17 research outputs found
Death on the table : anaesthetic registrars' experiences with perioperative deaths.
No full textM. Med. University of KwaZulu-Natal, Durban 2013.Please refer to the PDF file for the formatted abstract
Pediatric perioperative outcomes group: Defining core outcomes for pediatric anesthesia and perioperative medicine
No full textThe association between preoperative anemia and postoperative morbidity in pediatric surgical patients: A secondary analysis of a prospective observational cohort study
No full textBACKGROUND : The prevalence of anemia in the South African pediatric surgical population is unknown. Anemia may be associated with increased postoperative complications. We are unaware of studies documenting these findings in patients in low- and middle-income countries (LMICs).
AIM : The primary aim of this study was to describe the association between preoperative anemia and 26 defined postoperative complications, in noncardiac pediatric surgical patients. Secondary aims included describing the prevalence of anemia and risk factors for intraoperative blood transfusion.
METHOD : This was a secondary analysis of the South African Paediatric Surgical Outcomes Study, a prospective, observational surgical outcomes study. Inclusion criteria were all consecutive patients aged between 6 months and <16 years, presenting to participating centers during the study period who underwent elective and nonelective noncardiac surgery and had a preoperative hemoglobin recorded. Exclusion criteria were patients aged <6 months, undergoing cardiac surgery, or without a preoperative Hb recorded. To determine whether an independent association existed between preoperative anemia and postoperative complications, a hierarchical stepwise logistic regression was conducted.
RESULTS : There were 1094 eligible patients. In children in whom a preoperative Hb was recorded 46.2% had preoperative anemia. Preoperative anemia was independently associated with an increased risk of any postoperative complication (odds ratio 2.0, 95% confidence interval: 1.3-3.1, P = .002). Preoperative anemia (odds ratio 3.6, 95% confidence interval: 1.8-7.1, P < .001) was an independent predictor of intraoperative blood transfusion.
CONCLUSION : Preoperative anemia had a high prevalence in a LMIC and was associated with increased postoperative complications. The main limitation of our study is the ability to generalize the results to the wider pediatric surgical population, as these findings only relate to children in whom a preoperative Hb was recorded. Prospective studies are required to determine whether correction of preoperative anemia reduces morbidity and mortality in children undergoing noncardiac surgery.http://wileyonlinelibrary.com/journal/panhj2021Anaesthesiolog
Open destinies : modern American women and the short story cycle
No full textThis thesis examines the juncture between the short story cycle form and gender politics. It explores how twentieth-century women from the United States have been using the form to represent and question gender identity. The introduction outlines commentaries on the story cycle and considers definitions of the form. It includes case studies of earlier twentieth-century cycles by American women: cycles such as Mary McCarthy's The Company She Keeps that have been passed over by critics of the form.
Chapter One presents Eudora Welty's The Golden Apples as a cycle paradigm, examining conventions such as the form's metafictional dimension and its preoccupation with communal identity. Chapter Two argues that Grace Paley's scattered Faith narratives set a standard for more dispersed versions of the form. Chapter Three considers how Joyce Carol Oates uses the sequential cycle to represent gender identity as a social construct. Chapters Four and Five examine the macrocosmic cycles of Gloria Naylor and Louise Erdrich and consider changes in their form and gender politics. The final 'composite' chapters explore postmodern versions of the form such as Susan Minot's Monkeys. The prose works of Sandra Cisneros stretch across the story cycle continuum, whilst Toni Morrison's Paradise is universally regarded as a novel. Readings of contemporary cycles by Melissa Bank, Elissa Schappell and Emily Carter demonstrate that American women are re-invigorating the form to facilitate the plural identity of the postmodern heroine
A systematic review of outcomes reported in pediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group
No full textAn evaluation of severe anesthetic-related critical incidents and risks from the South African paediatric surgical outcomes study : a 14-day prospective, observational cohort study of pediatric surgical patients
No full textSUPPLEMENTARY MATERIAL 1 : The South African Paediatric Surgical Outcomes Study (SAPSOS): A 14-day
prospective, observational cohort study of paediatric surgical patients.SUPPLEMENTARY MATERIAL 2 : South African Paediatric Surgical Outcomes Study (SAPSOS) : Operating Room case record form.SUPPLEMENTARY MATERIAL 3 : Supplemental Tables and Figures.BACKGROUND :
Severe anesthetic-related critical incident (SARCI) monitoring is an essential component of safe, quality anesthetic care. Predominantly retrospective data from low- and middle-income countries (LMICs) report higher incidence but similar types of SARCI compared to high-income countries (HIC). The aim of our study was to describe the baseline incidence of SARCI in a middle-income country (MIC) and to identify associated risk for SARCI. We hypothesized a higher incidence but similar types of SARCI and risks compared to HICs.
