scholarly journals Comparison of the university hospital and county hospitals in western Sweden to identify potential weak links in the early chain of care for acute stroke: results of an observational study

BMJ Open ◽  
2015 ◽  
Vol 5 (9) ◽  
pp. e008228 ◽  
Author(s):  
Birgitta Wireklint Sundström ◽  
Johan Herlitz ◽  
Per Olof Hansson ◽  
Peter Brink
Keyword(s):  
Observational Study ◽  
Acute Stroke ◽  
University Hospital ◽  
Weak Links ◽  
Chain Of Care ◽  
The University

scholarly journals Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
H. Handelsmann ◽  
L. Herzog ◽  
Z. Kulcsar ◽  
A. R. Luft ◽  
S. Wegener
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Patient Characteristics ◽  
Posterior Circulation ◽  
University Hospital ◽  
Outcome Predictors ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
The University ◽  
Median Admission

AbstractDistinct patient characteristics have been proposed for ischaemic stroke in the anterior versus posterior circulation. However, data on functional outcome according to stroke territory in patients with acute stroke treatment are conflicting and information on outcome predictors is scarce. In this retrospective study, we analysed functional outcome in 517 patients with stroke and thrombolysis and/or thrombectomy treated at the University Hospital Zurich. We compared clinical factors and performed multivariate logistic regression analyses investigating the effect of outcome predictors according to stroke territory. Of the 517 patients included, 80 (15.5%) suffered a posterior circulation stroke (PCS). PCS patients were less often female (32.5% vs. 45.5%, p = 0.031), received thrombectomy less often (28.7% vs. 48.3%, p = 0.001), and had lower median admission NIHSS scores (5 vs. 10, p < 0.001) as well as a better median three months functional outcome (mRS 1 vs. 2, p = 0.010). Predictors for functional outcome were admission NIHSS (OR 0.864, 95% CI 0.790–0.944, p = 0.001) in PCS and age (OR 0.952, 95% CI 0.935–0.970, p < 0.001), known symptom onset (OR 1.869, 95% CI 1.111–3.144, p = 0.018) and admission NIHSS (OR 0.840, 95% CI 0.806–0.876, p < 0.001) in ACS. Acutely treated PCS and ACS patients differed in their baseline and treatment characteristics. We identified specific functional outcome predictors of thrombolysis and/or thrombectomy success for each stroke territory.

scholarly journals Oral candidosis in the oncology department of the University Hospital in Pisa: prospective observational study

2015 ◽  
Vol 26 ◽  
pp. vi113
Author(s):  
E. Frediani ◽  
A. Vietina ◽  
S. Fambrini ◽  
P. Carfagno ◽  
C. Pardossi ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Oral Candidosis ◽  
The University

scholarly journals Approach to the Airway in the Emergency Department (ED) and Intensive Care Unit (ICU) in a Portuguese University Hospital Center: a prospective observational study

2019 ◽  
Author(s):  
Tiago Cabral ◽  
Helena Figueira ◽  
Ricardo Oliveira ◽  
Ângela Mota ◽  
Irene Aragão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Statistical Analysis ◽  
Observational Study ◽  
Airway Management ◽  
Prospective Observational Study ◽  
Orotracheal Intubation ◽  
University Hospital ◽  
The University

Abstract Background Airway management is a commonly performed procedure in the Emergency Department (ED) and Intensive Care Unit (ICU), being tracheal intubation the gold standard with relatively high rates of complications in these settings. The purpose of our study was to analyse the airway approach in our institution at ED and ICU identifying the main complications associated and taking notice of possible factors related to them. Methods Prospective observational study conducted between May and September 2014 in the ICU and ED of Santo Antonio Hospital, with the primary aim of identifying the main complications of the airway approach in the critical patient and secondary aim to take notice of possible factors related with complications of the airway approach related to technical skills of the operator, patient´s specificities and airway approach techniques. The statistical analysis was done in cooperation with the Medical Informatics and Biostatistics Department of the Faculty of Medicine of the University of Porto. P values <0.05 were considered significant for all hypothesis testing. The analysis was done using the statistical analysis program SPSS® v.21.0 Results A total of 182 patients were included, corresponding to 257 attempted tracheal intubations (ATI). The rate of successful first-pass orotracheal intubation was 67%. Complications related to ATI were reported in 30% of all attempts, being most frequently among residents (81%, p=0.001) and those with little experience in airway approach (46%, p<0.001). The majority of complications was failed intubation (18%). In the group with complications, relation with an identifiable obvious cause was seen in 87% of cases (p<0.001), the major being inexperience in 42% of operators with complications, instead of 1% in the group without complications (p<0.001). Conclusions Failed ATI and its complications are largely dependent on operator´s expertise. Factors related to patient, lack of appropriate equipment and inappropriate strategy delineation also play a role. Recognition of patients at particular risk of difficult airway management is crucial.

scholarly journals Protocol of a retrospective, multicentre observational study on hyperthermic intrathoracic chemotherapy in Germany

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e041511
Author(s):  
Till Markowiak ◽  
Michael Koller ◽  
Florian Zeman ◽  
Gunnar Huppertz ◽  
Hans-Stefan Hofmann ◽  
...  
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Postoperative Recovery ◽  
Chemotherapeutic Agents ◽  
Additional Treatment ◽  
University Hospital ◽  
German Research Foundation ◽  
Registration Number ◽  
Clinical Trials Registry ◽  
The University

