1,720,975 research outputs found
Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality
No full textAbstract Objective to identify correlations between quality and quantity of health care resources, national economic indicators, and postoperative in-hospital mortality as reported in the EUSOS study. Methods Different variables were identified from a series of publicly available database. Postoperative in-hospital mortality was identified as reported by EUSOS study. Spearman non-parametric and Coefficients of non-linear regression were calculated. Results Quality of health care resources was strongly and negatively correlated to postoperative in-hospital mortality. Quantity of health care resources were negatively and moderately correlated to postoperative in-hospital mortality. National economic indicators were moderately and negatively correlated to postoperative in-hospital mortality. General mortality, as reported by WHO, was positively but very moderately correlated with postoperative in-hospital mortality. Conclusions Postoperative in-hospital mortality is strongly determined by quality of health care instead of quantity of health resources and health expenditures. We suggest that improving the quality of health care system might reduce postoperative in-hospital mortality
Tracheostomy in COVID-19 critically ill patients: a bibliometric and visual analysis
Full text linkBackground: Coronavirus disease 2019 (COVID-19)-induced acute respiratory failure often necessitates prolonged intubation and invasive mechanical ventilation, with tracheostomy frequently performed in critically ill patients requiring extended mechanical ventilation. Bibliometrics, employing statistical methods to scrutinize research papers on specific topics mathematically, has not yet been applied to analyze publications concerning tracheostomy in COVID-19 critically ill patients. This study employs bibliometric techniques to scrutinize publications addressing this topic. Methods: The global literature on tracheostomy in COVID-19 from 2020 to 2023 was surveyed using the Scopus database. VOSviewer facilitated the bibliometric analysis of these articles. Results: The Scopus database yielded 1,268 records on tracheostomy in COVID-19 critically ill patients. Following independent screening by two reviewers, 359 papers were ultimately selected. Michael J. Brenner and Luis Angel emerged as the most prolific and cited authors, respectively. Numerous organizations contributed to related publications, with the Global Tracheostomy Collaborative leading in activity. The Amandela ENT Head and Neck Centre of Singapore and the National University Hospital of Singapore were the most cited organizations. Publications on tracheostomy in COVID-19 originated from 77 countries; the USA was the most active and cited. A total of 135 journals published the related papers, with the European Archives of Oto-Rhino-Laryngology having the most publications and citations. Co-citation analysis identified JAMA as the most cited source and Brenner MJ as the most cited author among 6,726 cited authors. Conclusions: This bibliometric analysis provides a comprehensive perspective on the existing literature regarding tracheostomy in COVID-19
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
Nipple-sparing mastectomy in patients with preoperative diagnosis of non-invasive breast carcinoma. A single-center experience
No full textBACKGROUND:
Nipple-sparing mastectomy (NSM) is a recognized treatment for selected patients with breast cancer (BC). Our study aimed to analyze 7 years' experience in NSM and breast reconstruction for patients with preoperative diagnosis of non-invasive BC.
PATIENTS AND METHODS:
All NSMs with breast reconstruction, performed between January 2007 and December 2013 in patients with preoperative diagnosis of non-invasive BC, were considered.
RESULTS:
Thirty-five NSMs were performed, 23 cases confirming the diagnosis of non-invasive BC, and in 12 patients it also resulted in findings of an invasive component. Patients were stratified into two groups: breast reconstruction was performed i) with silicone definitive implant, ii) with a temporary breast tissue expander. An invasive component at the postoperative histological examination was significantly associated with tissue expander reconstruction (p=0.03).
