Background & Aims Complications after colectomy for ulcerative colitis (UC) have not been well characterized in large, population-based studies. We characterized postoperative in-hospital ...complications, stratified them by severity, and assessed independent clinical predictors, including use of immunosuppressants. Methods We performed population-based surveillance using administrative databases to identify all adults (≥18 y) who had an International Classification of Diseases-9th/10th revisions code for UC and a colectomy from 1996 to 2009. All medical charts were reviewed. The primary outcome was severe postoperative complications, including in-hospital mortality. Logistic regression was used to assess predictors of complications after colectomy and then restricted to patients undergoing emergent or elective surgeries. Results Of the 666 UC patients who underwent a colectomy, a postoperative complication occurred in 27.0% and the mortality rate was 1.5%. Independent predictors of postoperative complications were age (for patients >64 vs 18–34 y: odds ratio OR, 1.95; 95% confidence interval CI, 1.07–3.54), comorbidities (>2 vs none: OR, 1.89; 95% CI, 1.06–3.37), and admission status (emergent vs elective colectomy: OR, 1.62; 95% CI, 1.14–2.30). Significant risk factors for an emergent colectomy included time from admission to colectomy (>14 vs 3–14 d: OR, 3.32; 95% CI, 1.62–6.80) and a preoperative complication (≥1 vs 0: OR, 3.04; 95% CI, 1.33–6.91). A prescription of immunosuppressants before colectomies did not increase the risk for postoperative complications. Conclusions Postoperative complications frequently occur after colectomy for UC, predominantly among elderly patients with multiple comorbidities. Patients who were admitted to the hospital under emergency conditions and did not respond to medical treatment had worse outcomes when surgery was performed 14 or more days after admission.
The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was ...to characterise the incidence and outcomes of viral respiratory infections in LTR.
Patients were seen in three contexts: study-specific screenings covering all seasons; routine post-transplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses.
One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3).
There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection.
Introduction
Before referring patients to a palliative care service, oncologists need to inform them about disease stage and discuss prognosis, treatment options and possible advantages of ...specialized palliative care (SPC). They often find this a complex and emotionally difficult task. As a result, they may refer their patients to SPC too late in the disease course or even not at all. This study reports findings from interviews with Belgian medical oncologists identifying the barriers they experience to introduce palliative care to their patients with advanced cancer.
Methods
The interviews were semi-structured with open-ended questions and were supported by a topic list. The transcripts were analysed during an iterative process using the grounded theory principles of open and axial coding until a final coding framework was reached.
Results
The study identified seven heterogeneous categories of barriers which discourage oncologists from discussing palliative care: oncologist-related barriers, patient-related barriers, family-related barriers, barriers relating to the physician referring the patient to the medical oncologist, barriers relating to disease or treatment, institutional/organizational barriers and societal/policy barriers. These categories are further refined into subcategories.
Discussion
These findings provide an explanation for the possible reasons why medical oncologists feel hampered in initiating palliative care and consequently discuss it rather late in the disease trajectory. The exploration and description of these barriers may serve as a starting point for revising the medical education of oncologists. They are also a reminder to hospital management and policy makers to be aware of the impact of these barriers on the daily practice of oncology.
Purpose
Data concerning long-term outcomes and quality of life (QOL) in critically ill cancer patients are scarce. The aims of this study were to assess long-term outcomes and QOL in critically ill ...patients with hematological (HM) or solid malignancies (SM) 3 months and 1 year after intensive care unit (ICU) discharge, to compare these with QOL before ICU admission, and to identify prognostic indicators of long-term QOL.
Methods
During a 1 year prospective observational cohort analysis, consecutive patients with HM or SM admitted to the medical or surgical ICU of a university hospital were screened for inclusion. Cancer data, demographics, co-morbidity, severity of illness, organ failures, and outcomes were collected. The QOL before ICU admission, 3 months, and 1 year after ICU discharge was assessed using standardized questionnaires (EuroQoL-5D, Medical Outcomes Study 36-item Short Form Health Survey). Statistical significance was attained at
P
< 0.05.
