Elective Situations Research Articles

Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies.

Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy. In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model. Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates. This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.

Low-Profile Minos TM Stent Graft System for Endovascular Abdominal Aorta Aneurysm Repair—Early and Late Outcomes in Elective and Emergent Situations

BackgroundThe aim of the study was to present the results of a novel abdominal stent graft for patients with Abdominal aortic aneurysm (AAA), through 2 years follow-up. MethodsA single-center retrospective review with prospectively collected data was performed to assess the safety and effectiveness of the Minos Abdominal stent device for treating abdominal aortic aneurysms. We estimated technical success rate, in-hospital and 30-day mortality, and mortality at the end of follow-up as well as complication and reintervention rate in our study cohort. Follow-up imaging assessments consisted of computed tomography angiography (CTA) at 1 and 6 months and yearly thereafter. ResultsA total of 52 patients (92% males; mean age, 74±6 years) were enrolled with Minos Abdominal stent device from July 2020 until September 2023. Thirty one (60%) patients were asymptomatic while 21 (40%) were symptomatic. The technical success of the endovascular aortic repair (EVAR) was 95% (49/52 patients). In 5% (3/52) of the cases, cannulation of the contralateral limb was unsuccessful and was converted to aorto-uni-iliac graft (AIU). Two (4%) aortic related death were recorded during the 30-day period. The major adverse event rate was 3.8%. The overall mean follow-up was 30±6 months; no aorta-related deaths or graft related complications were observed. Sac shrinkage (>5mm) has been observed in 70% of patients. ConclusionsMinos endoprosthesis seems to be safe, effective and durable for treating AAA either in elective or emergent situations.

Precision in practice: Exploring the impact of AI and machine learning on ultrasound guided regional anaesthesia.

Ultrasound Guided Regional Anaesthesia (UGRA) is a commonly utilized practice in both elective and emergency situations during surgical procedures and for pain management. Its benefits include, being non-invasive, cost-effective, readily accessible, and providing the anaesthetist with clear visualization of essential anatomical landmarks, needle progression, and the spread of local anaesthetic. Ultrasonography has been shown to increase success rates for regional anaesthesia and decrease complications. One of the critical steps during UGRA is identifying relevant anatomical structures like nerves or vertebras. However, this aspect can be hindered by external influences such as variations in nerve structure and position, interference from noise, and positional instability. Machine learning is a promising branch of artificial intelligence. It is used to conduct predictive tasks without programming instructions by creating algorithms. Extensive research has been conducted to evaluate the influence of machine learning on innovative anaesthesia methods. In 2023, Lopez et al. published a systematic review on how Artificial Intelligence could positively impact traditional anaesthesia practices.1 Various studies included in the review employed different models to achieve variable targets during the induction of anaesthesia. In one experiment, Alkhatib et al. used Convolutional neural network (CNN) based deep trackers to track the median and sciatic nerve with a surprising accuracy of 0.87.2 Another study employed the same CNN model to locate and discriminate accurate images of sacrum, vertebral levels and intervertebral gaps during percutaneous spinal needle insertion.3 Another study used a different AI model called SVM (support vector machine) classification, image processing, and template matching to locate lumbar level L3-L4 and the ideal puncture site for epidural anaesthesia in real-time. In this experiment, anaesthetists with minimal experience in ultrasonography were able to successfully determine needle puncture sites accurately.4 All these studies utilizing AI models not only yielded beneficial results but also led to significant time savings. Considering this, anaesthesiologists nationwide must integrate effective AI models to improve their clinical practice. This would minimize adverse outcomes in regional anaesthesia and ultimately enhance patient care and satisfaction.

The pediatric DAV-expert algorithm: A GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access device in children

In pediatric patients, the choice of the venous access device currently relies upon the operator’s experience and preference and on the local availability of specific resources and technologies. Though, considering the limited options for venous access in children if compared to adults, such clinical choice has a great critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems fully satisfactory and useful in clinical practice. Thus, the GAVePed—which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT—has developed a national consensus about the choice of the venous access device in children. After a systematic review of the available evidence, the panel of the consensus (which included Italian experts with documented competence in this area) has provided structured recommendations answering 10 key questions regarding the choice of venous access both in emergency and in elective situations, both in the hospitalized and in the non-hospitalized child. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.

What Is the Optimal Treatment for Liver Hydatid Cysts in Emergency and Elective Situations?

What Is the Optimal Treatment for Liver Hydatid Cysts in Emergency and Elective Situations?

The Use of Hyaluronidase in Aesthetic Practice: A Comparative Study of Practitioner Usage in Elective and Emergency Situations.

