scholarly journals Analysis of Postoperative Complications In Urethrolithiasis Treatment Using Intracorporeal Ultrasonic Lithotripsy

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
R.V. Stetsyshyn
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Ureteral Calculi ◽  
Bivariate Analysis ◽  
Hounsfield Units ◽  
Risk Of Failure ◽  
Ultrasonic Lithotripsy

The causes of early and late postoperative complications in patients with ureteral calculi during ultrasonic ureterolithotripsy performance were analyzed. 287 early and late postoperative complications of different severity were noted in 204 patients included into the study. During the bivariate analysis of complications causes, the interrelationship with localization in the upper and middle third of the ureter, the size of more than1 cmand a density of more than 1000 Hounsfield units was revealed.Taking into account the high risk of failure and complications, intracorporeal ureterolithotripsy in patients with complicated ureteral calculi, a differentiated approach to the use of devices for the disintegration of the concretion, or other types of surgery should be used in this group of patients.

scholarly journals Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040817
Author(s):  
Patrick O'Byrne ◽  
Amanda Vandyk ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Outcome ◽  
Bivariate Analysis ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Risk Criteria

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

scholarly journals Multicentre analysis of second-line antiretroviral treatment in HIV-infected children: adolescents at high risk of failure

2017 ◽  
Vol 20 (1) ◽  
pp. 21930 ◽  
Author(s):  
Ragna S. Boerma ◽  
Torsak Bunupuradah ◽  
Dorothy Dow ◽  
Joseph Fokam ◽  
Azar Kariminia ◽  
...  
Keyword(s):  
High Risk ◽  
Antiretroviral Treatment ◽  
Second Line ◽  
Risk Of Failure

scholarly journals Evolution of social learning when high expected payoffs are associated with high risk of failure

2011 ◽  
Vol 8 (64) ◽  
pp. 1604-1615 ◽  
Author(s):  
Michal Arbilly ◽  
Uzi Motro ◽  
Marcus W. Feldman ◽  
Arnon Lotem
Keyword(s):  
High Risk ◽  
Social Learning ◽  
Risk Aversion ◽  
Individual Risk ◽  
Individual Experience ◽  
Agent Based ◽  
Risk Of Failure ◽  
Expected Payoffs ◽  
Maladaptive Behaviours ◽  
Optimal Behaviour

In an environment where the availability of resources sought by a forager varies greatly, individual foraging is likely to be associated with a high risk of failure. Foragers that learn where the best sources of food are located are likely to develop risk aversion, causing them to avoid the patches that are in fact the best; the result is sub-optimal behaviour. Yet, foragers living in a group may not only learn by themselves, but also by observing others. Using evolutionary agent-based computer simulations of a social foraging game, we show that in an environment where the most productive resources occur with the lowest probability, socially acquired information is strongly favoured over individual experience. While social learning is usually regarded as beneficial because it filters out maladaptive behaviours, the advantage of social learning in a risky environment stems from the fact that it allows risk aversion to be circumvented and the best food source to be revisited despite repeated failures. Our results demonstrate that the consequences of individual risk aversion may be better understood within a social context and suggest one possible explanation for the strong preference for social information over individual experience often observed in both humans and animals.

New possibilities of the use of surgical lasers in obstetrics

1997 ◽  
Vol 78 (6) ◽  
pp. 434-438
Author(s):  
I. F. Fatkullin
Keyword(s):  
Surgical Treatment ◽  
High Risk ◽  
Postoperative Complications ◽  
Cesarean Section ◽  
Laser Welding ◽  
Comparison Group ◽  
Obstetrics And Gynecology ◽  
Septic Complications ◽  
Basic Group ◽  
Section Operation

The laser welding suture of peritoneum in pregnants and in women in labor with high risk of pyo-septic complications is used in cesarean section operation. In the basic group the postoperative complications are three times as little than in the comparison group. The promise of the use of the biological laser @welding@ in obstetrics and gynecology to improve technology and results of surgical treatment especially in delivery of women with high risk of pyo-septic complications is noted.

