63 research outputs found
The impact of the COVID-19 outbreak on emergency general surgery in the first German "hotspot region" Aachen-Heinsberg - a multicentre retrospective cohort study
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Early Postoperative Parathormone and Calcium as Prognostic Factors for Postoperative Hypocalcemia
No full textBackground. Postoperative hypocalcemia is one of the most common complications after total thyroidectomy. Parathormone (PTH) and calcium levels, measured several hours after surgery, have been suggested as valuable markers for detecting patients at risk for post-thyroidectomy hypocalcemia. We aimed to determine if early post-surgery PTH and calcium levels can be used for the early identification of patients at risk for symptomatic hypocalcemia. Methods. PTH and calcium were measured before surgery and at 10 min and 4 h post-thyroidectomy, in 77 patients. Performance characteristics of PTH and calcium levels and their post/pre-surgery ratios were calculated. Results. Four-hour calcium was a sensitive (93.75%) but not specific (67.61%) indicator of patients at risk for symptomatic hypocalcemia. The 4-h/pre-surgery PTH ratio was the most accurate (90.81%) and the most specific (94.37%) test to identify patients at risk. Serum calcium at 4-h, 4-h/pre-surgery PTH ratio, and PTH at 10 min post-surgery had the higher diagnostic odds ratios (50.86, 32.85, and 29.04, respectively). The 4-h/pre-surgery PTH ratio also had the highest (0.694) Youden’s J statistic. Conclusions. Low serum calcium levels 4 h after thyroidectomy and the 4-h/pre-surgery PTH ratio could be valuable additions to everyday clinical practice in post-thyroidectomy patients
Correction: Daskalaki et al. Early Postoperative Parathormone and Calcium as Prognostic Factors for Postoperative Hypocalcemia. J. Clin. Med. 2022, 11, 2389
No full textIn the published article [...
Correction : Daskalaki et al. Early Postoperative Parathormone and Calcium as Prognostic Factors for Postoperative Hypocalcemia. J. Clin. Med. 2022, 11, 2389
No full textA Comparison of the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment-Short Form (MNA-SF) Tool for Older Patients Undergoing General Surgery
No full textThe optimal malnutrition screening tool in geriatric surgery has yet to be determined. Herein, we compare two main tools in older patients undergoing general surgery operations. Older patients (>65 years old) who underwent general surgery operations between 2012 and 2017 in a tertiary centre were included. The Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short Form (MNA-SF) were used for nutritional risk assessment. Preoperative variables as well as postoperative outcomes were recorded prospectively. Agreement between tools was determined with the weighted kappa (κ) statistic. Multiple regression analysis was used to assess the association of the screening tools with postoperative outcomes. A total of 302 patients (median age 74 years, range: 65–92) were included. A similar number of patients were classified as medium/high risk for malnutrition with the MNA-SF and MUST (26% vs. 36%, p = 0.126). Agreement between the two tools was moderate (weighted κ: 0.474; 95%CI: 0.381–0.568). In the multivariate analysis, MNA-SF was associated significantly with postoperative mortality (p = 0.038) and with postoperative length of stay (p = 0.001). MUST was associated with postoperative length of stay (p = 0.048). The MNA-SF seems to be more consistently associated with postoperative outcomes in elderly patients undergoing general surgery compared with the MUST tool
Review supplemental material - Cost of diagnosis in endocrine disease
No full textA table containing information on the quality of the studies that were included in the systematic review entitled ‘Economic Evidence on Optimal Approaches to Diagnosis and Monitoring in Rare Endocrine Disorders’ that was conducted in the years 2017-2018 at the University of Bristol. The quality assessment was based on a commonly used checklist for assessing economic evaluation studies
Laparoscopic repair of posttraumatic diaphragmatic rupture. Report of three cases
No full textAbstractINTRODUCTIONPosttraumatic diaphragmatic rupture (PTDR) is a rare complication of thoracoabdominal injuries. In the emergency phase, it is generally treated via wide laparotomy. The laparoscopic approach is controversial and it is reserved for the chronic type of PTDR. Herein we present three cases of laparoscopic treatment of PTDR, one of which was conducted early after the injury.PRESENTATION OF CASEThe patients’ age was 42, 66 and 53 years and the time from the injury until the operation 1 week, 2 months and 4 years, respectively. Hernia involved the left hemidiaphragm in two patients and the right hemidiaphragm in the second patient. Prolapsing viscera were the omentum/stomach/spleen, the small intestine and the omentum/large bowel, respectively. The PTDR was diagnosed right after the injury of the first patient but its treatment was postponed until the fourth day of hospitalization because of severe respiratory distress due to bilateral pneumothorax, flail chest and extended bilateral lung contusions. All patients underwent laparoscopic operation and correction of the hernia with the use of non-absorbable sutures or endoclips in two patients. There were no serious intra- or postoperative complications and the patients were discharged 30, 5, 6 days after the operation. After a period of 1, 8 and 9 years, respectively the patients remain without clinical evidence of recurrence.DISCUSSIONTrauma is the major cause of acquired diaphragmatic hernias.CONCLUSIONLaparoscopy is an attractive approach for the management of chronic PTDR. Moreover, it may offer the benefits of minimally invasive surgery during the acute phase of injury in highly selected patients
Sensitivity of Greek Organisations in Sustainability Issues
No full textRecently, the world has been faced with a variety of environmental, social, and economic problems. The effects of climate change and the lack of resources are constantly intensifying, while at the same time the impact of industrial production has become an international issue. Undoubtedly, this global paradigm and these relevant social and economic challenges require joint efforts at an international level. During the past few decades, a number of companies in Greece have undertaken initiatives towards sustainable development (SD) by adopting “green” practices. This work presents the findings of a survey that has been conducted in 2020, which investigates the extent of business contribution to the United Nations’ 17 Sustainable Development Goals (SDGs). Research was based on the analysis of sustainability reporting published by Greek companies. The key findings of the survey show that issues related to environmental protection, societal well-being, and citizens’ quality of life have attracted an increasing level of awareness in the Greek industry sectors. Issues such as climate change, as well as sustainable production and consumption, are becoming topics within companies’ day-to-day agenda
Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model
No full textBackground:
An estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom.
Methods:
We estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes.
Results:
Base-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045 and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to approximately £30,000 or below.
Conclusion:
DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective .
Trial registration:
ISRCTN registry number: ISRCTN44922411.
Date of registration: 06/02/2012.
Retrospectively registered
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