scholarly journals Smooth Extubation and Smooth Emergence Techniques: A Narrative Review

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Tiffany H. Wong ◽  
Garret Weber ◽  
Apolonia E. Abramowicz
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Review Paper ◽  
Significant Risk ◽  
Extubation Failure ◽  
Narrative Review ◽  
Infection Transmission ◽  
Aerosol Generation ◽  
Definition Of

There is a paucity of literature on extubation technique and a lack of consensus regarding the definition of smooth extubation. This narrative review paper defines an ideal extubation, otherwise known as a “smooth extubation,” reviews perioperative criteria for extubation and risks and adverse events related to extubation, and explores various perioperative techniques that can be used to achieve a smooth extubation while caring for an uncomplicated patient without significant risk factors for extubation failure. In light of the evolving practice during the SARS CoV2 (COVID-19) pandemic to minimize aerosol generation and infection transmission, smooth extubation is particularly important.

scholarly journals Predictors of adverse events in the mid-term postoperative period in patients who underwent carotid endarterectomy

2017 ◽  
Vol 21 (4) ◽  
pp. 50 ◽  
Author(s):  
R. S. Tarasov ◽  
A. N. Kazantsev ◽  
A. R. Shabaev ◽  
A. V. Mironov ◽  
N. N. Burkov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Carotid Endarterectomy ◽  
Postoperative Period ◽  
Conflict Of Interest ◽  
Significant Risk ◽  
Common Adverse Event ◽  
Functional Class ◽  
Syntax Score

<p><strong>Aim.</strong> Emphasis in the study was placed on the identification of unfavorable prognosis factors associated with carotid endarterectomy (CEE) during mid-term follow-up.<br /><strong>Methods.</strong> Over a period from 2015 to 2016, 222 CEE operations were performed. Most patients (n = 190; 85.5%) underwent CEE using a patch of xenopericardium, 14.4% (n = 32) received eversion CEE, and a temporary shunt was used in 14.4% (n = 32). Hybrid revascularization in the volume of percutaneous coronary intervention (PCI) + CEE was performed in 9.9% (n = 22) patients. The groups under study were compared by using a chi-square test followed by subsequent analysis of the shares, or if ordinal characters or quantitative traits with a distribution different from the normal one occurred—by using a Mann – Whitney U-test. Correction of multiple comparisons was done by calculating an average fraction of false discoveries of the hypotheses (false discovery rate). The analysis of prognostic factors was done using the odds ratio (OR) by means of the 2 × 2 tables.<br /><strong>Results.</strong> Among the complications detected in the mid-term follow-up, the most common adverse event was the development of MI in 3.6% (n = 8) of patients. According to color duplex scanning of brachiocephalic arteries, restenosis of the operated ICA was observed in 4.5% of patients. The following risk factors significantly increased the risk of adverse events: angina pectoris II–III functional class (OR = 3.84%, CI = 1.24–11.9), SYNTAX Score &gt;22 (OR = 2.83, CI = 1.137–7.086).<br /><strong>Conclusion.</strong> Based on the results of a single-center prospective retrospective study, significant risk factors for adverse outcome in the mid-term postoperative period were identified.</p><p>Received 10 May 2017. Revised 27 September 2017. Accepted 5 October 2017.</p><p><strong>Funding:</strong> The research was done with support of the grant (No. 12090ГУ/2017) awarded by the Fund for Facilitation of Innovations within the framework of the “Umnik-2016” project (Kemerovo).</p><p><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: R.S. Tarasov, A.I. Anufriyev <br />Data collection and analysis: A.R. Shabaev<br />Drafting the article: A.N. Kazantsev, N.N. Burkov <br />Critical revision of the article: A.V. Mironov<br />Final approval of the version to be published: L.S. Barbarash</p>

scholarly journals Risk factors for and timing of adverse events after revision total shoulder arthroplasty

2018 ◽  
Vol 11 (5) ◽  
pp. 332-343 ◽  
Author(s):  
Aakash Keswani ◽  
Debbie Chi ◽  
Andrew J Lovy ◽  
Daniel A London ◽  
Paul J Cagle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Shoulder Arthroplasty ◽  
Perioperative Complications ◽  
Total Shoulder Arthroplasty ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Perioperative Outcomes ◽  
Unplanned Readmission ◽  
Acs Nsqip Database

Background Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.

scholarly journals An Overview on Cardiovascular Risks Definitions by Using Survival Analysis Techniques-Tehran Lipid and Glucose Study: 13-Year Follow-Up Outcomes