Hyaluronic acids (HAs) continue to be the fillers of choice worldwide and their popularity is growing. Adverse events (AEs) are able to be resolved through the use of hyaluronidase (HYAL). However, routine HYAL use has been at issue due to perceived safety issues. There are currently no guidelines on the use of HYAL in aesthetic practice, leading to variability in storage, preparation, skin testing, and beliefs concerning AEs. This manuscript interrogated the use of this agent in daily practice. A 39-question survey concerning HYAL practice was completed by 264 healthcare practitioners: 244 from interrogated databases and 20 from the consensus panel. Answers from those in the database were compared to those of the consensus panel. Compared to the database group, the consensus group was more confident in the preparation of HYAL, kept reconstituted HYAL for longer, and was less likely to skin test for HYAL sensitivity and more likely to treat with HYAL in an emergency, even in those with a wasp or bee sting anaphylactic history. Ninety-two percent of all respondents had never observed an acute reaction to HYAL. Just over 1% of respondents had ever observed anaphylaxis. Five percent of practitioners reported longer-term adverse effects, including 3 respondents who reported loss of deep tissues. Consent before injecting HA for the possible requirement of HYAL was always obtained by 74% of practitioners. Hyaluronidase would appear to be an essential agent for anyone injecting hyaluronic acid filler. However, there is an absence of evidence-based recommendations with respect to the concentration, dosing, and treatment intervals of HYAL, and these should ideally be available.

Data tweet clustering using bidirectional gated recurrent unit and k-prototype for the Indonesian political year

As time passes, social media, which was formerly used as a means of communication between users, is experiencing a transition as a means for broadcasting information, conducting business, advertising, and even political campaigning. In elections, social media is also used to discredit political opponents to reduce the electability of opposing candidate. Spreading hate speech and fake news to undermine the electability of opposing candidate is a common violation of the law committed by supporters of one candidate over another. Considering that the number of social media users increases annually at a very rapid rate, the hazard of social media abuse has the potential to grow. In 2022, Indonesia had 191 million social media users in January 2022. Obviously, this will make the election situation more tumultuous and has the potential to cause societal divisions. The government must have a control system in place to screen social media content that can be considered illegal. In this study, fake news and hate speech are classified using the Bidirectional Gated Recurrent Unit (BiGRU). Lastly, K-Prototype was used to do clustering based on categorization dimensions and probable distribution to identify which clusters had the greatest risk of breaking the law, creating confusion, and dispersing broadly throughout society. It is hoped that the clusters that are created will represent the levels of priority of tweet data that requires prompt attention from the government to prevent it from spreading and inciting social unrest. Based on the results of the analysis, the BiGRU fake news model yields a F1-score of 95%, while the BiGRU hate speech model yields a F1-score of 90%. Clustering data using K-Prototype in this research can reduce the number of tweet data from 13,183 to 1,791 data. These new data are considered as a priority that must be pursued in preventing social media disputes.

Endovascular Options for the Ascending Aorta and Aortic Arch: A Scoping Review

The gold standard for aneurysmal repair of the ascending aorta and the aortic arch has been open surgery with an established track record of good results in suitable patients. In recent years, with innovations in the endovascular field alternative endovascular solutions for pathologies of the aortic arch and ascending aorta became available. At first reserved only for highly selected patients unfit for open surgery, endovascular aortic arch repair is now being offered to patients with suitable anatomy in high volume referral centers after discussion in an interdisciplinary team. The present scoping review aims at providing an overview on indications, available devices, technical aspects and feasibility studies of endovascular arch repair both in elective and emergent situations, including also experiences and considerations from our center.

Думи на водещите броя

Думи на водещите броя

Guideline on the investigation and management of acute transfusion reactions.

Guideline on the investigation and management of acute transfusion reactions.

Low-Profile Altura Endograft System for Endovascular Abdominal Aorta Aneurysm Repair. Preliminary Results in Elective and Emergent Situations

