scholarly journals Risk factors for 30-day unplanned readmission among patients undergoing laparotomy for perforation peritonitis

2017 ◽  
Vol 4 (2) ◽  
pp. 637 ◽  
Author(s):  
Sanjay Marwah ◽  
Priyanka Singla ◽  
Mahavir Singh ◽  
Himanshu Sharma
Keyword(s):  
Risk Factors ◽  
Prospective Observational Study ◽  
Improve Patient Care ◽  
Unplanned Readmission ◽  
Emergency Laparotomy ◽  
Optimal Care ◽  
Stoma Creation ◽  
Perforation Peritonitis ◽  
American Society ◽  
Improve Patient

Background: Unforeseen re-admissions are a consequence of natural course of patient’s disease or results from sub-optimal care during first admission. Apart from causing increased expenditure, readmission immensely adds to the distress of the patient as well as his relatives. The aim of the study was to assess the incidence and risk factors for 30-day unplanned readmission following emergency laparotomy for perforation peritonitis.Methods: This prospective observational study was conducted on 145 patients undergoing laparotomy for perforation peritonitis in over a period of two years. Various pre-operative, intra-operative and post-operative parameters were studied to identify the risk factors for readmission.Results: Overall readmission rate was 8.96% and in majority of the cases it was due to post-surgical complications. Various factors found significant for readmission were American Society of Anaesthesiology (ASA) grade (p = 0.014) hypoproteinemia (p<0.001), diabetes mellitus (p = 0.001), immuno compromised status (p<0.001), stoma creation (p<0.001), blood transfusion (p = 0.022), renal complications and UTI (p = 0.027 each). On multivariate analysis, hypoproteinemia and stoma creation were found to be significant.Conclusions: Risk factors for readmission among surgical patients are multi-factorial. Taking appropriate steps can reduce the burden of readmission. Moreover decreasing the rate of surgical readmission represents an opportunity to improve patient care.

scholarly journals Termination of wanted pregnancy and suicidal ideation in hyperemesis gravidarum: A mixed methods study

2021 ◽  
pp. 1753495X2110409
Author(s):  
Melanie Nana ◽  
Florence Tydeman ◽  
Georgie Bevan ◽  
Harriet Boulding ◽  
Kimberley Kavanagh ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Hyperemesis Gravidarum ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Termination Of Pregnancy ◽  
Free Text ◽  
Optimal Care ◽  
Specialist Services ◽  
Timely Access ◽  
Improve Patient

Background Difficulty accessing medication and poor patient experience have been implicated as risk factors for termination of pregnancy and suicidal ideation in women with hyperemesis gravidarum. We aimed to gain further insight into these factors in order to further inform and improve patient care. Methods We performed a sub-analysis on quantitative data generated through a UK-wide survey of 5071 participants. A qualitative analysis of free text comments was performed using an inductive thematic approach. Results 41.2% % of women taking prescribed medications had to actively request them. ‘Extremely poor’ or ‘poor’ experiences were described in 39.4% and 30.0% of participants in primary and secondary care respectively. Protective factors for termination of pregnancy and suicidal ideation include holistic support from family, friends and healthcare providers. Conclusion Optimal care in hyperemesis gravidarum should incorporate timely access to pharmacotherapy, assessment of mental health, consideration of referral to specialist services and care being delivered in a compassionate manner.

scholarly journals Molecular Mechanisms and Risk Factors for the Pathogenesis of Hydrocephalus

2022 ◽  
Vol 12 ◽  
Author(s):  
Jingwen Li ◽  
Xinjie Zhang ◽  
Jian Guo ◽  
Chen Yu ◽  
Jun Yang
Keyword(s):  
Risk Factors ◽  
Molecular Mechanisms ◽  
Cerebral Metabolism ◽  
Genetic Research ◽  
Improve Patient Care ◽  
Cell Dysfunction ◽  
Molecular Abnormalities ◽  
Precise Diagnosis ◽  
Radical Generation ◽  
Improve Patient

Hydrocephalus is a neurological condition due to the aberrant circulation and/or obstruction of cerebrospinal fluid (CSF) flow with consequent enlargement of cerebral ventricular cavities. However, it is noticed that a lot of patients may still go through symptomatic progression despite standard shunting procedures, suggesting that hydrocephalus is far more complicated than a simple CSF circulative/obstructive disorder. Growing evidence indicates that genetic factors play a fundamental role in the pathogenesis of some hydrocephalus. Although the genetic research of hydrocephalus in humans is limited, many genetic loci of hydrocephalus have been defined in animal models. In general, the molecular abnormalities involved in the pathogenesis of hydrocephalus include brain development and ependymal cell dysfunction, apoptosis, inflammation, free radical generation, blood flow, and cerebral metabolism. Moreover, recent studies have indicated that the molecular abnormalities relevant to aberrant cerebral glymphatic drainage turn into an attractive subject in the CSF circulation disorder. Furthermore, the prevalent risk factors could facilitate the development of hydrocephalus. In this review, we elicited some possible fundamental molecular mechanisms and facilitating risk factors involved in the pathogenesis of hydrocephalus, and aimed to widen the diagnosis and therapeutic strategies for hydrocephalus management. Such knowledge could be used to improve patient care in different ways, such as early precise diagnosis and effective therapeutic regimens.