IntroductionObjective of the ‘German hyperthermic intrathoracic chemotherapy (HITOC) study’ is to evaluate the HITOC as additional treatment after surgical cytoreduction for malignant pleural tumours. Even though HITOC is applied with increasing frequency, there is no standardised therapy protocol concerning the technique of HITOC, the selection as well as dosage of chemotherapeutic agents and perioperative management in order to provide a safe and comparable, standardised treatment regime.Methods and analysisThis trial is a retrospective, multicentre observational study, which is funded by the German Research Foundation. Approximately 300 patients will be included. Four departments of thoracic surgery, which are performing the most HITOC procedures in Germany, are contributing to this study: Center for Thoracic Surgery at the University Hospital Regensburg, Thoracic Clinic Heidelberg of the University of Heidelberg, Center for Thoracic Surgery of the Hospital University of Munich and the Department of Thoracic Surgery at the University Hospital Freiburg. All patients who underwent surgical cytoreduction and subsequent HITOC at one of the four centres between starting the HITOC programme in 2008 and December 2019 will be included. Information on the performed HITOC will be obtained, focusing on the technique as well as the applied perfusion solution including the chemotherapeutic agent. Furthermore, parameters of the patient’s postoperative recovery will be analysed to determine 30-day morbidity and mortality.Ethics and disseminationThe approvals by the local ethics committee of the respective clinic and the three participating clinics have been obtained. The results will be presented in conferences and published in a peer-reviewed journal.Trial registration numberGerman Clinical Trials Registry (DRKS00015012; Pre-results).

The early chain of care and risk of death in acute stroke in relation to the priority given at the dispatch centre: A multicentre observational study

2017 ◽  
Vol 16 (7) ◽  
pp. 623-631 ◽  
Author(s):  
Birgitta Wireklint Sundström ◽  
Magnus Andersson Hagiwara ◽  
Peter Brink ◽  
Johan Herlitz ◽  
Per Olof Hansson
Keyword(s):  
Observational Study ◽  
Acute Stroke ◽  
Risk Of Death ◽  
Dispatch Centre ◽  
Chain Of Care

scholarly journals Predictors of hospital-acquired bacterial and fungal superinfections in COVID-19: a prospective observational study

2020 ◽  
Author(s):  
Marco Falcone ◽  
Giusy Tiseo ◽  
Cesira Giordano ◽  
Alessandro Leonildi ◽  
Melissa Menichini ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Invasive Mechanical Ventilation ◽  
Length Of Hospital Stay ◽  
Previous Treatment ◽  
University Hospital ◽  
Reactive Protein ◽  
Control Rules ◽  
The University ◽  
Hospital Acquired

Abstract Background Bacterial and fungal superinfections may complicate the course of hospitalized patients with COVID-19. Objectives To identify predictors of superinfections in COVID-19. Methods Prospective, observational study including patients with COVID-19 consecutively admitted to the University Hospital of Pisa, Italy, between 4 March and 30 April 2020. Clinical data and outcomes were registered. Superinfection was defined as a bacterial or fungal infection that occurred ≥48 h after hospital admission. A multivariate analysis was performed to identify factors independently associated with superinfections. Results Overall, 315 patients with COVID-19 were hospitalized and 109 episodes of superinfections were documented in 69 (21.9%) patients. The median time from admission to superinfection was 19 days (range 11–29.75). Superinfections were caused by Enterobacterales (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%) and fungi (5.5%). Polymicrobial infections accounted for 18.3%. Predictors of superinfections were: intestinal colonization by carbapenem-resistant Enterobacterales (OR 16.03, 95% CI 6.5–39.5, P &lt; 0.001); invasive mechanical ventilation (OR 5.6, 95% CI 2.4–13.1, P &lt; 0.001); immunomodulatory agents (tocilizumab/baricitinib) (OR 5.09, 95% CI 2.2–11.8, P &lt; 0.001); C-reactive protein on admission &gt;7 mg/dl (OR 3.59, 95% CI 1.7–7.7, P = 0.001); and previous treatment with piperacillin/tazobactam (OR 2.85, 95% CI 1.1–7.2, P = 0.028). Length of hospital stay was longer in patients who developed superinfections ompared with those who did not (30 versus 11 days, P &lt; 0.001), while mortality rates were similar (18.8% versus 23.2%, P = 0.445). Conclusions The risk of bacterial and fungal superinfections in COVID-19 is consistent. Patients who need empiric broad-spectrum antibiotics and immunomodulant drugs should be carefully selected. Infection control rules must be reinforced.

Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽  
2004 ◽  
Vol 33 (2) ◽  
pp. 78-81 ◽  
Author(s):  
Thalhammer ◽  
Aschwanden ◽  
Jeanneret ◽  
Labs ◽  
Jäger
Keyword(s):  
Current Literature ◽  
Vascular Complications ◽  
University Hospital ◽  
Closure Device ◽  
Ultrasound Guided ◽  
Vascular Closure Device ◽  
Device Use ◽  
Arterial Stenoses ◽  
The University ◽  
Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

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