scholarly journals Results of Surgery in General Surgical Patients Receiving Warfarin: Retrospective Analysis of 61 Patients

2015 ◽  
Vol 100 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Sedat Belli ◽  
Huseyin Ozgur Aytac ◽  
Hakan Yabanoglu ◽  
Erdal Karagulle ◽  
Alper Parlakgumus ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Anticoagulation Therapy ◽  
Mortality Rates ◽  
Major Surgery ◽  
Factors Affecting ◽  
Long Duration ◽  
Prolonged Duration ◽  
Therapy Protocol

The aim of this study is to investigate postoperative complications, mortality rates, and to determine the factors affecting mortality on the patients receiving warfarin therapy preoperatively, as well as comparing the results obtained from emergency and elective surgeries. Surgical outcomes of 61 patients on long-term oral anticoagulation with warfarin who underwent surgery in our center were retrospectively reviewed over an 8-year period. Thirty-three (54.1%) patients were female, with a mean age of 53 years. Mitral valve replacement (62.3%) was the most frequent indication for chronic anticoagulation therapy. Twelve out of 61 (19.2%) patients underwent emergency surgery; 59 (96.7%) operations were classified as major surgery. We did not observe any thromboembolic events on patients receiving our bridging therapy protocol. Cardiopulmonary dysfunction (CPD; 19.7%) and hemorrhage (16.4%) were the most encountered postoperative complications. Presence of CPD, bleeding, endocarditis, and mortality were statistically significant for emergency surgeries when compared with the results obtained from elective surgeries. There were 5 (8.2%) deaths observed during follow-up. It was found that advanced age, prolonged duration of operations, and presence of CPD had a statistically significant effect on mortality (P < 0.05). The patients receiving oral anticoagulant had high postoperative complication and mortality rates. This case was more evident in emergency surgeries. It is recommendable that as mortality is more apparent in the patients who undergo emergency surgeries—being older, having long duration of operations as well as CPD. Therefore during the postoperative follow-up process, the patients should be closely monitored.

Long-term follow-up after bowel resection for necrotizing enterocolitis: Factors affecting outcome

1998 ◽  
Vol 33 (7) ◽  
pp. 967-972 ◽  
Author(s):  
Alan P Ladd ◽  
Frederick J Rescorla ◽  
Karen W West ◽  
L.R Scherer ◽  
Scott A Engum ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Bowel Resection ◽  
Factors Affecting ◽  
Long Term Follow Up

scholarly journals Febrile Neutropenia and Long-term Risk of Infection Among Patients Treated With Chemotherapy for Malignant Diseases

2018 ◽  
Vol 5 (10) ◽  
Author(s):  
Josefine Nordvig ◽  
Theis Aagaard ◽  
Gedske Daugaard ◽  
Peter Brown ◽  
Henrik Sengeløv ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Mortality Rates ◽  
Risk Of Infection ◽  
Increased Risk ◽  
Competing Events ◽  
Adjusted Incidence Rate ◽  
New Treatment ◽  
Rate Ratios

Abstract Background Febrile neutropenia (FN) is a common complication to chemotherapy, associated with increased short-term morbidity and mortality. However, the long-term outcomes after FN are poorly elucidated. We examined the long-term risk of infection and mortality rates in cancer patients with and without FN. Methods Patients aged >16 years treated with firstline chemotherapy were followed from 180 days after initiating chemotherapy until first infection, a new treatment with chemotherapy, death, or end of follow-up. Risk factors for infections were analyzed by competing risks regression, with death or another treatment with chemotherapy as competing events. Adjusted incidence rate ratios (aIRRs) of infection and death were analyzed using Poisson regression. In analyses of mortality, infection was included as a time-updated variable. Results We included 7190 patients with a median follow-up (interquartile range) of 0.58 (0.20–1.71) year. A total of 1370 patients had an infection during follow-up. The aIRRs of infection were 1.86 (95% confidence interval [CI], 1.56–2.22) and 2.19 (95% CI, 1.54–3.11) for patients with 1 or >1 episode of FN compared with those without FN. Mortality rate ratios were 7.52 (95% CI, 6.67–8.48) <1 month after, 4.24 (95% CI, 3.80–4.75) 1–3 months after, 2.33 (95% CI, 1.63–3.35) 3–6 months after, and 1.09 (95% CI, 0.93–1.29) >6 months after an infection, compared with the time before infection. Conclusions FN during chemotherapy is associated with a long-term increased risk of infection. Mortality rates are substantially increased for 6 months following an infection.

