1,720,991 research outputs found
Comparison of the Clavien-Dindo and Comprehensive Complication Index systems for grading of surgical complications after colorectal resections
No full textIntroduction Postoperative complications are associated with prolonged hospital stay and a rise in costs of treatment. The Comprehensive Complication Index (CCI) was developed as a scoring system that does not only take the most severe complication into account but all complications after surgery. Our aim was to compare the Clavien-Dindo scoring system with the CCI in predicting length of hospital stay (LOHS) and in-hospital costs after colorectal resections. Methods Complications occurring after surgical procedures, performed between October 2012 and September 2013, were prospectively recorded. During this period 164 patients developed complication(s). Only patients that underwent a colorectal resection were included. Multivariable linear regression analysis was performed to find independent predictors of in-hospital costs and LOHS. Results 64 patients (age (range): 69 (10-91) years, M/F: 36/28) were retained. 46 (71.9%) patients had a Clavien-Dindo score >= IIIb. Median (IQR) CCI was 40 (30.2-53.9). Mean (+/- SD) in-hospitals costs for all patients were euro12,920 +/- euro10,229. The adjusted difference (95% CI, p-value) in in-hospital costs for minor and major (Clavien-Dindo >= IIIb) complications was 10,021 (euro4283 to euro15,759, p = 0.001). A 10 point increase in CCI increased in-hospital costs by euro2040. Multivariable analysis retained CCI > 40 as the only independent risk factor for increased in-hospital costs (Standard Beta Coeffic (p-value): 8063 (p = 0.022). Conclusion CCI is a better predictor of in-hospital costs than Clavien-Dindo score to classify complications after colorectal resections, as it captures all complications. Further research is warranted to extrapolate our findings to other sub-specialities of surgery
Prognostic Relevance of Extracapsular Lymph Node Involvement in Pancreatic Ductal Adenocarcinoma
No full textIn several malignancies extracapsular lymph node involvement (ECLNI) identifies a subgroup of patients with worse prognosis but no data are available on its significance in pancreatic ductal adenocarcinoma (PDAC). The aim of our study was to assess the prognostic relevance of ECLNI in resectable PDAC. A retrospective analysis was performed of 137 consecutive pancreatic resections for PDAC. Two investigators blinded for survival data systematically reviewed all pathological data. Survival curves were estimated using the Kaplan-Meier method. Multivariable Cox regression models were used to identify predictors of disease-free survival (DFS) and overall survival (OS). The median follow-up after surgery was 19 months. ECLNI was identified in 59 of 99 node-positive patients. The median DFS in patients with ECLNI vs. intracapsular LNI (ICLNI) was 6.8 vs. 12.0 months, respectively (P = .027). The median OS in patients with ECLNI vs. ICLNI was 16.1 and 21.8 months, respectively (P = .098). On multivariable analysis extracapsular lymph node ratio (ECLNR) was identified as an independent predictor of OS (P = .003). In patients with ECLNI, both OS and DFS were improved after adjuvant chemoradiation compared with those who did not receive adjuvant treatment (P = .01). Extracapsular lymph node ratio is an independent predictor of survival in patients with PDAC. Patients with ECLNI from pancreatic cancer seem to benefit from adjuvant chemoradiation but not from chemotherapy alone
A survey of European-African surgeons' management of common bile duct stones
No full textBackground: Common bile duct (CBD) stones can be managed by either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). The aim of this survey was to document the management of CBD stones by European-African HPB Association (E-AHPBA) members. Methods: All 331 members of the E-AHPBA were invited by personal email to participate to an online survey. Results: Ninety-three (28%) surgeons replied within 2 months. Responding surgeons were attending surgeons (84%), working as HPB surgeons (75%) in academic hospitals (73%). In patients with clinically suspected CBD stones, MRCP was the preferred diagnostic test for 61% of respondents. LCBDE was the preferred therapeutic strategy for 11 (12%) respondents only. Previous gastric surgery was an absolute contraindication to ERCP for 47% of respondents. Absence of CBD dilation was considered an absolute contraindication for LCBDE in 24% of respondents. Yearly caseload exceeded 10 patients for only 30% of 56 centers performing LCBDE. The transcystic approach was preferred by 39% of surgeons performing LCBDE. There was considerable variation amongst respondents with regard to type and duration of drainage, bile duct closure technique and follow-up after LCBDE. Conclusion: Indications for single-stage LCBDE are not standardized and do not appear well established across E-AHPBA members