scholarly journals Hubungan Antara Paritas Dan Partus Lama Dengan Kejadian Asfiksia Neonatorum Pada Bayi Baru Lahir Di Rumah Sakit Umum Daerah Kota Prabumulih Tahun 2019

2020 ◽  
Vol 5 (2) ◽  
pp. 101-106
Author(s):  
Dwi Saputri Mayang Sari
Keyword(s):  
High Risk ◽  
General Hospital ◽  
Significant Relationship ◽  
Univariate Analysis ◽  
Bivariate Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Asphyxia Neonatorum ◽  
Prolonged Labor ◽  
The Relationship

Asphyxia Neonatorum is a failure to start and continue breathing spontaneously and regularly when a new baby is born or some time after birth. Babies may be born in asphyxia or may be able to breathe but then experience asphyxia some time after birth. The purpose of this study was to determine the relationship between parity and old parturition with the incidence of asphyxia neonatorum in the pre-Sumatran city general hospital in 2019. This study uses an Analytical Survey using a Cross Sectional approach. The population of this research is the babies born in the prehumulih city general hospital in 2019 amounted to 1763 people. The number of samples in this study were 326 respondents. In the univariate analysis it was found that from 326 respondents it was found that parity of high risk mothers was 168 respondents (51.5%) while parity of low risk mothers was 158 respondents (48.5%) and mothers who were diagnosed with prolonged labor were 149 respondents (45.7 %) while mothers who were not diagnosed with prolonged labor were 177 respondents (54.3%). Bivariate analysis shows parity has a significant relationship with the incidence of asphyxia neonatorum (p value 0,000) and old parturition has a significant relationship with the incidence of asphyxia neonatorum (p value 0,000). The conclusion of this study is that there is a relationship between parity and old parturition with the incidence of asphyxia neonatorum.

Sociodemographic factors affecting perceived stress during pregnancy and the association with immune-mediator concentrations

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Caroline McLeod ◽  
Myla D. Ebeling ◽  
John E. Baatz ◽  
Judy R. Shary ◽  
Jennifer R. Mulligan ◽  
...  
Keyword(s):  
High Risk ◽  
Perceived Stress ◽  
Linear Regression Analysis ◽  
Sociodemographic Factors ◽  
Bivariate Analysis ◽  
Necrosis Factor Alpha ◽  
Immune Mediator ◽  
Factors Affecting ◽  
Risk Pregnancy ◽  
Factor C

Abstract Objectives Determine which sociodemographic factors are most associated with increased maternal perceived stress during pregnancy. Evaluate the association between maternal stress and plasma immune-mediator concentrations (IMCs). Methods As part of a prospective, randomized clinical trial, 247 participants completed a Perceived Stress Scale survey (PSS-10) during each trimester of pregnancy. Blood samples were collected from participants and were analyzed for 25-hydroxyvitamin D (25(OH)D) concentration and for several IMCs: interferon-gamma, interleukins (IL-) IL-2, IL-4, IL-5, IL-10, vascular endothelial growth factor, c-reactive protein, and tumor necrosis factor alpha (TNF-α) (R&D Elisa). The potential associations between PSS-10 scores, sociodemographic factors, and IMCs were assessed. Results In bivariate analysis, participants who were not married and/or had high risk pregnancies were more likely to have increased PSS-10 scores (p<0.05). Increased PSS-10 scores were associated with higher serum concentrations of IL-2 and TNF-α, and decreased concentrations of IL-10 and 25(OH)D. In linear regression analysis, single marital status, high-risk pregnancy, IL-2, and TNF-α were independent predictors of PSS-10 scores. Conclusions This study identifies specific sociodemographic factors that are associated with increased perceived stress during pregnancy. This study also provides evidence that increased perceived stress is associated with physiological changes as measured by changes in circulating IL-2, TNF-α, IL-10, and 25(OH)D concentrations.