METHODS :
We performed a 14-day, prospective multicenter observational cohort study of pediatric patients (aged <16 years) undergoing surgery in government-funded hospitals in South Africa, a MIC, to determine perioperative outcomes. This analysis described the incidence and types of SARCI and associated perioperative cardiac arrests (POCAs). We used multivariable logistic regression analysis to identify risk factors independently associated with SARCI, including 7 a priori variables and additional candidate variables based on their univariable performance.
RESULTS :
Two thousand and twenty-four patients were recruited from May 22 to August 22, 2017, at 43 hospitals. The mean age was 5.9 years (±standard deviation 4.2). A majority of patients during this 14-day period were American Society of Anesthesiologists (ASA) physical status I (66.4%) or presenting for minor surgery (54.9%). A specialist anesthesiologist managed 59% of cases. These patients were found to be significantly younger (P < .001) and had higher ASA physical status (P < .001). A total of 426 SARCI was documented in 322 of 2024 patients, an overall incidence of 15.9% (95% confidence interval [CI], 14.4–17.6). The most common event was respiratory (214 of 426; 50.2%) with an incidence of 8.5% (95% CI, 7.4–9.8). Six children (0.3%; 95% CI, 0.1–0.6) had a POCA, of whom 4 died in hospital. Risks independently associated with a SARCI were age (adjusted odds ratio [aOR] = 0.95; CI, 0.92–0.98; P = .004), increasing ASA physical status (aOR = 1.85, 1,74, and 2.73 for ASA II, ASA III, and ASA IV–V physical status, respectively), urgent/emergent surgery (aOR = 1.35, 95% CI, 1.02–1.78; P = .036), preoperative respiratory infection (aOR = 2.47, 95% CI, 1.64–3.73; P < .001), chronic respiratory comorbidity (aOR = 1.75, 95% CI, 1.10–2.79; P = .018), severity of surgery (intermediate surgery aOR = 1.84, 95% CI, 1.39–2.45; P < .001), and level of hospital (first-level hospitals aOR = 2.81, 95% CI, 1.60–4.93; P < .001).
CONCLUSIONS :
The incidence of SARCI in South Africa was 3 times greater than in HICs, and an associated POCA was 10 times more common. The risk factors associated with SARCI may assist with targeted interventions to improve safety and to triage children to the optimal level of care.The Jan Pretorius Research Fund, South African
Society of Anaesthesiologists; Discipline of Anaesthesiology and Critical Care, Nelson R.