The objective of this study was to assess the Altura endoprosthesis outcomes up to 12 months for patients affected by infrarenal abdominal aortic aneurysms (AAA) either in elective or emergent situations. This was a single-center retrospective study identifying all patients undergoing endovascular aortic repair (EVAR) with the Altura endoprosthesis from January 2021 to August 2022. Outcomes evaluated included mortality, technical and clinical success (freedom from procedure-related death, endoleak, migration, thrombosis, and reintervention) and the freedom from reintervention rate. A total of 34 (25 elective and 8 emergent) patients who underwent AAA with Altura endoprosthesis were retrospectively reviewed. The technical success of the Altura endograft either in elective or emergent situations was 100%. There was no in-hospital mortality, but 1 (3 %) patient who underwent AAA repair emergently, died unexpectedly 7 days after the discharge due to massive pulmonary embolism. The clinical success and the freedom from reintervention during the median follow up of 12 months (IQR 12-18), were 97%. One patient presented with disabling intermittent claudication at 3rd month postoperatively, and the CTA revealed thrombosis of one of the iliac endografts (3%). The patient underwent femorofemoral bypass with an uneventful postoperative course and immediate relief of the symptoms. One type II endoleak was spontaneously resolved on the 6th month. Sac shrinkage (>3mm) was registered in 12 patients (35 %) but the sac size was stable in the remaining 22 (65%) patients. The preliminary outcomes of the Altura endograft seem to be promising, suggesting that the endograft could be safely used either in elective or emergent situations. Further studies with a major number of participants are needed to document its technical and clinical performance, especially in emergency situations that could be amenable to improvement.

Comparison Study of Herniorrhaphy at Emergency and Elective Situations

Comparison Study of Herniorrhaphy at Emergency and Elective Situations

Routine preoperative MRCP in screening choledocholithiasis in acute cholecystitis compared to selective approach: a population-based study.

Choledocholithiasis is more common in acute cholecystitis than in elective situations. Preoperative diagnosis of choledocholithiasis is essential to facilitate adequate planning of CBD (common bile duct) stone removal, preferably performed as a single-stage procedure. The purpose of this study was to test the feasibility of routine preoperative magnetic resonance cholangiopancreatography (MRCP) in acute cholecystitis followed by consequent cholecystectomy. A total of 180 consecutive patients operated for acute cholecystitis between January 2019 and December 2019 were prospectively enrolled. Preoperative routine MRCP was performed for bile duct evaluation when feasible. The control cohort consisted of 180 consecutive patients undergoing emergency laparoscopic cholecystectomy before the study period. Intraoperative cholangiography was used routinely in both groups when technically achievable. We examined the proportion of patients recruited in preoperative MRCP, possible time delay to MRCP and surgery, and the incidence of CBD stones compared to the control cohort. Routine MRCP in acute cholecystitis was achieved in 114/180 (63%) patients compared to 42/180 (23.3%) patients of the control group. The triage time from emergency to MRCP and the operating theatre was similar in both cohorts. The percentage of patients diagnosed with choledocholithiasis in the study group was notably higher (almost 18% vs 11%), p < 0.05. After a median follow-up time of 2.5years in the study group and almost 4years in the control group, recurrent choledocholithiasis was not detected in either group. Routine MRCP in patients with acute cholecystitis can be implemented with a fair execution rate in a population-based setting with minor effects on hospital stay and delays but higher detection of choledocholithiasis. We observed no additional benefit compared to the selective use of MRCP. However, routine preoperative MRCP allows an advantage when considering the appropriate exploration method if choledocholithiasis is detected.

Tratamiento de los aneurismas de la aorta abdominal. Mejoras y evidencias

A review of the literature on aortic aneurysms is carried out, focusing on abdominal aortic aneurysms as the most frequent location. After introducing the topic (concept, frequency, natural history of the disease, consequences -mortality-, etc.), the review focuses on the individualized treatment of this entity and the improvements obtained during the last decade, both in elective and non-elective situations, which have led to a reduction in mortality. These improvements are due to several components such as: a) early diagnosis (screening effect) and correct follow-up of aneurysms (using echo-Doppler) that have made it possible to increase more elective surgeries and reduce urgent surgeries; b) control of cardiovascular risk factors, mainly tobacco and the use of statins in this type of patient; c) the role of endovascular surgery, which has made it possible to expand surgical indications to patients previously not eligible for open surgery, including nonagenarians and some centenarians; and d) to the effect of centralizing the most complex cases (the higher the volume, the better the results).

To study the incidences of needle stick injury among critical care nurses working in rural tertiary care hospital

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses.

