1,720,957 research outputs found
MDR colonization: what ́s the matter in the perioperative setting?
No full textINTRODUCTION. Multi-Drug-Resistant (MDR) colonization is an actual major issue in intensive care units (ICUs) and perioperative medicine, frequently resulting in life-threatening infections. OBJECTIVES. The aim of this study was to evaluate the post- operative course of patients requiring ICU admission after surgery and to compare MDR colonized patients (pts) undergoing abdominal surgery to non colonized ones. METHODS. We retrospectively analyzed all consecutive patients undergoing surgery in our hospital for a three-month period (July- September 2017) who required admission to our 12-bed-medico- surgical ICU on post-operative day (POD) 0 (Dept Anesthesia and Intensive Care B, Policlinico GB Rossi). We then compared MDR col- onized (rectal and/or pharyngeal swab) patients (MDR+) to non col- onized patients (MDR-) for post operative complications, ICU and hospital length of stay (LOS) and mortality. We also investigated the impact of administered targeted perioperative antibiotic ther- apy compared to empiric antibiotic prophylaxis. RESULTS. 70 pts were included in the study (47 men), median age 67(55-79) years; they underwent either elective (n=57, 81.4%) or emergency (n= 13, 18.6%) surgery; 33 pts (47.1%) were submitted to pancreatic surgery, 15 (21.4%) to intestinal resection, 13 (18.6%) to hepato-biliary surgery, and the rest to other kind of abdominal sur- gery; they were admitted to ICU on POD 0 for scheduled (n =52, 74,3%) or unscheduled (n= 18, 25,7%) intensive PO monitoring. These latter were admitted because of surgical length (10, 4.9%), sep- tic episode (4, 5.7%), intraoperative hypotension (2, 2.9%) , intraoper- ative hemorrage (2, 2.9%). 11 pts were MDR+ pre operatively (15,7%), 4 of whom were either Klebsiella Pneumoniae Carbapenemasis Producer or Vancomycin Re- sistant Enterococcus (VRE) colonized and 7 pts were Extended Spectrum Beta Lactamase (ESBL) Escherichia Coli colonized. Both ICU and hospital LOS were significantly higher in MDR+ compared to MDR- (16±23 vs 2±3 and 37±25 vs 22±16, respectively, p < 0.05). Hospital mortality occured in 4 patients, all MDR+ (p< 0.001). Postop- erative complication incidence and type did not significantly differ between the two groups. 4 MDR+ patients (5.7%) received targeted pre-operative antibiotic therapy compared to standard prophylaxis but this did not influence their outcome (small number). CONCLUSIONS. Pre-operative surveillance swab positivity correlates with both ICU and hospital LOS and post-operative mortality, no matter swap and surgical sites. Targeted antibiotic therapy may be routinely used to improve patients' outcome. More studies are needed to further investigate the possibile therapeutic options in MDR+ patients undergoing surgery
04AP11-10 Feasibility study: non-invasive hemodynamic monitoring during cesarean section and intraoperative fluidic management
No full textBackground and Goal of Study: Maternal and neonatal outcome secondary to caesarean section surgery improved thanks to the evolution of surgical/anaesthetic techniques. Anaesthetic management aims to eliminate the algic stimulus and to reduce hemodynamic alterations linked to blood loss, caval compression and the vasodilatation(loco-regional anesthesia, ALR).The approaches to ALR-induced hypotension are defined as PRELOAD(fluid load carried out before anesthesia) and COLOAD(fluid load given during the execution of anesthesia), with no general standardization.This observational study aimed to evaluate the use of non-invasive hemodynamic monitoring in comparing the 2 approaches in patients undergoing a caesarean section under subarachnoid anesthesia. Materials and Methods: Pregnant patients (18-40 years), single fetus, gestational age> 36 w, ASA I, ordinary hospitalization were included. Two groups were identified depending on the choice of the present anesthesiologist. PRELOAD: pre-intervention 1 L of balanced solution, followed by 500 mL during the surgery; COLOAD:500 mL of balanced solution started during ALR execution. Monitoring: usual + Clear-sight probe (EV1000-Edwards Lifescience). Precise waypoints were identified: baseline, fluid-load, ALR, incision, fetal extraction, afterbirth. Results and Discussion: 18 patients. The two groups showed no significant differences in height, weight, ASA, comorbidity, home therapy, gestational week and CS indication. The characteristics of ALR was found to be superimposable in the 2 groups.Blood losses were not significantly different, as were the outcome of newborns (APGAR at I and V minute, umbilical blood gas values, weight in I and III day).The haemodynamic variables showed considerable inter-individual variability over time, but were not significantly different between the 2 groups, in relation to the received fluid load. Conclusion: The use of a completely non-invasive hemodynamic monitoring was proven feasible, reliable and well tolerated. Different fluid regimens do not significantly modify pregnant woman’s haemodynamics, nor the newborn’s conditions. The volume given before ALR may result ineffective (redistribution)
Intra-operative management of major pancreatica surgery: what matters most?
