Optimisation of perioperative investigations among elective orthopaedic patients in a Dublin-based teaching hospital

2018 ◽  
Vol 29 (9) ◽  
pp. 291-299
Author(s):  
Jane O’Sullivan ◽  
Jack Collins ◽  
David Cooper ◽  
Ana Magdalina ◽  
Frances Meehan ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Preoperative Assessment ◽  
Clinical Analysis ◽  
Full Blood Count ◽  
Time Interval ◽  
Potential Cost ◽  
Orthopaedic Patients ◽  
Day Of Surgery Admission ◽  
One Year ◽  
The One

Background The current National Institute for Health and Care Excellence guidelines, in accordance with the Association of Anaesthetists of Great Britain and Ireland guidelines, recommend the following haematological investigations for all patients undergoing major elective surgery: full blood count, renal profile and coagulation screen if clinically indicated. However, the guidelines fail to specify a time-interval for which normal blood results remain valid. Currently all patients in Ireland undergoing substantial elective surgery requiring general or regional anaesthetic have a preoperative assessment prior to the surgery. Patients have phlebotomy performed as part of this assessment. Patients admitted for elective surgery often have these bloods repeated on the morning of surgery. Objectives To determine if blood investigations taken over a one-year period prior to surgery can be used as a baseline for clinically stable patients undergoing elective surgery. Study design and methods All consecutive day of surgery admission patients >18 years of age undergoing elective orthopaedic surgery in Tallaght Hospital between 1 December 2014 and 1 December 2015 were identified using hospital records. Their blood results in the one-year period prior to surgery were compared to the blood results on the morning of surgery, using a McNemar’s test. A further clinical analysis was performed. Results There was no statistically significant change between blood results from three months prior to the surgery and the morning of surgery (P < 0.05). Furthermore, the blood results remained largely unchanged in the one year prior to surgery. No patient had the operation deferred due to aberrant blood results, following previously normal results prior to surgery. The potential cost-saving of omitting bloods is enormous. Conclusions There appears to be neither a statistical nor clinical benefit to repeating blood tests on the morning of surgery, following normal bloods <3 months in a clinically stable individual.

scholarly journals Εlectrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the anterior portion of the mitral annulus

2021 ◽  
Author(s):  
Chengye Di ◽  
Konstantinos Letsas ◽  
Peng Gao ◽  
Qun Wang ◽  
Yanxi Wu ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Mitral Annulus ◽  
Time Interval ◽  
Recurrence Rates ◽  
Anterior Portion ◽  
Premature Ventricular Contractions ◽  
Distinct Subgroup ◽  
One Year ◽  
The One

Abstract Background: We sought to clarify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the anterior portion of the mitral annulus (AP-MA).Methods and Results: Among 437 consecutive patients who presented with VAs for RFCA, twenty-six patients with acute successful RFCA at the AP-MA were included in this study. The ratio of the amplitude of the first positive peak (if present) vs. the nadir in the unipolar electrogram (EGM) was 0.00 – 0.03 (0.00) at the acute successful RFCA site. The time interval between the QRS onset to the maximum descending slope (D-Max) in the unipolar EGM (QRS - Uni) were 18.8 ± 13.6 ms. With bipolar mapping, the V-QRS interval was 3.75 – 17.3 (11) ms, 6 (23.1%) patients showed earliest V-QRS interval of 0 ms, and the other 20 patients (76.9%) showed V-QRS interval of 10-54 ms. The RFCA start-to-effect time was 14.1 ± 7.2 seconds in 23 patients (88.5%). In the remaining 3 patients (11.5%), the mean duration of successful RFCA were not well determined due to infrequent nature of clinical VAs during RFCA. Early (within 3 days) and late (one-year) recurrence rates were 23.1% (6 patients) and 26.9% (7 patients), respectively. The VAs disappeared 3 days later due to delayed RFCA efficacy in 2 patients (7.7%). No complications occurred during RFCA or the one-year follow up.Conclusions: AP-MA VAs are a rare but distinct subgroup of VAs. Bipolar and unipolar EGM features can help to detect the optimal RFCA site, and the QRS - Uni interval may work as a marker for guiding RFCA.