Risk Factors for Blood Transfusion with Neck Dissection

2019 ◽  
Vol 161 (6) ◽  
pp. 922-928 ◽  
Author(s):  
Monica C. Azmy ◽  
Juanita Pinto ◽  
Nirali M. Patel ◽  
Aparna Govindan ◽  
Evelyne Kalyoussef
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Neck Dissection ◽  
Free Flaps ◽  
Unplanned Readmission ◽  
Improvement Program ◽  
Acs Nsqip Database ◽  
American Society ◽  
Associated Risk Factors ◽  
American Society Of Anesthesiologists

Objectives To identify risk factors of perioperative blood transfusions (PBTs) for neck dissection and identify the association of PBTs with other postoperative outcomes. Methods This is a retrospective study of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The database was queried for neck dissection procedures performed by otolaryngologists from 2006 to 2014. Multivariable logistic regression was used to determine associations between demographic and preoperative factors, mortality, unplanned reoperation, and unplanned readmission with PBTs. Results Of the 3090 patients included in our study, 346 (11.2%) received a PBT, 249 patients (72.0%) received blood intraoperatively or on postoperative day (POD) 0, and 97 patients (28.0%) received blood within 5 PODs. American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.2), preoperative weight loss (OR, 2.2; 95% CI, 1.5-3.2), and anemia (OR, 5.5; 95% CI, 4.1-7.6) were independently associated with PBTs. Free flaps were also significantly associated with PBTs. PBTs were significantly associated with unplanned return to the operating room within 30 days (OR, 4.31; 95% CI, 3.01-6.18) but not with 30-day unplanned readmission or 30-day mortality. Discussion Eleven percent of patients undergoing neck dissection receive a PBT. Identifying associated risk factors may reduce PBT among patients with cancer. Comorbid data, such as weight loss, anemia, and ASA class, may be useful in determining risk for transfusion during these procedures. Implications for Practice Awareness of preoperative risk factors for PBT may lead surgeons to reduce the risk of PBT, anticipate the need for transfusion, and manage these patients carefully to prevent unplanned reoperation.

scholarly journals PHARMACOVIGILANCE

2016 ◽  
Vol 23 (11) ◽  
pp. 1298-1304
Author(s):  
Huma Ali ◽  
Farya Zafar ◽  
Hina Hasnain ◽  
Sana Ahmed ◽  
Neelam Mallick ◽  
...  
Keyword(s):  
Public Health ◽  
Medication Use ◽  
Improve Patient Care ◽  
Pharmacovigilance System ◽  
Identification System ◽  
Paradigm Change ◽  
Essential Factor ◽  
Optimal Care ◽  
Medication Utilization ◽  
Improve Patient

The solution for safe and rational medication use to improve patient care aswell as to enhance public health status is Pharmacovigilance (PV). Optimal care of patientand appropriate medication utilization in secure way with respect to various conditions is animperative function of pharmacovigilance system. PV mainly involves in the adverse drugreactions (ADRs) identification, system of reporting, scrutinizes the effectiveness of treatment,reduces the adverse consequences to utmost level and guarantees the patient wellbeing.The safety of drug is highly essential factor when it comes from the healthcare provider to thepatient. For a drug to be successful in market, it is crucial for it to be efficacious as well as safeand secure for the patients. Hence, adherence toward pharmacovigilance activities and systemis now based on a paradigm change from care to safety.

scholarly journals Incidence of Post-Tonsillectomy Hemorrhage in Children and Adults: A Study of 4,848 Patients

2002 ◽  
Vol 81 (9) ◽  
pp. 626-634 ◽  
Author(s):  
Jochen P. Windfuhr ◽  
Yue-Shih Chen
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Surgical Treatment ◽  
Patient Care ◽  
Older Adult ◽  
Improve Patient Care ◽  
Adult Group ◽  
History Of ◽  
Primary Hemorrhage ◽  
Improve Patient

We conducted a retrospective study of 4,848 patients to evaluate the age-specific incidence of post-tonsillectomy hemorrhage that required surgical treatment. We reviewed the charts of 2,567 patients younger than 15 years (pediatric group) and 2,281 patients aged 15 years and older (adult group) who had undergone tonsillectomy with or without adenoidectomy. We found that post-tonsillectomy hemorrhage occurred significantly more often in the adult group (3.9 vs 1.6%; p< 0.001). Moreover, primary hemorrhage (<24 hr postoperatively) was also significantly more common in the adult group than in the pediatric group (82.9 vs 65.9%, p = 0.023). Analysis of other parameters revealed that post-tonsillectomy hemorrhage was significantly more common in males and in patients who had a history of chronic or recurrent throat infection. Awareness of these risk factors should help improve patient care and outcomes.

Role of pulse oximetric monitoring during gastrointestinal endoscopy. Prospective multicenter study of the Gastroenterological Working Group of the Veszprém Regional Committee of the Hungarian Academy of Sciences (VEAB)

2013 ◽  
Vol 154 (21) ◽  
pp. 825-833
Author(s):  
Zoltán Döbrönte ◽  
Mária Szenes ◽  
Beáta Gasztonyi ◽  
Lajos Csermely ◽  
Márta Kovács ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Hungarian Academy ◽  
Prospective Multicenter Study ◽  
Standard Requirement ◽  
Long Duration ◽  
Related Risk ◽  
American Society ◽  
Academy Of Sciences ◽  
Endoscopic Investigation

Introduction: Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units. Aims: To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy. Method: A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation. Results: Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors. Conclusion: To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia. Orv. Hetil., 2013, 154, 825–833.

Sign in / Sign up

Export Citation Format

Share Document