1,720,957 research outputs found
Complications, length of hospital stay and cost of care after surgery for pyogenic spondylodiscitis
No full textObjective: Infectious spondylodiscitis is a heterogeneous disease usually affecting a fragile patient population with multiple comorbidities. Therefore, surgical and medical complications are important considerations before initiating treatment. Methods: This retrospective analysis included data of 218 patients who underwent surgical treatment for pyogenic spondylodiscitis between 2008 and 2016. Groups were divided into length of hospital stay (LOS) of >21 days (Group I = 21days). Analysis included patient age, gender, Charlson Comorbidity Index, smoking, obesity, osteoporosis, colonization with multidrug-resistant bacteria, preoperative neurological deficit, pre- und postoperative inflammation markers (CRP and WBC), duration of surgery, number of operated segments, vertebrectomy, postoperative medical and surgical complications. The case value for each patient expressed in Euro was retrieved from hospital records and included in the analysis. Results: Duration of stay after surgical treatment of spondylodiscitis was = 21 days (22 to 162, mean 41 days) in 59% of the patients. Multivariate analysis showed that both medical complications (OR 2.62, 95% CI 1.24-5.56, p=0.012) and surgical site infection (OR 6.04, 95% CI 2.35-15.51, p<0.001) were independently associated with a long hospital stay. Case values averaged at 21,667 ± 1,579 Euro (min: 2,888 and max: 203,802 Euro) and correlated significantly with the length of hospital stay (Pearson correlation coefficient 0.681, p<0.05). The occurrence of a postoperative complication increased the cost of care significantly from 17,790 to 24,527 Euro on average (p=0.025). Conclusions: This study provides benchmark data for patients treated surgically for spondylodiscitis. Surgical site infection and medical complications are the main drivers of prolonged hospital stays and cost of care
The role of diskectomy in reducing infectious complications after surgery for lumbar Spondylodiscitis
No full textIntroduction Surgery for pyogenic spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate discectomy in all cases. Others maintain that standalone instrumentation is sufficient. Patients and methods We reviewed charts of patients who underwent instrumentation for pyogenic spondylodiscitis with a minimum follow-up of one year. Patients were stratified according to whether they underwent discectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision and construct failure. Results N=257 patients who underwent surgery for pyogenic spondylodiscitis were identified. Discectomy and interbody procedure (group A) was performed in 102 patients while 155 patients underwent instrumentation surgery for spondylodiscitis without intradiscal debridement (group B). Mean age was 67±12 years, 102 patients (39.7%) were female. No significant differences were found in the need for epidural abscess recurrence therapy (group A (2.0%) and 5 cases in group B (3%; p=0.83)) and construct failure (p=0.575). The need for wound revisions showed a tendency towards higher rates in the posterior instrumentation only group which failed to reach significance (p=0.078). Conclusions Overall, intraspinal relapse of surgically treated pyogenic discitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no discectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population.Introduction Surgery for pyogenic spondylodiscitis as an adjunct to antibiotic therapy is an established treatment. However, the technique and extent of surgical debridement remains a matter of debate. Some propagate discectomy in all cases. Others maintain that standalone instrumentation is sufficient. Patients and methods We reviewed charts of patients who underwent instrumentation for pyogenic spondylodiscitis with a minimum follow-up of one year. Patients were stratified according to whether they underwent discectomy plus instrumentation or posterior instrumentation alone. Outcome measures included the need for surgical revision due to recurrent epidural intraspinal infection, wound revision and construct failure. Results N=257 patients who underwent surgery for pyogenic spondylodiscitis were identified. Discectomy and interbody procedure (group A) was performed in 102 patients while 155 patients underwent instrumentation surgery for spondylodiscitis without intradiscal debridement (group B). Mean age was 67±12 years, 102 patients (39.7%) were female. No significant differences were found in the need for epidural abscess recurrence therapy (group A (2.0%) and 5 cases in group B (3%; p=0.83)) and construct failure (p=0.575). The need for wound revisions showed a tendency towards higher rates in the posterior instrumentation only group which failed to reach significance (p=0.078). Conclusions Overall, intraspinal relapse of surgically treated pyogenic discitis was low in our retrospective series. The choice of surgical technique was not associated with a significant difference. However, a somewhat higher rate of wound infections requiring revision in the group where no discectomy was performed has to be weighed against a longer duration of surgery in an already ill patient population
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
Postoperative Quality of Life in Patients with Pyogenic Spondylodiscitis
No full textAbstract
Background Pyogenic spondylodiskitis affects a fragile patient population frequently fraught with severe comorbidities. Data on long-term outcomes, especially for patients undergoing surgery, are scarce. The aim of this study was to assess the long-term quality of life after surgical instrumentation.
Methods Data of 218 patients who were treated for spondylodiskitis at our institution between January 2008 and July 2017 were reviewed. In-hospital death and mortality rates at 1 year and follow-up were assessed. A survey was conducted using the following questionnaires: Oswestry Disability Index (ODI), Short Form Work Ability Index (SF-WAI), 36-Item Short Form Health Survey (SF-36), and Short Form McGill Pain Questionnaire (SF-MPQ). We investigated the correlation between the assessed variables and clinical data including patient age, comorbidity score at admission, number of operated levels, corpectomy, and length of hospital stay.
Results In-hospital mortality rate was 1.8% and 1-year mortality rate was 5.5%. At the final follow-up (mean 7 ± 6 years), the mortality rate was 45.4%. Seventy-four patients were lost to follow-up or refused to participate in the study. Forty-four patients responded to the survey and had a mean age of 73 years and mean follow-up of 7 ± 2 years. In the ODI questionnaire, disability grades were classified as minimal (23%), moderate (21%), severe (19%), complete (33%), and bed bound (4%). We found a significant correlation between inability to return to work and severe disability on ODI (p < 0.001), as well as a low score on any component of the SF-36 (p < 0.05).
Conclusion Despite low in-hospital and 1-year mortality rates, patients with surgically treated pyogenic spondylodiskitis are prone to long-term limitation in all domains of quality of life, especially in physical health and work ability.</jats:p
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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