Delirium-The Effect of Children Anesthesiology after Surgery

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)

Prospective Evaluation of a Standardized Screening for Atrial Fibrillation after Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

Aims: We aimed to prospectively investigate the effectiveness of a standardized follow-up for AF-detection after common atrial flutter (cAFL) ablation. Methods: A total of 309 patients after cAFL ablation without known AF, from 5 centers, and at least one completed, standardized follow-up at 3, 6 and 12 months, including a 24 h Holter-electrocardiogram (ECG), were included. The primary outcome was incident atrial fibrillation (AF), or atrial tachycardia (AT). Predictors were investigated by Cox proportional-hazards models. Results: The mean age was 67.9 years; 15.2% were female and the mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Sex category) score was 2.4 points. The great majority of patients (90.3%) were anticoagulated. Over a mean follow-up of 12.2 months with a standardized approach, AF/AT was detected in 73 patients, corresponding to 11.7% at 3 months, 18.4% at 6 months and 28.2% at 12 months of follow-up. AF was found in 64 patients, AT in 9 and both in 2 patients. Occurrence of AF was recorded in 40 (60.6%) patients by Holter-ECG and in the remaining 26 (39.4%) by clinical follow-up only. There was no difference in male versus female (p = 0.08), or in younger versus older patients (p = 0.96) for AF/AT detection. Only coronary artery disease (hazard ratio [95% confidence intervals] 1.03 [1.01–1.05], p = 0.01) was associated with the primary outcome. Conclusions: AF or AT was detected in a large proportion of cAFL patients after cavotricuspid-isthmus (CTI) ablation, using a standardized follow-up over 1 year. This standardized screening can be easily implemented with high patient acceptance. The high proportion of post-ablation AF needs to be taken into consideration when deciding on long-term oral anticoagulation.

Autism Spectrum Screening Checklist (ASSC): The Development of a Scale to Identify High-Risk Individuals Within the Children's Mental Health System

Autism Spectrum Disorder (ASD) is a complex childhood onset neurodevelopmental disorder that has become the fastest growing developmental disability. Due to the increased demand for diagnostic assessments and subsequent increased wait times, standardized screening as part of regular clinical practice is needed. More specifically, there is an important need for the development of a more streamlined screening tool within an existing assessment system to identify those at greatest risk of having ASD. The current study utilized data from ~17,000 assessments obtained within the province of Ontario, based on the interRAI Child and Youth Mental Health (ChYMH) and Child and Youth Mental Health and Developmental Disability (ChYMH-DD), to develop a scale to identify children who have a higher likelihood of having autism. The scale was then tested on a trial population with data from the interRAI Early Years instrument. Further analyses examined the predictive validity of the scale. The Autism Spectrum Screening Checklist (ASSC) was found to be a good predictor of ASD with a sensitivity of 0.73 and specificity of 0.62, at the recommended cut-point of 2+. The results were consistent across several age ranges, specifically from 2 to 21 years of age. The ASSC scale provides an initial screen to help identify children and youth at heightened risk for autism within larger populations being assessed as part of routine practice. The main goal for the development and implementation of the ASSC scale is to harness the power of the existing interRAI assessment system to provide a more efficient, effective screening and referral process. This will ultimately help improve patient outcomes through needs-based care.

Comparison of Colorectal cancer prognosis between developed and developing countries: A literature review.

Background: The cancer is caused when cells start dividing abnormally in the body. Age, genetics and lifestyle are major risk factors in developing cancer. The World Cancer Research Fund states that colorectal cancer incidence is globally ranked third in men and second in women. This highlights the need for effective screening and management of colorectal cancer to achieve better prognosis to prevent mortality and morbidity. Screening and management are not uniform all over the world, and it is affected by the economy of individual countries. In this context, we aimed to explore the prognosis of colorectal cancer in developed and developing countries and also to look for the factors affecting the prognosis.Material and Methods: A systematic search of the peer-reviewed journals from databases at Perdana University library which includes British Medical Journal, Up To Date, The Lancet, and Pubmed was done to answer the research questions. Results: We found that developed countries were in the west having a predominantly Caucasian population. The 5-year survival of patients with colorectal cancer (2008-13) was found to be least in Poland and the highest in Australia. In the developing countries it was found to have a broad representation from different ethnicities. The 5-year survival of colorectal cancer fwas ound to be least in Ghana and highest in Turkey.Conclusion: Looking at the results, the range of prognosis among developed countries is narrower than those in developing countries. This may be due to standardized screening and treatment practice in developed countries.

Delirium-The Effect off Children Anesthesiology after Surgery

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).

The Russian translations of the Alcohol Use Disorders Identification Test (AUDIT): A document analysis and discussion of implementation challenges

Aims: To analyze existing Russian translations of the Alcohol Use Disorders Identification Test (AUDIT) and their applicability in Russian-language populations. Method: Document analysis of different Russian-language versions of the AUDIT and its shorter versions as identified in a systematic search. Findings: A total of 122 Russian translations of the AUDIT or its shorter versions from Russia and other countries were included in the document analysis, 61 of which were unique versions. Across the translations, a series of inconsistencies was identified, most of which related to the first three consumption items and the concept of a standard drink. The identified problems appeared to have been caused by difficulties in adapting the tool to local drinking patterns and local beverage volumes. None of the analyzed sources mentioned systematic translation procedures according to a predetermined protocol. Conclusions: Despite the fact that the AUDIT was developed as a standardized screening tool almost 30 years ago, there is still no official translation into the Russian language according to the commonly used procedures for the translation and adaptation of instruments. A systematic translation and validation appears to be urgently needed in order to have an internationally comparable AUDIT for research and clinical purposes in Russian-speaking populations.

The Association Between Personality Disorder Traits and Suicidality Following Sudden Bereavement: A National Cross-Sectional Survey

Personality disorder is associated with increased risk of suicidal behavior. The authors aimed to investigate the association between number of personality disorder traits and suicidality risk following sudden bereavement. A secondary analysis of cross-sectional data on 3,167 young adults in the United Kingdom who had experienced sudden bereavement investigated the association between number of traits (measured using a standardized screening instrument) and postbereavement suicide attempt and suicidal ideation. Using multivariable logistic regression, the authors found a linear relationship between number of traits and suicide attempt (adjusted odds ratio [AOR] = 1.36, 95% CI [1.23, 1.49]) and suicidal ideation (AOR = 1.31, 95% CI [1.25, 1.38]) following bereavement. This represented an increase in odds by 36% and 31%, respectively, for each additional personality trait. The authors suggest that individuals with a greater number of traits suggestive of a personality disorder diagnosis are at increased risk of suicidality after a negative life event.