Radiotherapy after Prostatectomy

2002 ◽  
Vol 88 (6) ◽  
pp. 445-452 ◽  
Author(s):  
Giuseppe Sanguineti ◽  
Paola Franzone ◽  
Laura Culp ◽  
Michela Marcenaro ◽  
Salvina Barra ◽  
...  
Keyword(s):  
High Risk ◽  
Radical Prostatectomy ◽  
Adjuvant Radiotherapy ◽  
Potential Role ◽  
Specific Antigen ◽  
Salvage Treatment ◽  
Salvage Radiotherapy ◽  
Risk Of Failure

Aims and background The role of radiotherapy after prostatectomy is controversial. This paper tries to give some guidelines for everyday practice through an analysis of literature data. Methods The potential role of radiotherapy in the adjuvant and salvage setting is discussed. We also report and interpret available literature data for both settings. Results As regards an increase in or detectable prostate-specific antigen (PSA) after radical prostatectomy, about 40–50% of patients are rendered bNED with local salvage radiotherapy, but only 10–50% are long-term (5 years) biochemically controlled. A timely salvage treatment is crucial to optimize control probability. As regards adjuvant radiotherapy for undetectable postoperative PSA in patients at high risk of failure as judged on pathology, results are more encouraging. Recent data report bNED rates ≥70% at 5 years. Conclusions Although results are far from satisfactory, salvage radiotherapy should be considered for every patient with an increased or detectable PSA after surgery. Adjuvant radiotherapy seems preferable to salvage radiotherapy for patients at high (>30%) risk of failure.

scholarly journals Centralization of High-Risk Cancer Surgery Within Existing Hospital Systems

2019 ◽  
Vol 37 (34) ◽  
pp. 3234-3242 ◽  
Author(s):  
Kyle H. Sheetz ◽  
Justin B. Dimick ◽  
Hari Nathan
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Cancer Surgery ◽  
Independent Effect ◽  
Hospital System ◽  
American Hospital ◽  
Hospital Systems ◽  
High Risk Cancer

PURPOSE Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. We evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. PATIENTS AND METHODS We merged data from the American Hospital Association’s annual survey on hospital system affiliation with Medicare claims to identify patients undergoing surgery for pancreatic, esophageal, colon, lung, or rectal cancer between 2005 and 2014. We calculated the degree to which systems centralized each procedure by calculating the annual proportion of surgeries performed at the highest-volume hospital within each system. We then estimated the independent effect of centralization on the incidence of postoperative complications, death, and readmissions after accounting for patient, hospital, and system characteristics. RESULTS The average degree of centralization varied from 25.2% (range, 6.6% to 100%) for colectomy to 71.2% (range, 8.3% to 100%) for pancreatectomy. Greater centralization was associated with lower rates of postoperative complications and death for lung resection, esophagectomy, and pancreatectomy. For example, there was a 1.1% (95% CI, 0.8% to 1.4%) absolute reduction in 30-day mortality after pancreatectomy for each 20% increase in the degree of centralization within systems. Independent of volume and hospital quality, postoperative mortality for pancreatectomy was two times higher in the least centralized systems than in the most centralized systems (8.9% v 3.7%, P < .01). Centralization was not associated with better outcomes for colectomy or proctectomy. CONCLUSION Greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes. As hospitals affiliate in response to broader financial and organization pressures, these systems may also present unique opportunities to improve the quality of high-risk cancer care.