The Validity, Reliability and Usability of the Studio Alterazioni Cutanee Stomali (SACS) and Ostomy Skin Tool (OST) Instruments for Classification of Peristomal Skin Disorders A Systematic Review
No full textPURPOSE: The aim of this systematic review was to synthesize the published literature to determine the validity, reliability, and usability of the Studio Alterazioni Cutanee Stomali (SACS) and Ostomy Skin Tool (OST) instruments. METHOD: Systematic literature review. SEARCH STRATEGY: We searched the following electronic databases: PubMed, CINAHL via EBSCO, Embase, and CENTRAL. The search was limited to studies published after 2005 and written in the English or Dutch languages. Inclusion criteria were adults (18 years or older) with any type of abdominal ostomy created for any medical indication. Elements were selected for inclusion when they examined or described at least one psychometric aspect regarding validity, reliability, or usability of the OST or SACS. FINDINGS & CONCLUSIONS: The search retrieved 3077 records after removing duplicate elements. This systematic review is based on findings from four studies identifying two different psychometric properties. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist and the COSMIN Risk of Bias Tool were used to assess the methodological quality of the included studies. The modified GRADE-approach was used to evaluate the quality of evidence for outcomes reported in this systematic review. According to the COSMIN criteria, the overall assessment for reliability and content validity was variable or indeterminate. This results in a low quality of evidence regarding the assessment instruments SACS and OST. Based on these findings, we conclude that neither the SACS nor OST have been sufficiently evaluated to fully determine their validity, reliability and usability in the clinical setting. IMPLICATIONS: More research of peristomal skin assessment instruments SACS and OST is needed for further refining and validation before they can be introduced as a "gold standard" in practice among nurses, experts, and clinicians
Laparoscopic common bile duct exploration for common bile duct stones after gastric surgery
No full textBackground Gallstone disease is common after gastric surgery and especially after weight loss from bariatric surgery. In patients with normal gastroduodenal anatomy, treatment of common bile duct stones (CBS) generally consists of, endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic sphincterotomy (ES), followed by cholecystectomy in a second stage. However, after gastric surgery the papilla may not be easily accessible endoscopically. The aim of our study was to evaluate the therapeutic success of single-stage laparoscopic cholecystectomy and common bile duct exploration (LCBDE) after previous gastric surgery. Methods In this observational cohort study, all LCBDE in patients with previous gastric surgery between January 2014 and July 2022 were retrospectively reviewed. Gastric surgery consisted of Roux-en-Y gastric bypass, BII subtotal gastrectomy, total gastrectomy and subtotal gastrectomy with Roux-en-Y reconstruction. Outcomes of interest consisted of successful duct clearance, postoperative adverse events and CBS recurrence. Results Forty-four patients (M/F: 22/22) underwent LCBDE after previous gastric surgery, in which simultaneous cholecystectomy was performed in 38 cases. Median (range) age 68 (25-90) years. Presence of CBS was confirmed in 38 patients (85%), a choledochal polyp in one patient (2%) and recurrence of gastric cancer in another (2%). Duct clearance was successful in 37 out of 38 patients (97%). Median (range) length of stay after LCBDE was 1 (0-12) day(s). Eight patients developed a postoperative adverse event, of which three Clavien-Dindo > 3a complications. Three patients were readmitted. At a median (range) follow-up of 60 (24-120) months, no CBS recurrences were observed. Conclusions LCBDE is a safe technique, with a high rate of successful duct clearance after previous gastric surgery, even after previous cholecystectomy. In experienced centers, LCBDE provides a valid alternative for complex interventional endoscopy, omitting the need for the creation of a gastro-gastric fistula.Funding No funding source
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
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