CORTISOL, CORTICOSTERONE AND NON-PROTEIN-BOUND CORTISOL IN EXTRACORPOREAL CIRCULATION

Acta Endocrinologica ◽

10.1530/acta.0.0690517 ◽

1972 ◽

Vol 69 (3) ◽

pp. 517-525 ◽

Cited By ~ 15

Author(s):

T. Uozumi ◽

H. Manabe ◽

Y. Kawashima ◽

Y. Hamanaka ◽

Y. Monden ◽

...

Keyword(s):

Cortisol Level ◽

Extracorporeal Circulation ◽

Plasma Cortisol ◽

Elevated Level ◽

Marked Decrease ◽

Binding Capacity ◽

Biologically Active ◽

Major Surgery ◽

Plasma Samples ◽

Effective Factor

ABSTRACT The response of plasma cortisol, corticosterone and non-protein-bound cortisol in the extracorporeal circulation was investigated in 14 patients. The pre-perfusion levels of plasma cortisol, corticosterone and non-protein-bound cortisol were significantly elevated. During and immediately after perfusion, the levels of cortisol and corticosterone were found to decrease significantly from the pre-perfusion levels, while the percentage of non-protein-bound cortisol was shown to increase significantly. This indicates a marked decrease in cortisol binding capacity of plasma during extracorporeal circulation. Moreover in 200 plasma samples, it was demonstrated that the cortisol level increased markedly and the cortisol binding capacity decreased slightly during and shortly after major surgery without perfusion. It is concluded that stressful situations in major surgery with or without perfusion are associated with markedly increased levels of biologically active non-protein-bound cortisol. The elevated level of non-protein-bound cortisol in surgery seems to be dependent on the increase in the level of plasma cortisol as well as on the decrease in the cortisol binding capacity of plasma. Although the increased plasma cortisol plays the most important role in surgery with no perfusion, the decreased cortisol binding capacity may be the more effective factor involved during perfusion.

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Exploring the Use of Machine Learning to Automate the Qualitative Coding of Church-related Tweets

Fieldwork in Religion ◽

10.1558/firn.40610 ◽

2020 ◽

Vol 14 (2) ◽

pp. 140-159

Author(s):

Anthony-Paul Cooper ◽

Emmanuel Awuni Kolog ◽

Erkki Sutinen

Keyword(s):

Machine Learning ◽

Online Community ◽

High Volume ◽

Machine Learning Algorithms ◽

Supervised Machine Learning ◽

Social Media Data ◽

Twitter Data ◽

Resource Intensity ◽

Media Data ◽

Better Than

This article builds on previous research around the exploration of the content of church-related tweets. It does so by exploring whether the qualitative thematic coding of such tweets can, in part, be automated by the use of machine learning. It compares three supervised machine learning algorithms to understand how useful each algorithm is at a classification task, based on a dataset of human-coded church-related tweets. The study finds that one such algorithm, Naïve-Bayes, performs better than the other algorithms considered, returning Precision, Recall and F-measure values which each exceed an acceptable threshold of 70%. This has far-reaching consequences at a time where the high volume of social media data, in this case, Twitter data, means that the resource-intensity of manual coding approaches can act as a barrier to understanding how the online community interacts with, and talks about, church. The findings presented in this article offer a way forward for scholars of digital theology to better understand the content of online church discourse.

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Management and engineering solutions to improve processing stock quality and reduce resource-intensity of mining

MINING INFORMATIONAL AND ANALYTICAL BULLETIN ◽

10.25018/0236-1493-2018-12-64-56-68 ◽

2018 ◽

pp. 56-68

Author(s):

V. V. Agafonov ◽

V. Yu. Zalyadinov ◽

M. E. Yusupov ◽

N. S. Bikteeva

Keyword(s):

Development Strategy ◽

Open Pit ◽

Mining Operations ◽

High Concern ◽

General Production ◽

Resource Intensity ◽

Product Output ◽

And Control ◽

A Company

Sustainability of mining companies is of of high concern. The problem is specifically acute at companies that are monotownor monosettlement-forming. Sustainability of a mine depends in many ways on product quality and production resource-intensity. This article discusses formation of mineral quality indexes in terms of an open pit chrysotile mine. The studies took into account specific features of operation procedures implemented by each structural division of the mine. The analysis has found managerial and technological inconsistencies which affect quality and marketable product output, as well as efficiency of the mine in whole. The background for efficiency enhancement at a company is, by the authors’ opinion, consolidation of personnel subject to the single development strategy, namely: improvement of production and control efficiency, as well as use of available reserves and resources by means of better setup for production. The proposed approaches to planning mining operations and forming mineral quality allow higher quality of processing stock. In addition, a new model proposed for interaction between structural divisions of a mining company ensures improvement of general production indexes.

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PREP — The Preoperative Risk Education Package: an online educational resource for primary care clinicians to encourage community based prehabilitation prior to major surgery

British Journal of General Practice ◽

10.3399/bjgp18x697277 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X697277

Author(s):

James Durrand ◽

F McHardy ◽

E Land ◽

Z Llewellyn ◽

C Norman ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Perioperative Risk ◽

Perioperative Outcomes ◽

Major Surgery ◽

Educational Resource ◽

Major Step ◽

Early Evaluation ◽

Risk Education ◽

Primary Care Clinicians

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.

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