scholarly journals Delirium-The Effect of Children Anesthesiology after Surgery

2021 ◽  
Vol 1 (3) ◽  
pp. 63-66
Author(s):  
Yuni Dwi Marantika
Keyword(s):  
Vital Sign ◽  
Recovery Period ◽  
Significant Risk ◽  
Predisposing Factors ◽  
Preoperative Anxiety ◽  
Screening Tools ◽  
Anesthetic Induction ◽  
Emergence Delirium ◽  
Clinical Phenomenon ◽  
Standardized Screening

Delirium of anesthesiology is a clinical phenomenon widespread in children. Although the pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, pre-anesthetic medication, and inhalational anesthetics. There remain unanswered questions and implications related to the emergence of delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still cannot accurately identify those at most significant risk. Emergent delirium should be considered a ‘vital sign,’ which should be followed and documented in every child in the postanaesthesia recovery period. What should adopt standardized screening tools for pediatric emergence delirium (ED)

Delirium-The Effect off Children Anesthesiology after Surgery

2021 ◽  
Vol 1 (3) ◽  
pp. 63-66
Author(s):  
Yuni Dwi Marantika
Keyword(s):  
Vital Sign ◽  
Recovery Period ◽  
Significant Risk ◽  
Predisposing Factors ◽  
Preoperative Anxiety ◽  
Screening Tools ◽  
Anesthetic Induction ◽  
Emergence Delirium ◽  
Clinical Phenomenon ◽  
Standardized Screening

Delirium of anesthesiology is a clinical phenomenon widespread in children. Although the pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, pre-anesthetic medication, and inhalational anesthetics. There remain unanswered questions and implications related to the emergence of delirium in children. Although we know that there are some predisposing factors to emergence delirium, we still cannot accurately identify those  at most significant risk. Emergent delirium should be considered a ‘vital sign,’ which should be followed and documented in every child in the postanaesthesia recovery period. What should adopt standardized screening tools for pediatric emergence delirium(ED).  

Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium

2021 ◽  
Author(s):  
Diego Gil Mayo ◽  
Pascual Sanabria Carretero ◽  
Luis Gajate Martin ◽  
Jose Alonso Calderón ◽  
Francisco Hernández Oliveros ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Pediatric Anesthesia ◽  
Preoperative Anxiety ◽  
Preoperative Preparation ◽  
Parental Presence ◽  
Emergence Delirium ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Preparation Strategy

Abstract Introduction Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery. Materials and Methods This prospective observational study included 638 pediatric American Society of Anesthesiologists I–II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0–12 months), Group 2 (13–60 months), Group 3 (61–96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group. Results Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3–37.5]; p < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p = 0.001). Conclusion PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED.

Significant Risk of a Second Melanoma in Patients with a History of Melanoma but No Further Predisposing Factors

Dermatology ◽  
2003 ◽  
Vol 206 (2) ◽  
pp. 76-77 ◽  
Author(s):  
Dorothee Nashan ◽  
Burak Kocer ◽  
Meinhard Schiller ◽  
Thomas Luger ◽  
Stephan Grabbe
Keyword(s):  
Significant Risk ◽  
Predisposing Factors ◽  
History Of

scholarly journals Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Alberto Vieco-García ◽  
Amanda López-Picado ◽  
Manuel Fuentes ◽  
Laura Francisco-González ◽  
Belén Joyanes ◽  
...  
Keyword(s):  
Trait Anxiety ◽  
Outpatient Surgery ◽  
The State ◽  
Anxiety Scale ◽  
Preoperative Anxiety ◽  
State Trait Anxiety Inventory ◽  
Anesthetic Induction ◽  
The Moment ◽  
Assessment Scales ◽  
Surgical Unit

Abstract Introduction Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). Methods An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. Results The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. Conclusions Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.

scholarly journals POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities

2020 ◽  
Vol 11 ◽  
pp. 215145932093167
Author(s):  
William L. Johns ◽  
Benjamin Strong ◽  
Stephen Kates ◽  
Nirav K. Patel
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Mortality Rate ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Significant Risk ◽  
Screening Tools ◽  
Morbidity And Mortality ◽  
Mortality And Morbidity ◽  
Operative Severity Score

Introduction: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients. Materials and Methods: Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury. Results: Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring. Discussion/Conclusion: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.