Isolated iliac artery aneurysm : Clinical background and interventional treatment strategies

Isolated iliac artery aneurysms are less frequent than abdominal aortic aneurysms, with the same, predominantly atherosclerotic-degenerative etiology, but patients present more frequently with symptoms or at the stage of rupture. The majority of those affected are men over the age of65. The ideal imaging technique for diagnosis, treatment planning and follow-up is computed tomography (CT) angiography. Below adiameter of 4 cm, the risk of rupture is 6.3%, and then increases significantly with increasing diameter. Today, treatment is recommended from asize of 3.5 cm at the earliest. Because of the lower mortality, endovascular therapy is the leading treatment for the elective and emergency situation. The quality of the landing zones, which are important for sealing, is decisive for elimination of the aneurysm. The elimination is carried out by means of stent grafts, often in combination with embolization. Due to the risk of buttock claudication and erectile dysfunction, the preservation of ipsilateral pelvic perfusion is recommended in cases of insufficient collateralization. Special iliac branch devices or various parallel endograft techniques are available for this purpose. The main problem of endovascular treatment are endoleaks and the associated need for reintervention. Imaging control by means of CT angiography is crucial for timely endoleak detection, especially in the early phase.

(De)Constructing Myths in Editorial Cartoons: The Case of Philippine Elections

The electoral situation in the Philippines can be described as dramatic, and it seems to be a severe political competition since various media are exploited and manipulated; either the purpose is to construct or to assassinate one's character. This paper analyzed 20 editorial cartoons to identify the signifiers, infer the connotative meanings, and analyze the myths present in the editorial cartoons that represent the upcoming Philippine National election in 2022. This research employed a qualitative descriptive research design and content analysis. The researchers utilized purposive sampling in selecting the twenty editorial cartoons from reputable newspaper companies in the Philippines. Results of the study showed that the common signifiers present in the editorial cartoons were the men in barong and wearing salakot representing the Filipino citizens, alligator, lion, and pig representing the candidates, and finger-pointing that connotes blaming. Another significant finding that emerged from this study was the nine deconstructed myths inferred from the signifiers: political feud, hiding true intentions, political colors, election promises, power tripping, social media influence in electoral campaigns, foreign influence, honesty in an election, and nuisance candidates. In conclusion, from the perspective of the cartoonists of different media outlets, the election situation in the Philippines is negatively framed. Thus, the researchers recommend to conduct a study related to the signs used to portray the election process to understand the relationship of the concepts between its denotative and connotative meanings.

Transitivity Analysis of President Obama's Speech a More Perfect Union from the Perspective of Systemic Functional Grammar

Obama's friend reverend Wright was photographed with racist remarks that were extremely hostile to whites during his sermon, which shocked the United States and caused Obama's election situation to lag behind. As a result, Obama made this speech to address the situation. The transitivity system under Halliday's systemic functional grammar is used to analyze Obama's A More Perfect Union in order to explore the effectiveness and maneuverability of the transitivity system in achieving the purpose of the speech.

Patient Satisfaction Scoring After Pre Anesthesia Evaluation

Background: Evaluation of patient satisfaction after pre anesthesia has become an important part in the improvement of anesthesia services. This can also be used for the improvement of staff-patient relationship. This study is done to know about the satisfactory condition of the patient after pre anesthesia. The satisfactory tool we use are the same for both adult and paediatric age group since only few paediatric patients were included in the study.&#x0D; Methods: This study is a research, conducted on one hundred and twenty patients who undergone several surgeries at Saveetha Hospitals in Chennai, Tamil Nadu, India between January and March of 2021. Patients were asked several questions 24 h in the post-op section using a pre anesthesia Patient Satisfaction questionnaire. Based on their responses the data was collected to analyse the level of satisfaction of the patient.&#x0D; Results: The overall satisfaction score was found to be 68.8%. Percentage of satisfactory patients who were found to be less feared and concerned is 87.5%. Percentage of patients with whom the doctor maintained a good relationship with is 75%. 82% Patients were found to be happy with the amount information provided to them about the procedure. In elective situations the patient satisfaction was at a higher level.&#x0D; Conclusion: The satisfaction level among the patients were moderate. Patients described the staff-patient relationship was very satisfactory. They also described low fear and concern regarding anesthesia. The study also emphasised that the information regarding the anesthesia to the patients were satisfactory overall.The study was approved by the authors institution.

"Branch-First total arch replacement": a valuable alternative to frozen elephant trunk in acute type A aortic dissection?

The "Branch-First total arch replacement" technique has been used extensively in both elective and acute situations, including in type A aortic dissection. The focus of the Branch-First technique is to reduce the risk of neurological and end-organ dysfunction associated with arch replacement by optimising neuroprotection, distal organ perfusion and myocardial protection. The Branch-First technique is a valuable alternative to the frozen elephant trunk (FET) technique in type A aortic dissection, providing a stable landing zone for subsequent interventions on the distal aorta should they be required. Combining the Branch-First technique with FET in appropriate cases can further improve outcomes. We discuss the merits of the Branch-First technique, and contrast them to those of FET techniques for repair of type A aortic dissection.