Overuse of small chest drains for pleural effusions: a retrospective practice review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Pattraporn Tajarernmuang ◽  
Anne V. Gonzalez ◽  
David Valenti ◽  
Stéphane Beaudoin
Keyword(s):  
Health Centre ◽  
Radiology Department ◽  
Chest Drain ◽  
Pleural Effusions ◽  
Content Type ◽  
Mcgill University ◽  
Practice Review ◽  
Pleural Infection ◽  
Malignant Effusions ◽  
One Year

PurposeSmall-bore drains (≤ 16 Fr) are used in many centers to manage all pleural effusions. The goal of this study was to determine the proportion of avoidable chest drains and associated complications when a strategy of routine chest drain insertion is in place.Design/methodology/approachWe retrospectively reviewed consecutive pleural procedures performed in the Radiology Department of the McGill University Health Centre over one year (August 2015–July 2016). Drain insertion was the default drainage strategy. An interdisciplinary workgroup established criteria for drain insertion, namely: pneumothorax, pleural infection (confirmed/highly suspected), massive effusion (more than 2/3 of hemithorax with severe dyspnea /hypoxemia), effusions in ventilated patients and hemothorax. Drains inserted without any of these criteria were deemed potentially avoidable.FindingsA total of 288 procedures performed in 205 patients were reviewed: 249 (86.5%) drain insertions and 39 (13.5%) thoracenteses. Out of 249 chest drains, 113 (45.4%) were placed in the absence of drain insertion criteria and were deemed potentially avoidable. Of those, 33.6% were inserted for malignant effusions (without subsequent pleurodesis) and 34.5% for transudative effusions (median drainage duration of 2 and 4 days, respectively). Major complications were seen in 21.5% of all procedures. Pneumothorax requiring intervention (2.1%), bleeding (0.7%) and organ puncture or drain misplacement (2%) only occurred with drain insertion. Narcotics were prescribed more frequently following drain insertion vs. thoracentesis (27.1% vs. 9.1%, p = 0.03).Originality/valueRoutine use of chest drains for pleural effusions leads to avoidable drain insertions in a large proportion of cases and causes unnecessary harms.

scholarly journals Biomarkers in routine diagnosis of pleural effusions

2018 ◽  
Vol 87 (1-2) ◽  
Author(s):  
Tiva Nemanič ◽  
Aleš Rozman ◽  
Katja Adamič ◽  
Mateja Marc Malovrh
Keyword(s):  
Pleural Fluid ◽  
Biochemical Parameters ◽  
Biochemical Analysis ◽  
Pleural Effusions ◽  
Routine Diagnostics ◽  
Routine Diagnosis ◽  
Malignant Effusions ◽  
One Year ◽  
The University ◽  
Aetiological Spectrum

Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE) diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine diagnosis of PE.Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH), alpha amylase (AA), pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions.Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154) or infection (n = 108). In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %). Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005) and proteins (p < 0.0005), and higher pH (p < 0.0005) values in the paramalignant effusions.Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.

Changes in commitment to change among leaders in home help services

2015 ◽  
Vol 28 (3) ◽  
pp. 216-227 ◽  
Author(s):  
Kristina Westerberg ◽  
Susanne Tafvelin
Keyword(s):  
Organizational Change ◽  
Structured Interviews ◽  
Change Initiatives ◽  
Commitment To Change ◽  
Content Type ◽  
Team Meetings ◽  
Home Help ◽  
Home Help Services ◽  
One Year ◽  
Over Time

Purpose – The purpose of the this study was to explore the development of commitment to change among leaders in the home help services during organizational change and to study this development in relation to workload and stress. During organizational change initiatives, commitment to change among leaders is important to ensure the implementation of the change. However, little is known of development of commitment of change over time. Design/methodology/approach – The study used a qualitative design with semi-structured interviews with ten leaders by the time an organizational change initiative was launched and follow-up one year later. Thematic content analysis was used to analyze the interviews. Findings – Commitment to change is not static, but seems to develop over time and during organizational change. At the first interview, leaders had a varied pattern reflecting different dimensions of commitment to change. One year later, the differences between leaders’ commitment to change was less obvious. Differences in commitment to change had no apparent relationship with workload or stress. Research limitations/implications – The data were collected from one organization, and the number of participants were small which could affect the results on workload and stress in relation to commitment to change. Practical implications – It is important to support leaders during organizational change initiatives to maintain their commitment. One way to accomplish this is to use management team meetings to monitor how leaders perceive their situation. Originality/value – Qualitative, longitudinal and leader studies on commitment to change are all unusual, and taken together, this study shows new aspects of commitment.

