scholarly journals Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 23
Author(s):  
Yen-Ju Chen ◽  
Wen-Hao Yu ◽  
Li-Wen Chen ◽  
Chao-Ching Huang ◽  
Lin Kang ◽  
...  
Keyword(s):  
Gestational Age ◽  
Significant Risk ◽  
Neonatal Resuscitation ◽  
Comfort Care ◽  
Before And After ◽  
Long Term Follow Up ◽  
Neonatal Resuscitation Program ◽  
Definition Of ◽  
The Impact

Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

The Introduction of a Crisis Unit in a Mental Hospital

1974 ◽  
Vol 19 (5) ◽  
pp. 445-452 ◽  
Author(s):  
George Voineskos ◽  
M. F. Morrison ◽  
R. C. Jain
Keyword(s):  
Mental Hospital ◽  
Clinical Service ◽  
Treatment Programs ◽  
Open Door Policy ◽  
Number Of Patients ◽  
Before And After ◽  
Long Term Follow Up ◽  
The Impact

A community oriented Crisis Unit was introduced in a mental hospital as an integral part of a comprehensive Clinical Service. The unit is doing crisis assessment and intervention for patients referred to this Clinical Service and a 72-hour inpatient or day-care crisis oriented therapy. The locale, the organization of the team and the work of the unit are described. Data are given regarding the number of patients seen during the first six months, of those admitted and of those discharged within 72 hours or transferred to another unit of the service. Additional data referring to the patients admitted to the Crisis Unit and during a corresponding six-month period of the previous year when the Unit was not operating are also given. The reduction of the inpatient population of the service and the associated financial savings are outlined. The management of the Unit on an open-door policy is described. The impact of the Unit on the treatment programs of the other units of the service is discussed. It is suggested that crisis therapy oriented units should be considered an essential and integral component of the psychiatric services offered by mental or general hospitals. Comparative studies of patient populations before and after the introduction of such units and long-term follow-up evaluative studies are required.

Premature Adrenarche and its Association with Cardiovascular Risk in Females

2020 ◽  
Vol 26 (43) ◽  
pp. 5609-5616
Author(s):  
Sarantis Livadas ◽  
Christina Bothou ◽  
Djuro Macut
Keyword(s):  
Polycystic Ovary ◽  
Dehydroepiandrosterone Sulfate ◽  
Adrenal Androgen ◽  
Premature Adrenarche ◽  
Adrenal Hyperandrogenism ◽  
Long Term Follow Up ◽  
History Of ◽  
Hormonal Milieu ◽  
The Impact

Early activation of the adrenal zona reticularis, leading to adrenal androgen secretion, mainly dehydroepiandrosterone sulfate (DHEAS), is called premature adrenarche (PA). The fact that adrenal hyperandrogenism in females has been linked to a cluster of cardiovascular (CV) risk factors, even in prepubertal children, warrants investigation. Controversial results have been obtained in this field, probably due to genetic, constitutional, and environmental factors or differences in the characteristics of participants. In an attempt to understand, in depth, the impact of PA as a potential activator of CV risk, we critically present available data stratified according to pubertal status. It seems that prepubertally, CV risk is increased in these girls, but is somewhat attenuated during their second decade of life. Furthermore, different entities associated with PA, such as polycystic ovary syndrome, non-classical congenital adrenal hyperplasia, heterozygosity of CYP21A2 mutations, and the impact of DHEAS on CV risk, are reviewed. At present, firm and definitive conclusions cannot be drawn. However, it may be speculated that girls with a history of PA display a hyperandrogenic hormonal milieu that may lead to increased CV risk. Accordingly, appropriate long-term follow-up and early intervention employing a patient-oriented approach are recommended.

scholarly journals The Demerger Impact upon Sustainable Development of Economic Entities: Evidence from Romania

2021 ◽  
Vol 13 (15) ◽  
pp. 8316
Author(s):  
Camelia Mirela Baba ◽  
Constantin Duguleană ◽  
Marius Sorin Dincă ◽  
Liliana Duguleană ◽  
Gheorghița Dincă
Keyword(s):  
Sustainable Development ◽  
Business Strategies ◽  
The Sustainable Development ◽  
Ex Post ◽  
Before And After ◽  
Almost All ◽  
The Impact ◽  
Profitability Ratios ◽  
Positive Effect