scholarly journals Periarticular Calcification Causing Acute Carpal Tunnel Syndrome: A Case Report

2009 ◽  
Vol 17 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Vasu Pai ◽  
Vishal Pai ◽  
Ross Muir
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Wrist Joint ◽  
Full Blood Count ◽  
Normal Ranges ◽  
Tunnel Syndrome ◽  
Hydroxyapatite Deposition Disease ◽  
One Year ◽  
The One ◽  
Acute Carpal Tunnel Syndrome

We report a case of acute carpal tunnel syndrome caused by periarticular calcification (hydroxyapatite deposition disease) around the wrist joint in a 64-year-old woman. She had acute severe pain, exacerbated by wrist movements and extension of the fingers. Her full blood count, urea, electrolytes, uric acid, calcium, phosphate, alkaline phosphatase, and thyroid function levels were all within normal ranges, and her serum was negative for rheumatoid factor. Computed tomography revealed lobulated calcification close to the volar capsule. She underwent an emergency surgical decompression of the carpal tunnel under general anaesthesia within 3 hours of presentation. The flexor tendon sheaths were excised, and ‘toothpaste-like’ chalky material (hydroxyapatite crystals) in the capsule was removed. The pain was relieved dramatically and her median nerve function recovered. She was symptom-free at the one-year follow-up.

scholarly journals New vaccination protocols for the dog and cat: the challenge of today for a better and safer prevention

2017 ◽  
Vol 62 (3) ◽  
pp. 257
Author(s):  
M. E. MYLONAKIS (Μ.Ε. ΜΥΛΩΝΑΚΗΣ) ◽  
A. F. KOUTINAS (Α.Φ. ΚΟΥΤΙΝΑΣ) ◽  
M. SARIDOMICHELAKIS (Μ. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽  
C. K. KOUTINAS (Χ.Κ. ΚΟΥΤΙΝΑΣ) ◽  
N. SOUBASIS (Ν. ΣΟΥΜΠΑΣΗΣ) ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Scientific Evidence ◽  
Herd Immunity ◽  
Care Program ◽  
Preventive Health Care ◽  
Time Interval ◽  
Vaccination Programs ◽  
One Year ◽  
The One ◽  
The Individual

Vaccinations are an integral part of a comprehensive preventive health care program targeting to minimize the incidence of major canine and feline infectious diseases. Currently, vaccination practices are re-evaluated globally towards a twofold objective: to strengthen "herd immunity", which depends on the percentage of vaccinated animals in a population, and to reduce the "vaccine load" per animal in order to minimize the vaccine-associated adverse reactions. To this end, the updated canine and feline vaccination guidelines, encourage the vaccination of as many animals as possible, while at the same time classify the vaccines into core, non-core and not recommended. Core vaccines should be administered, if possible, to every dog and cat.Canine parvovirus-2, canine adenovirus-2, canine distemper virus, feline parvovirus, feline calicivirus/herpesvirus-1 and rabies vaccines fall into this category. Non-core vaccines are selectively given to dogs and cats after assessing the risk/benefit ratio. There are also vaccines for which there is currently no sufficient scientific evidence to justify their use. Importantly, after the one-year booster inoculation that follows the completion of the initial puppy/kitten vaccination series, core vaccines should be given no more frequently than every three years, as the duration of the protective immunity far exceeds this time interval. This review focuses on the updated canine and feline vaccination guidelines pertaining to the individual animal as well as to those living in groups. Important questions related to vaccination programs and to relevant adverse reactions are also answered. An effort has been made to align these guidelines according to what is considered a "norm" among the small amimal practitioners in Greece.

scholarly journals Cardiopulmonary Resuscitation of Patients with Coronavirus Disease 2019: A One-Year Survey in The West of Iran

2021 ◽  
Author(s):  
Afshin Goodarzi ◽  
Masoud Khodaveisi ◽  
Alireza Abdi ◽  
Rasoul Salimi ◽  
Khodayar Oshvandi
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Underlying Disease ◽  
Spontaneous Circulation ◽  
Time Interval ◽  
Chi Square ◽  
Cross Sectional ◽  
Epinephrine Administration ◽  
Administration Time ◽  
One Year ◽  
The One