Substance Use Disorder Screening Capacity Lags Behind Depression Screening Capacity in Community Health Centers

2017 ◽  
Vol 48 (2) ◽  
pp. 152-164 ◽  
Author(s):  
Emily Jones ◽  
Traci Rieckmann
Keyword(s):  
Substance Use ◽  
Community Health ◽  
Substance Use Disorder ◽  
Community Health Centers ◽  
Health Centers ◽  
Screening Tools ◽  
Depression Screening ◽  
Federally Qualified Health Centers ◽  
Ehr Adoption ◽  
Standardized Screening

Despite their prevalence, screening for depression and substance use disorder (SUD) is often not routinely practiced in primary care. This study uses a survey of community health centers to identify characteristics associated with depression and SUD screening. In 2010, 76.9% of federally qualified health centers routinely screened for depression, and about half of health centers (54.1%) routinely screened for SUDs. Higher Medicaid caseload and region were associated with routine screening for both depression and SUDs. SUD screening was also associated with the percent of total staff comprised of behavioral health specialists, electronic health record (EHR) adoption, urban location, and higher uninsured caseload. Implications include the need to build SUD screening capacity, encourage the use of standardized screening tools, and monitor SUD screening capacity in health centers in the future.

scholarly journals Abuse Experienced by Persons with Severe Mental Illness

2020 ◽  
Vol 3 ◽  
pp. 1-16
Author(s):  
Akanksha Rani ◽  
Janaki Raman ◽  
Sojan Antony ◽  
Ammapattian Thirumoorthy ◽  
Ammapattian Thirumoorthy ◽  
...  
Keyword(s):  
Mental Illness ◽  
Protective Factors ◽  
Severe Mental Illness ◽  
Risk And Protective Factors ◽  
Screening Tools ◽  
Health Concern ◽  
Second Phase ◽  
Group Discussions ◽  
Standardized Screening ◽  
Depth Interviews

Background: Abuse among person with severe mental illness is a serious public health concern and over the several decades researchers have focused on violence perpetrated by person with mental illness giving little consideration to the fact that severity and chronicity of mental disorder makes a person susceptible to all kinds of abuse. The current study attempts to identify three types of abuse-physical, sexual and psychological by using socio-ecological framework which takes into consideration individual, family and socio-cultural factors which acts as a risk or protective factors against abuse. Methods/Design: The study will screen severity of mental illness and abuse among men and women by using standardized screening tools. The first phase of the study focuses on developing risk and protective factors checklist through in-depth interviews and focused group discussions. The second phase of the study is identifying risk and protective factors of abuse by administering the checklist on 257 persons with severe mental illness. Qualitative data will be analyzed by using thematic analysis and quantitative data will be analyzed by testing for normality and accordingly using parametric and non-parametric test.  Logistic regression model will be used to identify risk and protective factors for the abuse. Discussion: This study would help to understand abuse from ecological perspective and develop a framework for risk management by capitalizing on what people know, what they can do, where they can go and how they can utilize indigenous resources to buffer the effect of abuse.

scholarly journals A Chart Review of Substance Use Screening and Related Documentation among Adolescents in Outpatient Pediatric Clinics: Implications for Practice

2020 ◽  
Author(s):  
Lisa M. Kuhns ◽  
Brookley Rogers ◽  
Katie Greeley ◽  
Abigail L. Muldoon ◽  
Niranjan Karnik ◽  
...  
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Logistic Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Screening Tools ◽  
Multiple Logistic Regression ◽  
Related Factors ◽  
Standardized Screening

Abstract Background: Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. Methods: We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. Results: Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. Conclusions: Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.

scholarly journals App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data (Preprint)

2020 ◽  
Author(s):  
Martin Zens ◽  
Arne Brammertz ◽  
Juliane Herpich ◽  
Norbert Südkamp ◽  
Martin Hinterseer
Keyword(s):  
Predictive Value ◽  
Odds Ratio ◽  
Significant Risk ◽  
Nausea And Vomiting ◽  
Screening Tools ◽  
Positive Test ◽  
Polymerase Chain Reaction Test ◽  
Positive Test Result ◽  
Reporting Tool ◽  
Test Result

BACKGROUND COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients. OBJECTIVE To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool. METHODS The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous. RESULTS In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value. CONCLUSIONS Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection.

Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia

2019 ◽  
Vol 128 (10) ◽  
pp. 903-910 ◽  
Author(s):  
Murat Gumussoy ◽  
Ulku Kucuk
Keyword(s):  
Vocal Fold ◽  
Inhaled Corticosteroids ◽  
Medical Center ◽  
Age Groups ◽  
Significant Risk ◽  
Case Series ◽  
Predisposing Factors ◽  
Retrospective Case ◽  
Vocal Fold Leukoplakia

Objective: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient’s complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Study Design: Retrospective case control study. Setting: Tertiary medical center. Subjects and Methods: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Results: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade ( P < .001). The use of inhaled corticosteroids was a significant risk factor ( P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Conclusion: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

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