scholarly journals ACTR-38. A SINGLE CENTER STUDY: LONG-TERM OUTCOMES OF COMBINED CHEMORADIATION THERAPY WITH TEMOZOLOMIDE FOR NEWLY DIAGNOSED GLIOBLASTOMA IN KOREAN PATIENT

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi21-vi21
Author(s):  
Kyeong-O Go ◽  
Ha Young Yang ◽  
Kihwan Hwang ◽  
Jung Ho Han ◽  
Hyoung Soo Choi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Treatment ◽  
Genetic Factors ◽  
Newly Diagnosed ◽  
Factors Affecting ◽  
Korean Patients ◽  
Significant Difference ◽  
Newly Diagnosed Glioblastoma

Abstract In newly diagnosed glioblastoma (GBM), Temozolomide (TMZ) during and after radiation therapy has become standard treatment. This study describes the long-term use and follow-up results of this therapy for GBM. From 2004 to 2013 in a single institute, 112 Korean patients with newly diagnosed GBM were analyzed retrospectively. The Kaplan-Meier method, the two-sided log-rank test and Cox’s regression analysis was used to determine survival and its affecting factors. The toxicities of TMZ were evaluated using CTCAE v5.0. During the median follow-up period of 18.8 months, median PFS and OS were 9.2 and 20.3 months, respectively. This better survival outcome than the Stupp’s original study might be probably a large treatment effect of a single institution, ethnicity, and associated genetic factors. The TMZ during radiation therapy was completed in 108 patients (96.4%) and TMZ after radiation therapy in 59 patients (52.7%). Eight patients presented with grade 3 or 4 hematologic toxic effects during the protocol. Sixty-six patients (58.9%) received salvage treatment because of the poor response to adjuvant treatment or progression of the disease who achieved completion of adjuvant treatment was shown significantly longer median OS (p= 0.007) and PFS (p< 0.001). Age (< 60 years), preoperative KPS score (≥ 90), the extent of resection (≥ 78% by volumetric measurement, gross total resection), and completion of the Stupp’s protocol were significant factors affecting better survival. Between the sexes, and ages over 65 years did not show any significant difference among their groups. With marginal significances, the mutated IDH-1 and the methylated MGMT promoter showed longer median PFS(p= 0.075 and 0.777, respectively) and OS (p= 0.085 and 0.131, respectively). TMZ during and after radiation therapy might be effective and safe for newly diagnosed Korean patients with GBM. Further studies about various clinical and genetic factors affecting better survival are mandatory.

scholarly journals New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032949 ◽  
Author(s):  
Zhihui Zhu ◽  
Yuehuan Li ◽  
Xu Meng ◽  
Jie Han ◽  
Yan Li ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Heart Valve ◽  
Anticoagulation Therapy ◽  
Internet Technology ◽  
Heart Valve Replacement ◽  
Management Model ◽  
The Internet ◽  
Anticoagulation Management

IntroductionWarfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects.Methods and analysisA prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor–patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled.Ethics and disseminationThis study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal.Trial registration numberChiCTR1800016204.

scholarly journals Lifestyle and Long-Term Smoking Cessation

2020 ◽  
Vol 13 ◽  
pp. 1179173X2096306
Author(s):  
Tove Sohlberg ◽  
Karin Helmersson Bergmark
Keyword(s):  
Smoking Cessation ◽  
Smoking Initiation ◽  
Lifestyle Changes ◽  
Factors Affecting ◽  
Quit Smoking ◽  
Swedish Health Care ◽  
The Impact ◽  
Term Maintenance

Background: Since smoking is the leading cause of preventable death, discouraging smoking initiation, encouraging smoking cessation, and exploring factors that help individuals to stay smoke free are immensely important. One such relevant factor may be the impact of lifestyle for long-term smoking cessation. Method: A representative sample of successful quitters was recruited for a study about smoking cessation. These respondents are now part of a 7-year follow-up with the overall aim of revealing factors affecting long-term smoking cessation. Descriptive analyses were carried out at baseline and at follow-up, as well as a further two-step cluster analysis to explore profiles of long-term smoke-free individuals. Results: A majority did not make any particular lifestyle changes, but among those who did, most adopted a healthier lifestyle and/or increased their quota of physical training, where permanent changes in this direction seem to promote a more enduring smoke-free life. Conclusions: Individuals who want to quit smoking should be encouraged to increase their level of physical activity. Swedish health care institutions should be able to provide support for this both initially and over time to promote the long-term maintenance of a smoke-free lifestyle.