Post-surgery, post-anaesthesia complications

2017 ◽  
Author(s):  
Andrew Toner ◽  
Mark Hamilton ◽  
Maurizio Cecconi
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Inflammatory Responses ◽  
Enhanced Recovery ◽  
Clinical Intervention ◽  
Evidence Base ◽  
Thromboembolism Prophylaxis ◽  
Surgical Safety ◽  
Post Surgery ◽  
Recovery Protocols

Postoperative complications are common in high-risk surgical populations and are associated with poor short-term and long-term outcomes. Morbidity can be identified using prospective assessment of pathological criteria, or deviations from the ideal postoperative course requiring clinical intervention. While infections are the most prevalent complication type, morbidity affecting the heart, lungs, kidneys, or brain carry the worst prognosis. Specific pathophysiological processes drive morbidity in each organ system. In addition, dysfunction of the cardiovascular and immune systems can lead to multiorgan impairment, and have been the focus of many clinical trials. Perioperative strategies backed by the strongest evidence base include smoking cessation, surgical safety checklists, perioperative warming, pre-emptive antibiotics, venous thromboembolism prophylaxis, enhanced recovery protocols, and early critical care rescue when complications arise. Isolated attempts to optimize cardiovascular function or attenuate inflammatory responses have not been consistently successful in improving outcomes. As the proportion of surgical patients meeting high-risk criteria rises, reducing the incidence of postoperative complications has become a priority in many developed healthcare systems. To meet this need, improved implementation of proven strategies should be combined with routine and rigorous surgical outcome reporting. In addition, advances in pathophysiological understanding may lead to novel interventions offering multisystem protection in the surgical period.

P23 MALNUTRITION INDICES AS PROGNOSTIC FACTORS FOR POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Lidoriki Irene ◽  
Schizas Dimitrios ◽  
Mpaili Efstratia ◽  
Mpoura Maria ◽  
Hasemaki Natasha ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
High Risk ◽  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Cancer Patients ◽  
Preoperative Assessment ◽  
Low Risk ◽  
Major Complications ◽  
The Impact

Abstract Aim To investigate the impact of malnutrition on postoperative complications in esophageal cancer patients. Background and Methods Malnutrition is common in esophageal cancer patients due to the debilitating nature of their disease. Several methods of nutritional assessment have emerged as significant prognostic factors for short-and long-term outcomes in patients operated for esophageal cancer. The study sample consisted of 85 patients with esophageal (n=11) and gastroesophageal junction (n=74) cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and March 2019. Out of them, 65 patients underwent esophagectomy, while 20 patients underwent total gastrectomy. The assessment of nutritional status included the Geriatric Nutritional Risk Index (GNRI), the Patient Generated Subjective Global Assessment (PG-SGA) and sarcopenia. GNRI was based on preoperative values of patients’ serum albumin and body weight. The preoperative assessment of sarcopenia was based on Skeletal Muscle Index (SMI) derived from analysis of CT scans using SliceOmatic® Software version 4.3 (Tomovision, Montreal, Canada). Postoperative complications were graded according to Clavien-Dindo classification. Minor complications included categories I-II, whereas major complications included categories III-V. Results Thirty nine patients (47.6%) developed postoperative complications. More specifically, 21 patients (24.7%) developed minor complications and 18 patients (21.2%) developed major complications, while anastomotic leakage occurred in 10 patients (11.8%). Eighty patients (94.1%) had a high-risk GNRI (<92), while 5 patients (5.9%) had a low-risk GNRI (≥92). Forty four patients (51.8%) were diagnosed with sarcopenia. The mean PG-SGA score was 8.82 ± 5.57. Patients with a high-risk GNRI demonstrated significantly higher rate of overall complications compared to low-risk GNRI patients (100% vs 44.2%, p<0.05 respectively). Moreover, the rate of anastomotic leakage was significantly higher in the sarcopenia group than in the non-sarcopenia group (29% vs 3.4%, p<0.05). Nonetheless, PG-SGA was not significantly associated with postoperative outcomes. Conclusion Higher-risk scores on the GNRI are associated with an increased risk for developing postoperative complications, while sarcopenia is associated with higher risk for anastomotic leakage among esophageal cancer patients. Preoperative assessment of GNRI and sarcopenia should be performed in all patients in order to detect patients who are at greater risk of postoperative morbidity.

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