Assessing emphasis gaps among MBA alumni: a model framework

2016 ◽  
Vol 9 (1) ◽  
pp. 31-51
Author(s):  
Stuart Van Auken ◽  
Earl Chrysler ◽  
Ludmilla Gricenko Wells
Keyword(s):  
Methodological Approach ◽  
A Priori ◽  
Dimensional Structure ◽  
Assessment Procedure ◽  
Model Framework ◽  
Mba Programs ◽  
Content Type ◽  
Program Delivery ◽  
Mba Program ◽  
One Year

Purpose This paper aims to focus on Master of Business Administration (MBA) alumni and their ability to provide institution-specific insights into MBA program delivery. Given desired MBA positioning dimensions, a case exemplar is used to reveal gaps between “should have” program emphases and “actual” emphases. Departures from expectations are used to reveal either under- or over-emphases which require repair. Design/methodology/approach The study develops a gap assessment procedure and the theory of gaps, and it presents insights into the prioritization of gaps for closing through the revelation of gap themes of varying magnitude. It also reveals the benefits and the limitations of emphasis-based gap assessments. Additionally, the study addresses the complexity of creating the dimensional structure for MBA program gap revelation. Findings This paper reports on the issues of framing dimensions, including the possibility of dimensional omissions, with a particular emphasis on the utilization of an emphasis-based gap model within an a priori identified structure. Practical implications The methodological approach provides a blueprint for additional program review, and it produces a strong structural base for MBA program positioning. It is also is particularly important in evaluating newly created one-year MBA programs. Originality/value The work reveals the potential for the revelation of both under- and over-emphases in MBA program delivery and the possible issue of sub-optimization in gap closing (i.e. the closing of one gap while opening another).

Predicting recidivism for offenders in UK substance dependence treatment: do mental health symptoms matter?

2014 ◽  
Vol 4 (2) ◽  
pp. 102-115 ◽  
Author(s):  
Josefien J.F. Breedvelt ◽  
Lucy V. Dean ◽  
Gail Y. Jones ◽  
Caroline Cole ◽  
Hattie C.A. Moyes
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Substance Dependence ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type ◽  
Health Factors ◽  
Substance Dependence Treatment ◽  
One Year ◽  
Mental Health Factors

Purpose – The purpose of this paper is to assess whether mental health symptoms affect one-year reoffending rates upon release from prison for participants engaging in substance dependence treatment in the UK. Design/methodology/approach – A retrospective cohort study was used to assess reconviction outcomes upon release. The Comprehensive Addiction and Psychological Evaluation (CAAPE) was administered to 667 inmates admitted to the programme. The effect of mental health, drug use, and static risk factors on reoffending was assessed at one-year post release. Findings – Logistic regression analysis showed that symptoms of Major Depressive Disorder at the start of substance dependence treatment increased the likelihood to reoffend, whilst Obsessive Compulsive Disorder symptoms and length of sentence decreased the likelihood to reoffend. Antisocial Personality Disorder symptoms show a trend towards increasing the likelihood to reoffend. In addition, previously established risk factors for reoffending, including dependence on heroin, crack/cocaine, and poly drug use significantly increased the likelihood of reconviction. Practical implications – Depressive symptomatology pre-treatment could affect reoffending outcomes for participants in substance dependence treatment in prison. An integrative approach addressing both substance misuse and mental health factors is pivotal. Future efforts to address both simultaneously can be made to improve assessment, training, treatment, and through care for prisoners in substance dependence treatment. Originality/value – Few studies have assessed the effect of mental health factors on reoffending outcomes for offenders in substance dependence treatment. A large sample was studied in an understudied population of UK prisoners in substance dependence treatment. The results have implications for clinical settings where mental health symptoms are not addressed concurrently with substance dependence. This finding can inform policy makers and practitioners who provide substance dependence treatment in prison.