Abstract Background The coronavirus disease 2019 (COVID-19) is associated with high risk of cardiac arrest (CA). Therefore, assessing cardiopulmonary resuscitation (CPR) success among patients with COVID-19 and employing effective strategies for its improvement are essential. The present study aimed at assessing the one-year epidemiology and outcomes of CPR among patients with COVID-19. Methods This cross-sectional descriptive-analytical study was conducted in January 2021 in the emergency departments of two hospitals in Hamadan and Kermanshah, Iran. Participants were 487 patients with confirmed COVID-19 and CA who had undergone CPR during the one-year period between January 20, 2020 and January 20, 2021. Data were collected using the available CPR documentation forms developed based on the Utstein Style. Data analysis was performed via the Chi-square, Fisher’s exact, and Mann-Whitney U tests and the logistic regression analysis. Results Participants’ age was 69.31 ± 14.73 years and most of them were male (61.8%) and suffered from at least one underlying disease (58.1%). The rate of total and in-hospital CA was 9.67% and 9.39%, respectively. The most prevalent first documented rhythm was asystole and the highest responsivity to CPR was for shockable rhythms. The rate of the return of spontaneous circulation was 9% and the rate of survival to hospital discharge was 2%. The significant predictors of CPR success were age, epinephrine administration time interval, and CPR duration. Conclusion CPR outcomes among patients with COVID-19 are poor, particularly among those with asystole and bradycardia. Old age and high or low doses of epinephrine can reduce CPR success, while CPR prolongation can improve CPR outcomes.

scholarly journals Electrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the superior portion of the mitral annulus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chengye Di ◽  
Konstantinos P. Letsas ◽  
Peng Gao ◽  
Qun Wang ◽  
Yanxi Wu ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Mitral Annulus ◽  
Time Interval ◽  
Recurrence Rates ◽  
Premature Ventricular Contractions ◽  
Distinct Subgroup ◽  
One Year ◽  
The One ◽  
Superior Portion

Abstract Background We sought to identify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the superior portion of the mitral annulus (SP-MA). Methods and results Among 437 consecutive patients who presented with VAs for RFCA, twenty-six patients with acute successful RFCA at the SP-MA were included in this study. The ratio of the amplitude of the first positive peak (if present) versus the nadir in the unipolar electrogram (EGM) was 0.00–0.03 (0.00) at the acute successful RFCA site. The time interval between the QRS onset and the maximum descending slope (D-Max) in the unipolar EGM (QRS-Uni) was 18.8 ± 13.6 ms. With bipolar mapping, the ventricular QRS (V-QRS) interval was 3.75–17.3 (11) ms, 6 (23.1%) patients showed the earliest V-QRS interval of 0 ms, and the other 20 patients (76.9%) showed a V-QRS interval of 10–54 ms. The RFCA start-to-effect time was 14.1 ± 7.2 s in 23 patients (88.5%). In the remaining 3 patients (11.5%), the mean duration of successful RFCA was not well defined due to the infrequent nature of clinical VAs during RFCA. Early (within 3 days) and late (1-year) recurrence rates were 23.1% (6 patients) and 26.9% (7 patients), respectively. VAs disappeared 3 days later due to delayed RFCA efficacy in 2 patients (7.7%). No complications occurred during the RFCA procedure or the one-year follow-up. Conclusions SP-MA VAs are a rare but distinct subgroup of VAs. Bipolar and unipolar EGM features can help to determine the optimal RFCA site, and the QRS-Uni interval may serve as a marker that could be used to guide RFCA.