No full textINTRODUCTION AND OBJECTIVES. Some intra-operative variables may significantly affect patient outcomes after major pancreatic sur- gery. The identification of one or more of them could be very useful for choosing the best intra-operative management and for planning the best measures to be taken in the post-operative period. METHODS. We collected data of patients operated for major pancreatic surgery during 12-month period from two clinical data- bases (Verona University Hospital and Peschiera Pederzoli Clinic). We took into account the following preoperative variables: BMI, smoking habitus, presence of jaundice, pre-operative drainage of jaundice, recent chemotherapy, anamnesis positive for cardiovascular, pulmonary, renal, neurological disease and the American Society of Anesthesiologist (ASA) score. Recorded outcome data included incidence of postoperative ab- dominal surgical-related complications, systemic complications (infec- tious, respiratory, cardiovascular, nefrologic and neurologic), in-hospital mortality, ICU admission and days of hospitalization. RESULTS. A total of 638 (320 women and 318 men, aged 61.4±12.5 years, mean + SD) were operated of major pancreatic surgery during 2013 and 2014 in the two hospitals. ICU admission was 8.9%. Total of post-operative complications were 57.6%,in-hospital mortality was 2.2%. We observed abdominal surgical-related complications in 43.5% and general complications (cardiac, respiratory, infectious and renal) in 34.1% of total patients. Mean ± SD surgical time was 333 ±106 minutes, and mean hospitalization was 16±18 days. Ten pa- tients (1.6%) needed intraoperative infusion of inotropes or vasopres- sors and 72 (11.4%) received blood products. Colloids were administered to 221 patients (34.9%), and 179 patients (28.2%) re- ceived more than 4500ml of cristalloids. The multivariate analysis showed that the incidence of abdominal complication was higher in group who received colloids (42.1%vs52%, p 0.017, O.R. 1.49 C.I.95% 1.073-2.069) and that the development of tachyarrhythmia in post-operative period was higher in the patients who received colloids (4.1%vs10%, p0.017, O.R. 2.245 C.I.95% 1.153-4.372) and when surgery time was longer than 300 mi- nutes. The incidence of cardiac ischemia (0.3%vs10%) and hearth fail- ure (0.3%vs10%) was higher in patients who needed infusion of inotropes or vasopressor during the surgery. All the analisys were ad- justed for sex, age and preoperative physical status. CONCLUSIONS. Our data suggest that the use of colloids, administration of cristalloids >4500ml and the infusion of inotropes or vasopressor can be related to development of post operative complication. These complications seem to be indipendent from pre-operative physical status and not influenced by sex and age. Also a time of surgery >300 minutes can be considered a risk factor for post operative complications
Tryptase serum level as a possible indicator of scombroid syndrome.
No full textScombroid syndrome (histamine fish poisoning--HFP) is a complex of symptoms caused by biogenic amines, mainly histamine, contained in seafood. The diagnosis of HFP is quite difficult as the symptoms of this particular condition are similar to the symptoms of a normal allergic syndrome.We have collected 10 cases (3 male and 7 female) of HFP and 50 non-HFP patients (35 female and 15 male) with allergic disorders, all from the Emergency Department of Ospedale Civile Maggiore in Verona.As expected, tryptase serum concentrations of most of the patients with allergic or anaphylactic disorders were increased above normal value (24.4+/-8.0 ng/mL mean+/-SD, normal value<11 ng/mL), whereas the tryptase serum concentrations of all the 10 patients with HFP were within the normal range (8.1+/-1.8 ng/mL).Our data suggest that tryptase serum concentrations can discriminate between the allergic and HFP syndromes. As the tryptase half-life is 90-120 min, blood samples must be taken 1-2 h from the beginning of symptoms.Finding a biomarker could help physicians to formulate a correct diagnosis and thus in choosing the best therapeutic strategy. In this work, we analyzed the role of tryptase serum concentrations to differentiate real allergic syndromes from the HFP syndrome, which causes similar histamine-mediated effects by a different mechanism
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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