Results
There were 483 patients (85 HM, 398 SM) (64 % men) with a median age of 62 years included. Mortality rates of HM compared to SM were, respectively: hospital (34 vs. 13 %), 3 months (42 vs. 17 %), and 1 year (66 vs. 36 %) (
P
< 0.001). QOL declined at 3 months, but improved at 1 year although it remained under baseline QOL, particularly in HM. Older age (
P
= 0.007), severe comorbidity (
P
= 0.035), and HM (
P
= 0.041) were independently associated with poorer QOL at 1 year.
Conclusions
Long-term outcomes and QOL were poor, particularly in HM. Long-term expectations should play a larger role during multidisciplinary triage decisions upon referral to the ICU.
Conventional endoscopic drainage of symptomatic pancreatic pseudocysts has its limitations when the content of the collection is nonfluid. This leads to obstruction of placed flap stents; it requires ...the placement of an irrigation catheter and repeated implantation of several stents. Herein we describe the temporary use of a special self-expanding partially covered metal mesh stent, which was designed to keep the pancreaticogastrostomy open for drainage of walled-off necrosis and for further endoscopic necrosectomies. The stent has a diameter of 20-25 mm and a length of 50 mm and was placed following the first transgastric removal of necrotic masses. After a treatment period of 7-11 days involving 2-3 endoscopic procedures we achieved clinical success, defined as complete removal of necrotic masses, in all cases without major complications.
A polymer planar Bragg grating sensor is used for measuring both mechanical compressive and tensile strain. The planar waveguide with integrated Bragg grating is fabricated in bulk ...Polymethylmethacrylate in a single writing step using combined amplitude and phase mask technique. After butt coupling of a single-mode optical fiber the planar structure can be applied for measuring both mechanical tensile and compressive strain alongside the integrated waveguide without the need of further modifications. In this respect, we particularly report for the first time compressive strain measurements using a polymer Bragg grating. Furthermore, the sensitivity of the sensor against tensile and compressive strain, its reproducibility and hysteresis are investigated and discussed.
This book offers an internalist view on the history of astrology by studying the case of S. Belle, an astrologer who lived in late fifteenth-century France. It addresses his methods of work, his ...process of learning, and his practice.
Informal settlements, in addition to making up not a substantial proportion of urban populations, also present all the conditions for rapid spread: very high population density, scant access to water ...and sanitation, widespread poverty and inadequate health infrastructure. ...favelas, barrios, slums and shantytowns seem to be the Achilles heel of many health systems, yet, political leaders in low- and middle-income countries have largely been silent about how they plan to face this significant but extremely important challenge. ...the absence of formal governance in informal settlements does not equal a lack of governance.
•Single writing step fabrication of polymer planar Bragg gratings in COC polymer.•Characterization of the refractive index modification with phase-shifting MZI.•High reflectivity of the humidity ...insensitive polymer planar Bragg gratings (PPBGs).•Investigating the temperature hysteresis and sensitivity of the PPBGs.•Application of the PPBGs for measuring tensile and compressive strain.
We report on the fabrication of polymer planar waveguides with inscribed Bragg gratings in TOPAS employing an efficient UV based single writing step technique using excimer laser. Phase shifting Mach–Zehnder interferometry indicates an UV induced increase of the refractive index in TOPAS of 6×10−4 and a modification depth of about 30μm, respectively. The planar Bragg grating structures in the cyclo-olefin copolymer are characterized by a high reflectivity of about 93% and are studied with respect to their potential in optical waveguide sensing, namely temperature and strain sensing. While the Bragg reflection shows almost no cross sensitivity against humidity, it exhibits a spectral blue shift with increasing temperature of −6.5pm/°C after multiple thermal annealing cycles. Compressive and tensile strain measurements reveal a sensitivity of 0.70pm/μɛ.
With the increasing number of surgical interventions for obesity, the numbers of associated complications, such as gallstones after bariatric surgery are also increasing. The incidence of ...postbariatric symptomatic cholecystolithiasis is 5-10%; however, the numbers of severe complications due to gallstones and the probability of a necessary extraction of gallstones are low. For this reason, a simultaneous or preoperative cholecystectomy should only be carried out in symptomatic patients. Treatment with ursodeoxycholic acid reduced the risk of gallstone formation in randomized trials but not the risk of complications related to gallstones in cases of pre-existing gallstones. The most frequently used access route to bile ducts after intestinal bypass procedures is the laparoscopic approach via the stomach remnants. Other possible access routes are the enteroscopic approach as well as the endosonography-guided puncture of the stomach remnants.
PDF