The Covid-19 induced economic crisis has significantly affected almost all businesses from nearly every sector, causing severe financial problems, lack of cash assets, and decrease of revenues. In this context, the economic entities were forced to look for adjustment and rescue solutions of their activities. One possible solution for the recovery and reorganization of economic entities’ activities is demerger. This paper evaluates the impact of demerger upon the sustainable development of economic entities in terms of economic efficiency and financial performances. To achieve this goal, a statistical analysis of profitability ratios before and after the demerger, as well as a structural analysis of 268 demerger projects for the April 2012–April 2021 period, were performed. The results attest there are no significant differences between the ex-ante and ex-post financial performances. However, demerger seems to have a positive effect upon analyzed companies helping them to overcome economic hardships, rethink their business strategies, and continue their activity in the medium and long-term time horizon.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Aortic endograft and bridging stent-graft remodeling after branched endovascular aortic repair

Vascular ◽  
2020 ◽  
pp. 170853812098369
Author(s):  
Stefano Fazzini ◽  
Giovanni Torsello ◽  
Martin Austermann ◽  
Efthymios Beropoulis ◽  
Roberta Munaò ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Main Body ◽  
Thoracoabdominal Aneurysm ◽  
Before And After ◽  
Long Term Follow Up ◽  
Instability Rate ◽  
One Year ◽  
The Impact

Objectives The results of branched endovascular repair of thoracoabdominal aneurysms are mainly dependent on durability of the graft used. The purpose of this study was to evaluate postoperative aortic main body and bridging stent-graft remodeling, and their impact on bridging stent-graft instability at one year. Methods Computed tomoangiographies of 43 patients (43 aortic main body mated with 171 bridging stent-grafts) were analyzed before and after branched endovascular repair as well as after a follow-up of 12 months. Primary endpoint was aortic main body remodeling (migration >5 mm, shortening >5 mm, scoliosis >5° or lordosis >5°). Shortening was defined as a reduced length in the long axis, scoliosis as left-right curvature, and lordosis as antero-posterior curvature. Aortic main body remodeling, aneurysm sac changes, and bridging stent-graft tortuosity were evaluated to study their correlations and the impact on the bridging stent-graft instability. Results At 12 months, aortic main body remodeling was observed in 72% of the cases, migration in 39.5% (mean 5.21 mm), shortening in 41.9% (mean 5.79 mm), scoliosis in 58.1%, (mean 10.10°), lordosis in 44.2% (mean 5.78°). Migration, shortening, and scoliosis were more frequent in patients with larger aneurysms ( p = .005), while scoliosis was significantly more frequent in type II thoracoabdominal aneurysm ( p = .019). Aortic main body remodeling was significantly associated to bridging stent-graft remodeling (r: 0.3–0.48). The bridging stent-graft instability rate was 9.3%. Despite a trend toward significance ( p = .07), none of the evaluated aortic main body and bridging stent-graft changes were associated with bridging stent-graft instability at 12 months. Conclusions Aortic main body remodeling is frequent especially in large and extended thoracoabdominal aneurysm aneurysms. Aortic main body and bridging stent-graft remodeling was significantly correlated. While these geometric changes had no significant impact on bridging stent-graft instability at one year, a close long-term follow-up after branched endovascular repair could predict bridging stent-graft failures.

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (&lt;72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

scholarly journals Studies of the Logistics Services Market: Information and Analytical Support and a System of Statistical Indicators

2020 ◽  
pp. 5-11
Author(s):  
N. HRYNCHAK
Keyword(s):  
Medium Term ◽  
Secondary Sources ◽  
The Core ◽  
Logistics Services ◽  
Rational Management ◽  
Definition Of ◽  
Definition Of Information ◽  
The Impact ◽  
Statistical Indicators

Information and analytical database for the market support is required to prevent communications of contradictory information to higher levels of management, with adverse effects for the process of taking rational management decisions. The article’s objective is to substantiate the information and analytical support for studies of the logistics services market, with constructing a system of statistical indicators for this market assessment, to be laid as the solid basis for elaborating medium-term and long-term strategies and policies of the logistics services market in Ukraine.  A definition of information and analytical support for studies of the logistics services market is given; a review of secondary sources of data for this market studies is made. A conceptual model for information and analytical studies of the logistics services market is proposed. The key statistical indicators for studies of this market are identified, with substantiating the feasibility of their use in computing multivariate indicators for the assessment of performance and capacities of the logistics services market in Ukraine. The core criteria to be met by the abovementioned system of statistical indicators are highlighted. A system of statistical indicators for the assessment of the logistics services market is proposed, containing four modules. It allows for diagnosis of this market performance and tendencies, with accounting for the impact of other related markets and activities, and for forecasting. This system, constructed with consideration to the global practice, is designed for comprehensive studies of the logistics services market.