2016 ◽  
Vol 9 (4) ◽  
pp. 197
Author(s):  
Nezhat Shakeri ◽  
Farhad Hajsheikholeslami ◽  
Amir abbas Momenan ◽  
Fereidoun Azizi
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Sugar ◽  
Elderly Population ◽  
Significant Risk ◽  
Fasting Blood Sugar ◽  
Cardiovascular Risks ◽  
Elderly Males ◽  
Definition Of

<p>Risk assessment is an important issue for starting medication for patients. Literature reveals that diabetes, hypertension, dyslipidemia and Body Mass Index (BMI) are among major risk factors for longevity. Since the cut-off points proposed in various sources are generally irrespective of age, sex and race, it has been attempted to validate current definitions for Tehran’s elderly population by using a prospective cohort study. For this purpose, one thousand seven hundred and ninety eight (1,798) individuals above 60 years old were recruited in the primary phase of the Tehran Lipid and Glucose Study (TLGS) during 1998-2001, and were tested for their systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, high density lipoprotein cholesterol (HDL), triglyceride (TG), fasting blood sugar (FBS), 2-h plasma glucose (2HPG) and some other factors at the time of entry to the study. They were followed up for 13 years and their vital statuses were registered (1998-2011).</p><p>According to the standard definition of diabetes, dyslipidemia and hypertension, the participants were divided into ill and healthy groups. By using univariate Cox proportional hazard model, a 95% hazard ratio for various risk factors was estimated. Cut-off points of 126 mg/dL for fasting blood sugar or 200 mg/dL for 2HPG for defining diabetes were identified as appropriate points for predicting longevity for elderly males and females. Systolic blood pressure over 140 mmHg or diastolic blood pressure over 90 mmHg or having medication as a definition of hypertension were identified as a significant risk factor for elderly males only. Dyslipidemia which is defined based on Cholesterol&gt;240 or TG&gt;400 or LDL&gt;160 or HDL&lt;35, was not identified as a longevity predictor for elderly men and women. The results showed that BMI&gt;31 Kg/m<sup>2</sup> at the time of entry to the study significantly reduced the survival time of women. In conclusion, the definitions of diseases like hypertension and dyslipidemia based on cut-off points don’t classify the Tehran’s elderly population accurately. More investigation in this regard is required.</p>

scholarly journals Patient safety in the process of pharmacotherapy carried out by nurses – A Polish-Slovak prospective observational study

2021 ◽  
Author(s):  
Izabela Witczak ◽  
Łukasz Rypicz ◽  
Mária Šupínová ◽  
Elena Janiczeková ◽  
Piotr Pobrotyn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Patient Safety ◽  
Adverse Events ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Adverse Reactions ◽  
Significant Risk ◽  
Alpha Coefficient ◽  
Training Activities ◽  
Medicine Administration

Abstract Aim This study was aimed at the determination and comparison of safety levels at the nurse-managed stage of the pharmacotherapy process in Poland and Slovakia by identifying the key risk factors which directly affect patient safety. Background/Introduction: Pharmacotherapy, i.e. the use of medicines for combating a disease or its symptoms, is one of the crucial elements of patient care. Studies carried out with regard to nursing workloads in the pharmacotherapy process prove that nurses spend 40% of their work on the management of medications. Medicine administration is the most frequent task of all nursing activities, and there is a possibility of committing errors at this stage due to the complex and multifaceted nature of the pharmacotherapy process. Methods The study involved a group of 1774 nurses, of whom 1412 were from Poland and 362 from Slovakia. The original Nursing Risk in Pharmacotherapy (NURIPH) tool was used. The Cronbach alpha coefficient was 0.832. Results Nurses from Slovakia most often, i.e. for 6 out of 9 factors (items: 1, 5, 6, 7, 8, 9), assessed the risk factors as “significant risk (3)”, and Polish nurses most often, i.e. for as many as 8 out of 9 risk factors (items: 1, 2, 3, 4, 5, 6, 7, 9), assessed the risk factors as “very significant (5)”. Significant differences (p < 0.05) were demonstrated in 8 (out of 9) risk factors. Conclusions The pharmacotherapy process implemented by nurses, regardless of the country, is burdened with a considerable number of risk factors and it might negatively affect patient safety. It has been found that the safety of the pharmacotherapy process is assessed by Polish nurses as much lower than by Slovak ones. Training activities in the field of adverse events, adverse reactions to medications and appropriate and effective communication should be introduced for all members of the medical staff involved in the pharmacotherapy process.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

MEASLES OUTBREAK IN A RURAL AREA OF A DEVELOPING COUNTRY: A CASE CONTROL STUDY

2018 ◽  
Vol 7 (4) ◽  
pp. 197-201
Author(s):  
Mir M Hassan Bullo ◽  
Mirza Amir Baig ◽  
Jawad Faisal Malik ◽  
Ejaz Ahmad Khan ◽  
Muazam Abbas Ranjha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vaccine Coverage ◽  
Significant Risk ◽  
Public Health Problem ◽  
Maculopapular Rash ◽  
Healthcare Facility ◽  
Control Measures ◽  
Major Public Health Problem ◽  
District Health ◽  
Active Case