Hygrothermal analysis of historic buildings

2016 ◽  
Vol 34 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Hugo Entradas Silva ◽  
Fernando M.A. Henriques
Keyword(s):  
Historic Buildings ◽  
Biological Degradation ◽  
Conservation Area ◽  
Content Type ◽  
Preventive Conservation ◽  
Climate Targets ◽  
One Year ◽  
Hygrothermal Analysis ◽  
Practical Implications ◽  
Temperate Climates

Purpose – The purpose of this paper is to verify the applicability and efficiency of two statistical methods to obtain sustainable targets of temperature and relative humidity in historic buildings located in temperate climates. Design/methodology/approach – The data recorded along one year in a non-heated historic building in Lisbon (Portugal) was analysed with the two methodologies, EN 15757 and FCT-UNL. To evaluate their adequacy it was calculated the performance index for each target and it was verified the mechanical and biological degradation risks. Findings – While the use of the two approaches is suitable for temperate climates, there is a higher efficiency of the FCT-UNL methodology, allowing a better response for the three parameters in evaluation. Research limitations/implications – Despite the better results obtained, the FCT-UNL methodology was only tested for one city; therefore the application to other situations may be required to obtain more robust conclusions. Practical implications – The effectiveness of the FCT-UNL methodology to obtain sustainable climate targets can lead to important energy conservation in historic buildings and to contribute for the change of old approaches in the preventive conservation area. Originality/value – This paper provides a comparison between two recent methods. The results can lead to some advances in the science of preventive conservation, interesting to conservators and building physic scientists.

Archival Big Data and the Spanish Flu in Copenhagen

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kim Abildgren
Keyword(s):  
Big Data ◽  
Birth Cohort ◽  
Mortality Risk ◽  
Early Life ◽  
Birth Cohorts ◽  
Content Type ◽  
Individual Level ◽  
Early Life Exposure ◽  
Spanish Flu ◽  
One Year

Purpose The Spanish Flu 1918–1920 saw a high degree of excess mortality among young and healthy adults. The purpose of this paper is a further exploration of the hypothesis that high mortality risk during The Spanish Flu in Copenhagen was associated with early life exposure to The Russian Flu 1889–1892. Design/methodology/approach Based on 37,000 individual-level death records in a new unique database from The Copenhagen City Archives combined with approximate cohort-specific population totals interpolated from official censuses of population, the author compiles monthly time series on all-cause mortality rates 1916–1922 in Copenhagen by gender and one-year birth cohorts. The author then analyses birth cohort effects on mortality risk during The Spanish Flu using regression analysis. Findings The author finds support for hypotheses relating early life exposure to The Russian Flu to mortality risk during The Spanish Flu. Some indications of possible gender heterogeneity during the first wave of The Spanish Flu – not found in previous studies – should be a topic for future research based on data from other countries. Originality/value Due to lack of individual-level death records with exact dates of birth and death, previous studies on The Spanish Flu in Denmark and many other countries have relied on data with lower birth cohort resolutions than the one-year birth cohorts used in this study. The analysis in this paper illustrates how archival Big Data can be used to gain new insights in studies on historical pandemics.

scholarly journals Hyaluronic acid levels are increased in complicated parapneumonic pleural effusions

2015 ◽  
Vol 75 (3) ◽  
Author(s):  
T. Zaga ◽  
D. Makris ◽  
I. Tsilioni ◽  
T. Kiropoulos ◽  
S. Oikonomidi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Extracellular Matrix ◽  
Congestive Heart Failure ◽  
Hyaluronic Acid ◽  
Pleural Fluid ◽  
Inflammatory Process ◽  
Serum Levels ◽  
Pleural Effusions ◽  
Tnf Α ◽  
Malignant Effusions

