1,720,974 research outputs found
Current practice in colonoscopy in the elderly
Full text linkColonoscopy in the elderly is a reliable practice of great diagnostic and management value. However, patient’s age has long been considered to af- fect the success of the procedure, achieved when the ce- cum is intubated, there is a good view of the colon if preparation has been properly carried out, and the ex- amination does not cause excessive discomfort or complications. Substantial improvements have been made to the latter two aspects, due to more widespread use of deep sedation with propofol and cardiocircula- tory monitoring during the procedure. The aim of our work was to assess whether, in the everyday prac- tice of an open-access, digestive endoscopy teaching center, staffed by various providers delivering screen- ing for polyposis, age is still a limitation to the success of the procedure and whether appropriate measures have been taken to improve colonoscopy in geriatric pa- tients. We analysed 1480 consecutive colonoscopies, of which 319 were performed in patients aged over 73 years. The examination was significantly less success- ful in this group of patients (88.1 vs 94.4, p=0.0001), but there were no major technical or use-related com- plications connected with administration of propofol for sedation purposes, despite lower doses to the el- derly (2.2±1.1 mg/kg total dose, mean 151±72.4 mg vs 2.9±1.3 mg/kg total dose, mean 199±77.9 mg in younger patients, p<0.001). More experienced tech- nical staff were not allocated to these colonoscopies (for endoscopic or anesthesiological purposes) and, according to the results of multivariate stepwise logistic regression analysis, inadequate preparation was the main factor affecting the success of the procedure in el- derly patients (OR 5.9, 95% CI 2.25-15.72; p=0.0003). Only body weight over 60 kg facilitated it (weight ≥60 kg, OR 0.46, 95% CI 0.26-0.83). In colonoscopy in the elderly, safety appears to be the primary concern and, good outcomes can be achieved, but sometimes at the expense of diagnostic accuracy. This could probably be improved through better pre- and post-procedure care, not currently differentiated between young and elderly patients
Death after an accidental fall of a 101 year old hospitalized patient. Medico-legal implication of falling in geriatrics
Full text linkBackground: The case presented by the authors gives the opportunity to discuss the medico-legal issues related
to lack of prevention of falls in elderly hospitalized patients.
Case presentation: A 101 year old Caucasian female was admitted to a surgery division for evaluation of
abdominal pain of uncertain origin. During hospitalization, after bilateral bed rails were raised, she fell and reported
a femoral fracture. Before surgical treatment of the fracture, scheduled for the day after injury, the patient reported
a slight reduction in hemoglobin. She received blood transfusion but her general condition suddenly worsened;
heart failure was observed and pulseless electrical activity was documented. The patient died 1 day after the fall.
Patient relatives requested a judicial evaluation of the case.
The case was studied with a methodological approach based on the following steps: 1) examination of clinical
records; 2) autopsy; 3) evaluation of clinicians’ behavior, in the light of necroscopic findings and a review of the
literature.
Conclusions: The case shows that an accurate evaluation of clinical and environmental risk factors should be
always performed at the moment of admission also in surgery divisions. A multidisciplinary approach is always
recommended also with the involvement of the family members. In some cases, as in this one a fall of the patient
is expectable but not always avoidable. Physical restraint use should be avoided when not necessary and used
only if there are no practical alternatives
Choices in surgical treatment of diverticulitis
Full text linkComplications after surgical treatment of diverticulitis are not very frequent, in view of the total number of patients affected by this pathology, but they do become significant in absolute terms because of the high prevalence of the disease itself. Surgeons continue to debate which option is better: Hartmann re- section or combined resection and anastomosis. Since age is a crucial factor when surgery is being considered, we evaluated the outcome of surgical treatment for di- verticulitis in patients treated in our unit over a six- month period, in view of the number of elderly patients generally admitted. Between January 2001 and June 2012, 77 patients underwent surgery for diverticular disease in the Geriatric Surgery Unit of the Department of Surgical and Gastroenterological Sciences, Univer- sity of Padova Hospital. Gastrointestinal resection and anastomosis were performed in 75 patients (97%), re- sulting in an overall complication rate of 37% and a mortality rate of 1%. This surgical strategy was chosen because, when it is performed by experienced sur- geons, it offers the same results in terms of mortality and morbidity as Hartmann resection, while presenting significant advantages as regards the patient's quality of life. Various factors such as the timing of surgery, severity of the disease defined according to the Hinchey classification, patient’s clinical condition, and sur- geon's experience and expertise can all influence the surgical choice. Several studies in the literature confirm that combined resection and anastomosis is safe and ef- ficacious, but more research is needed to confirm these data
N0 Stage colon cancer: prognostic role of age in relation to tumor site.
Full text linkThis work investigates the prognostic role of advanced age as a risk factor for recurrence in a population of patients undergoing surgery for N0 stage colon cancer, and also evaluates whether that role is affected by tumor location. A population of 129 con- secutive patients who underwent radical surgery for N0 stage colon cancer was selected. Patients were subdi- vided into three age groups: 80. The only correlation found in the examined population between age and clinical-pathological features was be- tween advanced age (>80) and tumor location in the right side of the colon. Overall survival (OS) and dis- ease-free survival (DFS) were significantly lower in pa- tients over 80 than in the other two classes. Two mul- tivariate analyses were carried out: when tumor loca- tion was not considered, age >80 represented a neg- ative prognostic factor for risk of recurrence, regardless of the other factors examined. This role was also con- firmed when tumor location was considered. As hy- pothesized by several authors, the role of advanced age which emerges from this study is mainly due to the in- creased fragility of elderly patients caused by multiple pathophysiological factors, but it does not necessarily represent an absolute contraindication to surgery. The role played by tumor location remains contro- versial, as more and more studies show that right colon cancer (RCC) is a biological entity distinct from left colon cancer (LCC). Further studies are required to examine right and left colon cancers as two separate diseases
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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