Resources: Internet Resources for the Independent Medical Evaluator – 2007

2007 ◽  
Vol 12 (4) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham ◽  
Jenny Walker
Keyword(s):  
Head Trauma ◽  
Clonic Seizure ◽  
Acute Subdural Hematoma ◽  
Orbital Fracture ◽  
Orbital Wall ◽  
First Occurrence ◽  
One Year ◽  
The One ◽  
Neurological Injuries ◽  
Medial Orbital Wall

Abstract Rating patients with head trauma and multiple neurological injuries can be challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 13.2, Criteria for Rating Impairment Due to Central Nervous System Disorders, outlines the process to rate impairment due to head trauma. This article summarizes the case of a 57-year-old male security guard who presents with headache, decreased sensation on the left cheek, loss of sense of smell, and problems with memory, among other symptoms. One year ago the patient was assaulted while on the job: his Glasgow Coma Score was 14; he had left periorbital ecchymosis and a 2.5 cm laceration over the left eyelid; a small right temporoparietal acute subdural hematoma; left inferior and medial orbital wall fractures; and, four hours after admission to the hospital, he experienced a generalized tonic-clonic seizure. This patient's impairment must include the following components: single seizure, orbital fracture, infraorbital neuropathy, anosmia, headache, and memory complaints. The article shows how the ratable impairments are combined using the Combining Impairment Ratings section. Because this patient has not experienced any seizures since the first occurrence, according to the AMA Guides he is not experiencing the “episodic neurological impairments” required for disability. Complex cases such as the one presented here highlight the need to use the criteria and estimates that are located in several sections of the AMA Guides.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad
Keyword(s):  
Saphenous Vein ◽  
Short Term ◽  
Foam Sclerotherapy ◽  
Results Of Treatment ◽  
Ulcer Healing Rate ◽  
Complete Obliteration ◽  
Ceap Classification ◽  
One Year ◽  
The One

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.

Regional household poverty and mobility analysis – a transition probability approach

2020 ◽  
Vol 63 (3) ◽  
pp. 286-302
Author(s):  
Damian Mowczan ◽  
Keyword(s):  
Transition Probability ◽  
General Level ◽  
Transition Matrices ◽  
Equivalent Unit ◽  
Central Statistical ◽  
Per Capita ◽  
Probability Matrices ◽  
General Mobility ◽  
One Year ◽  
The One

The main objective of this paper was to estimate and analyse transition-probability matrices for all 16 of Poland’s NUTS-2 level regions (voivodeship level). The analysis is conducted in terms of the transitions among six expenditure classes (per capita and per equivalent unit), focusing on poverty classes. The period of analysis was two years: 2015 and 2016. The basic aim was to identify both those regions in which the probability of staying in poverty was the highest and the general level of mobility among expenditure classes. The study uses a two-year panel sub-sample of unidentified unit data from the Central Statistical Office (CSO), specifically the data concerning household budget surveys. To account for differences in household size and demographic structure, the study used expenditures per capita and expenditures per equivalent unit simultaneously. To estimate the elements of the transition matrices, a classic maximum-likelihood estimator was used. The analysis used Shorrocks’ and Bartholomew’s mobility indices to assess the general mobility level and the Gini index to assess the inequality level. The results show that the one-year probability of staying in the same poverty class varies among regions and is lower for expenditures per equivalent units. The highest probabilities were identified in Podkarpackie (expenditures per capita) and Opolskie (expenditures per equivalent unit), and the lowest probabilities in Kujawsko-Pomorskie (expenditures per capita) and Małopolskie (expenditures per equivalent unit). The highest level of general mobility was noted in Małopolskie, for both categories of expenditures.

From Scarcity to Abundance: Achieving Quality-Assured Mass Higher Education

2011 ◽  
Vol 15 (2) ◽  
Author(s):  
Peter P. Smith
Keyword(s):  
Higher Education ◽  
Knowledge Economy ◽  
Good Practice ◽  
The United States ◽  
The Other ◽  
Secondary System ◽  
Mass Higher Education ◽  
Post Secondary ◽  
One Year ◽  
The One

The United States is in a bind. On the one hand, we need millions of additional citizens with at least one year of successful post-secondary experience to adapt to the knowledge economy. Both the Gates and Lumina Foundations, and our President, have championed this goal in different ways. On the other hand, we have a post-secondary system that is trapped between rising costs and stagnant effectiveness, seemingly unable to respond effectively to this challenge. This paper analyzes several aspects of this problem, describes changes in the society that create the basis for solutions, and offers several examples from Kaplan University of emerging practice that suggests what good practice might look like in a world where quality-assured mass higher education is the norm.

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