P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Kalinczuk ◽  
Z Chmielak ◽  
K Zielinski ◽  
G S Mintz ◽  
M Dabrowski ◽  
...  
Keyword(s):  
Clinical Importance ◽  
Mortality Rates ◽  
Paravalvular Leak ◽  
Single Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Common Location ◽  
Long Term Mortality

Abstract Background Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations. Purpose To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR. Methods Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed. Results Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B). Figure 1 Conclusions Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.

Unit Manager's Role with Family Members of Clients in Complex Continuing Care Settings: An Untold Story

2005 ◽  
Vol 24 (2) ◽  
pp. 127-137
Author(s):  
Sepali Guruge ◽  
Katherine McGilton ◽  
Linda Yetman ◽  
Heather Campbell ◽  
Ruby Librado ◽  
...  
Keyword(s):  
Family Relationships ◽  
Family Members ◽  
Future Research ◽  
Continuing Care ◽  
Theory Approach ◽  
Term Care ◽  
Factors Affecting ◽  
Closing The Loop

ABSTRACTMost literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC) environments from the perspective of staff were found in the literature. A qualitative study that draws on a grounded theory approach was conducted to explore staff-family relationships in CCC, and the findings presented in this article illuminate the unit manager's role. Data were collected through in-depth interviews with nine unit managers and a follow-up focus group with five unit managers who work in three CCC facilities. Three categories reflecting the unit manager's role with family members of clients in CCC settings were derived: establishing supportive entry; building and preserving relationships; and closing the loop. Implications of the findings for practice and future research are presented.

P12 LONG-TERM QUALITY OF LIFE AFTER TOTAL GASTRECTOMY VERSUS IVOR LEWIS ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E Jezerskyte ◽  
L M Saadeh ◽  
E R C Hagens ◽  
M A G Sprangers ◽  
L Noteboom ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Nausea And Vomiting ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Significant Difference

Abstract Aim The aim of this study was to investigate the difference in long-term health-related quality of life in patients undergoing total gastrectomy versus Ivor Lewis esophagectomy in a tertiary referral center. Background & Methods Surgical treatment for gastroesophageal junction (GEJ) cancers is challenging. Both a total gastrectomy and an esophagectomy can be performed. Which of the two should be preferred is unknown given the scarce evidence regarding effects on surgical morbidity, pathology, long-term survival and health-related quality of life (HR-QoL). From 2014 to 2018, patients with a follow-up of > 1 year after either a total gastrectomy or an Ivor Lewis esophagectomy for GEJ or cardia carcinoma completed the EORTC QLQ-C30 and EORTC QLQ-OG25 questionnaires. Problems with eating, reflux and nausea and vomiting were chosen as the primary HR-QoL endpoints. The secondary endpoints were the remaining HR-QoL domains, postoperative complications and pathology results. Multivariable linear regression was applied taking confounders age, gender, ASA classification and neoadjuvant therapy into account. Results 30 patients after gastrectomy and 71 after Ivor Lewis esophagectomy with a mean age of 63 years were included. Median follow-up was two years (range 12-84 months). Patients after total gastrectomy reported significantly less choking when swallowing and coughing (β=-5.952, 95% CI -9.437 – -2.466; β=-13.084, 95% CI -18.525 – -7.643). Problems with eating, reflux and nausea and vomiting were not significantly different between the two groups. No significant difference was found in postoperative complications or Clavien-Dindo grade. Significantly more lymph nodes were resected in esophagectomy group (p=0.008). No difference in number of positive lymph nodes or R0 resection was found. Conclusion After a follow-up of > 1 year choking when swallowing and coughing were less common after total gastrectomy. No significant difference was found in problems with eating, reflux or nausea and vomiting nor in postoperative complications or radicality of surgery. Based on this study no general preference can be given to either of the procedures for GEJ cancer. Patients may be informed about the HR-QoL domains that are likely to be affected by the different surgical procedures, which in turn may support shared decision making when a choice between the two treatment options is possible.

Sign in / Sign up

Export Citation Format

Share Document