scholarly journals NEUROPHYSIOLOGICAL AND NEUROPSYCHOLOGICAL FEATURES AT PATIENTS FROM OCCUPATIONAL NOISE-INDUCED HEARING LOSS

2019 ◽  
Vol 98 (10) ◽  
pp. 1068-1073
Author(s):  
Oksana I. Shevchenko ◽  
D. V. Rusanova ◽  
O. L. Lakhman
Keyword(s):  
Latent Period ◽  
Cognitive Activity ◽  
Functional Condition ◽  
Long Term Memory ◽  
Term Memory ◽  
Diagnostic Signs ◽  
Constant Potential ◽  
Definition Of ◽  
The Impact

Introduction. Issues of studying the central origins and development of оccupational pathology in the faces of flight personnel define a need for the application of neurophysiological and neuropsychological methods of research. Material and methods. The levels of constant potential (LCP), characteristics the somatosensory caused potentials (SSVP), neuropsychological features in 95 patients with оccupational neurosensory deafness (ONSD) and 35 cases in a group of comparison are studied. Methods of the statistical analysis with a definition of W-of criterion of Shapiro-Uilka, Mann-Whitney›s U-criterion, coefficient of correlation of Spirmen, the discriminant analysis are applied. Results. in ONSD at patients the quantity of cases with the increased values of average LCP were established to prevail significantly in comparison with those in patients of a group of comparison (39% and 13% respectively, р = 0.03), strengthening of neuropower exchange in right and left frontal, central, left central, left parietal, right temporal assignments, increase in duration of the latent period of N18, N30 components are registered (р < 0.05). The condition of the cognitive sphere was characterized by the easily expressed violations of functions of analytical and synthetic thinking, оral-aural memory, visual, long-term memory, reciprocal coordination, impressive speech. Correlation connection between the index of N13-N20 and indices characterizing a condition of long-term memory, reciprocal coordination, the expressional speech is established (rs=0.45; 0.28; 0.28 at р =0.008; 0.04; 0.03 respectively), an index the between hemispheres of the relations Fd-Fs and latency of P25 and N30 (rs = 0.53 and 0.29 at р =0.009; 0.02 respectively). Diagnostic signs of brain deficiency at patients with ONSD were indices of visual gnosis, reciprocal coordination, LCP in right central, central parietal assignments of a brain, duration of the latent period of N30, N18-N20 (F=9.14; 5.43; 6.08; 4.41 4.77; 4.34 respectively). Conclusions. Violations of power metabolism in the frontal and central and parietal and temporal assignments of a brain, a functional condition of the central carrying-out structures, disorganization of cognitive activity were established to be a consequence of the impact of aviation noise and the reason of brain deficiency.

scholarly journals Surgical Results of Retrograde Mastoidectomy with Primary Reconstruction of the Ear Canal and Mastoid Cavity

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Chao-Yin Kuo ◽  
Bor-Rong Huang ◽  
Hsin-Chien Chen ◽  
Cheng-Ping Shih ◽  
Wei-Kang Chang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Mastoid Cavity ◽  
Surgical Results ◽  
Ear Canal ◽  
Hearing Results ◽  
Hearing Gain ◽  
Before And After ◽  
Hearing Outcomes ◽  
The Impact

The aim of this study was to retrospectively review the long-term hearing results and the impact of mastoid exclusion/obliteration in patients with cholesteatoma (102 ears) who underwent retrograde tympanomastoidectomy and in whom bone chips/paté were applied as the sole materials during the procedure. In 79 ears, this was combined with ossiculoplasty in a single-stage procedure. In >71% of ears, the results of audiometric testing were monitored for more than 2 years. The results suggested there was a significant gain in hearing following surgery, with respect to the postoperative change in both air-conduction thresholds and air-bone gaps (P<0.001). Linear regression analyses of pure-tone averages at different frequencies, before and after surgery, demonstrated that patients benefitted from a postoperative hearing gain at low and middle frequencies, but their hearing often deteriorated at frequencies of 8000 Hz. As for the impact of the type of tympanoplasty on hearing outcomes, type III-interposition markedly increased hearing gain. The overall rate of postoperative adverse events was 8.8%. We conclude that reconstruction of the ear canal and mastoid via mastoid exclusion/obliteration using bone chips/paté can be considered as an alternative procedure following retrograde mastoidectomy. It gives excellent surgical results and has fewer postoperative adverse events.

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