Background and Aim. Hyaluronic acid (HA) is a component of extracellular matrix and may play a role in the pleural inflammation which is implicated in parapneumonic effusions.The aim of the current study was to investigate HA levels in serum and pleura in patients with parapneumonic effusions. Methods. We prospectively studied pleural and serum levels of HA in 58 patients with pleural effusions due to infection (complicated and uncomplicated parapneumonic effusions), malignant effusions and transudative effusions due to congestive heart failure. In addition to HA, TNF-α and IL-1β levels were determined in pleural fluid and serum by ELISA. Results. The median±SD HA levels (pg/ml) in pleural fluid of patients with complicated effusions (39.058±11.208) were significantly increased (p&lt;0.005), compared to those with uncomplicated parapneumonic effusions (11.230±1.969), malignant effusions (10.837±4.803) or congestive heart failure (5.392±3.133). There was no correlation between pleural fluid and serum HA values. Pleural fluid TNF-α levels (146±127 pg/mL) and IL-1β levels (133.4±156 pg/mL) were significantly higher in patients with complicated parapneumonic effusions compared to patients with other types of effusion (p&lt;0.05). No significant association between HA and TNF-α or IL-1β was found. Conclusions. HA may play a significant role in the inflammatory process which characterises exudative infectious pleuritis. Further investigation might reveal whether HA is a useful marker in the management of parapneumonic effusions.

Resource access mechanisms in networks and SME survival in Ghana

2018 ◽  
Vol 12 (5) ◽  
pp. 611-631 ◽  
Author(s):  
George Acheampong ◽  
Raphael Odoom ◽  
Thomas Anning-Dorson ◽  
Patrick Amfo Anim
Keyword(s):  
Census Data ◽  
Local Level ◽  
Directed Network ◽  
Resource Access ◽  
Content Type ◽  
Structural Hole ◽  
One Year ◽  
Global And Local ◽  
Access Mechanisms ◽  
Global Influence

Purpose The study aims to determine the resource access mechanism in inter-firm networks that aids SME survival in Ghana. Design/methodology/approach The authors collect census data on a poultry cluster in Ghana and construct a directed network. The network is used to extract direct and indirect ties both incoming and outgoing, as well as estimate the structural holes of the actors. These variables are used to estimate for survival of SMEs after a one-year period using a binary logit model. Findings The study finds that out-indirect ties and structural hole have a significant influence on SME survival. This works through the global influence and the vision advantage that these positions and ties offer the SMEs. Originality/value The study offers SMEs a choice of whom to collaborate with for information (resources) in the form of outgoing and incoming ties at both the global and local level.

What the fake? Assessing the extent of networked political spamming and bots in the propagation of #fakenews on Twitter

2019 ◽  
Vol 43 (1) ◽  
pp. 53-71 ◽  
Author(s):  
Ahmed Al-Rawi ◽  
Jacob Groshek ◽  
Li Zhang
Keyword(s):  
Social Media ◽  
Data Sets ◽  
Fake News ◽  
Content Type ◽  
Mainstream Media ◽  
News Discourse ◽  
Twitter Data ◽  
News Organizations ◽  
Twitter Users ◽  
One Year

PurposeThe purpose of this paper is to examine one of the largest data sets on the hashtag use of #fakenews that comprises over 14m tweets sent by more than 2.4m users.Design/methodology/approachTweets referencing the hashtag (#fakenews) were collected for a period of over one year from January 3 to May 7 of 2018. Bot detection tools were employed, and the most retweeted posts, most mentions and most hashtags as well as the top 50 most active users in terms of the frequency of their tweets were analyzed.FindingsThe majority of the top 50 Twitter users are more likely to be automated bots, while certain users’ posts like that are sent by President Donald Trump dominate the most retweeted posts that always associate mainstream media with fake news. The most used words and hashtags show that major news organizations are frequently referenced with a focus on CNN that is often mentioned in negative ways.Research limitations/implicationsThe research study is limited to the examination of Twitter data, while ethnographic methods like interviews or surveys are further needed to complement these findings. Though the data reported here do not prove direct effects, the implications of the research provide a vital framework for assessing and diagnosing the networked spammers and main actors that have been pivotal in shaping discourses around fake news on social media. These discourses, which are sometimes assisted by bots, can create a potential influence on audiences and their trust in mainstream media and understanding of what fake news is.Originality/valueThis paper offers results on one of the first empirical research studies on the propagation of fake news discourse on social media by shedding light on the most active Twitter users who discuss and mention the term “#fakenews” in connection to other news organizations, parties and related figures.

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