Mandela School of Medicine, University of KwaZulu-Natal; Department of Anaesthesia and
Perioperative Medicine, Groote Schuur Hospital and University of Cape Town; Department
of Anaesthesia, University of the Witwatersrand; and Paediatric Anaesthesia Community of
South Africa.https://journals.lww.com/anesthesia-analgesia/pages/default.aspxhj2023Anaesthesiolog
Core outcome sets for pediatric perioperative research: An international stakeholder engagement exercise and consensus report from the Pediatric Perioperative Outcomes Group
No full textBACKGROUND:
Identifying the outcomes that matter in clinical research is important, especially those that matter to patients and their parents/guardians. Consistency in outcome reporting enables meaningful assessments of interventions and facilitates comparison of results across trials. The aim of this study was to develop core outcome sets for pediatric perioperative research. / /
METHODS:
We determined core outcome sets through extensive stakeholder engagement, following a stepwise process as recommended by the COMET initiative. We surveyed patients, parents/guardians, and healthcare providers to elicit views on the importance of perioperative outcomes. These results informed a subsequent Delphi process of expert stakeholder representatives. Final core outcome sets were agreed to following virtual face-to-face meetings of the investigators. / /
RESULTS:
1,178 total subjects were included in the international stakeholder survey: 81 patients ages 8–12 years, 99 patients ages 13–17 years, 587 parents/guardians, and 411 healthcare providers (128 nurses, 147 anesthesiologists, and 136 surgeons). Subjects were recruited in Australia, Canada, China, Colombia, the Netherlands, New Zealand, South Africa, Switzerland, and the USA. Sixty-seven expert stakeholders completed a two-round Delphi, including 7 patient family representatives, 9 surgeons, 7 nurses, and 44 anesthesiologists. Proposed core outcome sets were voted on and unanimously agreed to following the virtual face-to-face meetings for the following populations: neonates, infants, children ages 1–12 years, and adolescents ages 13–17 years. Core outcomes for all populations included cardiovascular or respiratory adverse events, pain, assessment of pain relief, and unplanned medical attention. Quality of recovery was included in all but the neonate population, while return to normal function was also included in the adolescent population. / /
CONCLUSIONS:
We identified perioperative core outcome sets for four age-based pediatric populations. Researchers should include these outcomes in their studies whenever appropriate, in addition to the outcomes specific to their research question
Quality of recovery after total hip and knee arthroplasty in South Africa : a national prospective observational cohort study
No full textBACKGROUND: Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip
and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first
performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives
of this second phase of changing practice were to document quality of patient recovery, record patient
characteristics and audit standard perioperative practice.
METHODS: From May to December 2018, nine South African public hospitals conducted a 10-week prospective
observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30
days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital
length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative
patient characteristics and perioperative care were documented to audit practice.
RESULTS: Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study
patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate
was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%)
were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic,
multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively.
On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic
regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%).
CONCLUSION: Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South
African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked
standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of
ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is
feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative.http://www.biomedcentral.com/bmcmusculoskeletdisordpm2021AnaesthesiologyOrthopaedic SurgeryPhysiotherap
Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds): study protocol and statistical analysis plan for a multicentre international observational cohort study
No full textIntroduction Surgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries.Methods and analysis LASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission.Ethics and dissemination This study received approval from the Institutional Review Board of the coordinating centre (Hospital das Cl & iacute;nicas, Faculdade de Medicina, Universidade de S & atilde;o Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences.Trial registration number NCT05934682.Smile Trai
The V471A polymorphism in autophagy-related gene ATG7 modifies age at onset specifically in Italian Huntington disease patients
No full textThe cause of Huntington disease (HD) is a polyglutamine repeat expansion of more than 36 units in the huntingtin protein, which is inversely correlated with the age at onset of the disease. However, additional genetic factors are believed to modify the course and the age at onset of HD. Recently, we identified the V471A polymorphism in the autophagy-related gene ATG7, a key component of the autophagy pathway that plays an important role in HD pathogenesis, to be associated with the age at onset in a large group of European Huntington disease patients. To confirm this association in a second independent patient cohort, we analysed the ATG7 V471A polymorphism in additional 1,464 European HD patients of the "REGISTRY" cohort from the European Huntington Disease Network (EHDN). In the entire REGISTRY cohort we could not confirm a modifying effect of the ATG7 V471A polymorphism. However, analysing a modifying effect of ATG7 in these REGISTRY patients and in patients of our previous HD cohort according to their ethnic origin, we identified a significant effect of the ATG7 V471A polymorphism on the HD age at onset only in the Italian population (327 patients). In these Italian patients, the polymorphism is associated with a 6-years earlier disease onset and thus seems to have an aggravating effect. We could specify the role of ATG7 as a genetic modifier for HD particularly in the Italian population. This result affirms the modifying influence of the autophagic pathway on the course of HD, but also suggests population-specific modifying mechanisms in HD pathogenesis