Background: Measles is highly contagious vaccine preventable disease (VPD), and a major public health problem considered as leading cause of morbidity and mortality in developing countries like Pakistan. An outbreak of measles was reported in Sharifabad Islamabad on 15th of April 2017, and an investigation was launched to assess the magnitude of outbreak, evaluate risk factors and recommend control measures. Methods: A comprehensive house to house active case search along with vaccine coverage survey was conducted from April 19-22, 2017. A case was defined as "onset of maculopapular rash with fever in a resident of Sharifabad with at least one of the following signs/ symptoms, Coryza, Conjunctivitis, Cough, Otitis media or Pneumonia present in between 19 March to 22nd April 2017". Four age & sex matched controls were selected from the neighborhood. Data was collected through interview method using structured questionnaire and vaccination coverage was determined by using Epi survey form. Blood samples were sent for laboratory confirmation. Results: A total of eight cases were identified through active case finding while three were reported by local practitioner. Mean age of cases were 20 months (range 8-36 months). Severely affected age-group was 1-2 years with attack rate of 46%. Around two-third (64%) of cases and a few (16%) of controls were unvaccinated against measles. Contact with measles patient [OR 25.2, CI 3.9-160.1, P=0.00], unvaccinated children [OR 9.2 CI 2.12-40.4, P=0.000], social misconception regarding vaccination [OR 7.8 CI 1.42-42.6, P=0.00], and distance from healthcare facility [OR 5.7 CI 1.15-28.35, P=0.02] were significant risk factors. Vaccine efficacy was 90%. Conclusion: Main reasons of the outbreak were contact with the cases, and low vaccination status. We recommended comprehensive measles vaccination and community awareness sessions. On our recommendations district health authority Islamabad carried out mop up of whole area.

Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

2015 ◽  
Vol 18 (1) ◽  
pp. 006
Author(s):  
Hasan Reyhanoglu ◽  
Kaan Ozcan ◽  
Murat Erturk ◽  
Fatih İslamoglu ◽  
İsa Durmaz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Significant Risk ◽  
High Morbidity ◽  
Factors Associated

<strong>Objective:</strong> We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery.<br /><strong>Methods:</strong> One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group <br />(C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated.<br /><strong>Results:</strong> Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while <br />26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P &lt; .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively.<br /><strong>Conclusion:</strong> Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.<br /><br />

Prevalence and Risk Factors of Hepatitis C Virus (HCV) in Tehsil Batkhela District Malakand, KPK, Pakistan

2018 ◽  
Vol 9 (06) ◽  
pp. 20251-20256
Author(s):  
Mudassir Khan ◽  
Shahrukh Khan ◽  
Shohra Haider ◽  
Fazal Jalil ◽  
Muhsin Jamal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Skin Color ◽  
Significant Risk ◽  
Rapid Test ◽  
Prevalence Ratio ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Common Symptom

Background: Prevalence of Hepatitis C viral infection and its major risk factors has been found out in population of Batkhela, Khyber Pakhtunkhwa, Pakistan by taking number of volunteers from the interested area. HCV prevalence has not been researched in recent time here in this area, so that’s why we contributed. Materials and Methods: Ab rapid test cassette serum/plasma (USA) kit has been used for the mentioned purpose following by ELISA and finally PCR to find out active infection of virus. ICT positive individuals were reconfirmed by ELISA and then ELISA positive samples were carefully investigated by RT-PCR for Hepatitis C Virus. Results: The study population was of 770 volunteers belonging to the mentioned area of research, 453 males and 317 females. The overall prevalence was found to be 5.32% of HCV in Batkhela. This prevalence ratio was 3.12% in males and 2.20 % in females. 3rd generation ELISA was used to refine ICT positive samples which showed that 37 of the ICT positive samples had antibodies detected by ELISA. To find out active HCV infection, ELISA positive samples were refined by real time PCR which showed 2.98% of prevalence of active HCV infection in Batkhela based on HCV RNA in their blood. Principle Conclusion: Overall prevalence was found 5.32%, contaminated reused syringes and blades at Barbour’s shop, blood transfusion, surgical operations and unhygienic food in stalls etc were found significant risk factors for acquiring HCV infection. Body weakness and pale yellow skin color was common symptom in HCV positive volunteers. Safe sexual activities, blood screening before donation and sterilizing surgical equipment’s can protect us from Hepatitis C Virus.

Sign in / Sign up

Export Citation Format

Share Document