CONCLUSION:
In selected cases, NSM is a valid and safe procedure. Further critical evaluations are required for more evidence on this argument
Electric impedance tomography and protective mechanical ventilation in elective robotic-assisted laparoscopy surgery with steep Trendelenburg position: a randomized controlled study
Full text link: Electrical impedance tomography (EIT) reconstructs functional lung images and evaluates the variations of impedance during the breathing cycle. The aim of this study was to evaluate the effect of protective mechanical ventilation on ventilation distributions recorded by the EIT during elective robotic-assisted laparoscopy surgery with steep Trendelenburg position. This prospective, randomized single center study included patients with healthy lungs undergoing elective robot-assisted laparoscopic urological surgery in general anesthesia. Patients were randomly assigned to either protective lung ventilation or conventional ventilation. In the protective ventilation group, tidal volume (TV) was set at 6 ml/Kg predicted body weight (PBW), with PEEP 6 cmH2O, and recruitment maneuvers (RM) as needed. In the conventional ventilation group, TV was set at 9 ml/Kg PBW, with PEEP 2 cmH2O and RM only as needed. Ventilation distribution was assessed using an EIT device. This study included 40 patients in the functional image analysis. Significant differences were found in ventilation distribution in the region of interest (p < 0.05). Driving pressure was significantly lower in protective ventilation group (p < 0.05). Peak and plateau pressures were not different between the groups while statical significance was found in tidal volume and respiratory rate. EIT may be a valuable tool for monitoring lung function during general anesthesia. During elective robotic-assisted laparoscopy surgery with steep Trendelenburg position, protective mechanical ventilation may have a more homogenous distribution of intraoperative and postoperative ventilation. Larger sample size and long-term evaluation are needed in future studies to assess the benefit of EIT monitoring in operation room.Clinical trial registration ClinicalTrials.gov Identifier: NCT04194177 registered at 11th December 2019
Non-invasive Ventilation in Severe Pneumonia
No full textNIV is widely used in the acute care setting for acute respiratory failure (ARF) across a variety of etiologies. NIV has become the first-choice ventilation technique in many clinical conditions, such as acute hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema, severe hypoxemia in immunosuppressed patients, and in order to facilitate the transition from invasive mechanical ventilation (IMV) to spontaneous breathing [2–4]
Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study
No full textAuthors analyze their experience of parathyroid autotransplantation during total thyroidectomy, with the purpose of seeing whether this practice influenced the rate of postoperative hypocalcemia and/or hypoparathyroidism. We identified three groups of patients: group A, consisting of 57 patients, underwent parathyroid autotransplantation during total thyroidectomy; group B consisting of 87 patients not submitted to intraoperative autotransplantation in whom, as an incidental finding, a parathyroid gland was detected in the surgical specimen; group C consisted of 100 patients who did not undergo autotransplantation and whose surgical specimens were not found to contain parathyroid glands. The three groups were compared for sex and age as well as for a series of clinical and laboratory parameters on the first three postoperative days and at six months after surgery. The rate of permanent hypoparathyroidism was 3.5% in Group A, 3.45% in Group B, and 1% in Group C. Multivariate analysis revealed that all three groups showed postoperative recovery of calcium levels, although the rate and extent of this recovery differed between them. The control group showed a more rapid and more complete recovery of serum calcium values compared with Groups A and B. Calcium recovery in Groups A and B was comparable, in terms of both rate and extent. The same pattern of results emerged for the iPTH values. The analysis of the data showed that there were no significant differences in the analyzed parameters between Groups A and B. This suggests that parathyroid autotransplantation does not influence the rate of postoperative hypocalcemia and/or hypoparathyroidism.Authors analyze their experience of parathyroid autotransplantation during total thyroidectomy, with
the purpose of seeing whether this practice influenced the rate of postoperative hypocalcemia and/or
hypoparathyroidism.
We identified three groups of patients: group A, consisting of 57 patients, underwent parathyroid
autotransplantation during total thyroidectomy; group B consisting of 87 patients not submitted to
intraoperative autotransplantation in whom, as an incidental finding, a parathyroid gland was detected
in the surgical specimen; group C consisted of 100 patients who did not undergo autotransplantation and
whose surgical specimens were not found to contain parathyroid glands. The three groups were
compared for sex and age as well as for a series of clinical and laboratory parameters on the first three
postoperative days and at six months after surgery.
The rate of permanent hypoparathyroidism was 3.5% in Group A, 3.45% in Group B, and 1% in Group C.
Multivariate analysis revealed that all three groups showed postoperative recovery of calcium levels,
although the rate and extent of this recovery differed between them. The control group showed a more
rapid and more complete recovery of serum calcium values compared with Groups A and B. Calcium
recovery in Groups A and B was comparable, in terms of both rate and extent. The same pattern of results
emerged for the iPTH values.
The analysis of the data showed that there were no significant differences in the analyzed parameters
between Groups A and B. This suggests that parathyroid autotransplantation does not influence the rate
of postoperative hypocalcemia and/or hypoparathyroidism
Airway management in patients undergoing maxillofacial surgery: State of art review
No full textAirway management in maxillofacial surgery is a critical aspect of anesthesia and perioperative care, demanding a broad array of techniques to ensure effective ventilation and oxygenation. The anatomical and physiological complexities of maxillofacial procedures necessitate a deep understanding of airway management strategies. Patients undergoing maxillofacial surgery often face heightened risks of airway compromise due to trauma, congenital abnormalities, or the surgical interventions themselves, requiring clinicians to be proficient in both routine and advanced techniques. This narrative review synthesizes current evidence and clinical practices in airway management for maxillofacial surgery. It examines the anatomical and physiological considerations, preoperative assessment protocols, intraoperative management, and postoperative care strategies. Preoperative assessments are crucial for identifying potential airway management difficulties, utilizing risk assessments, physical examinations, and imaging. Intraoperative strategies include endotracheal intubation while surgical techniques such as tracheostomy, cricothyroidotomy, submental, and retromolar intubation offer alternatives for securing the airway. Postoperative care focuses on meticulous planning and coordination to prevent complications such as airway obstruction and hypoxemia. Extubation is identified as a particularly high-risk phase, necessitating advanced techniques and multidisciplinary collaboration to ensure patient safety. The review underscores the importance of a comprehensive, multidisciplinary approach to airway management in maxillofacial surgery, highlighting the need for ongoing advancements in techniques and technologies to enhance patient outcomes
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