Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a major undertaking with profound peri-operative metabolic and haemodynamic alterations. It requires standardised ...protocols for immediate postoperative intensive care management to improve patient-related outcomes. A retrospective analysis of a prospectively maintained data-base of 244 patients who underwent CRS and HIPEC between June 2017 and July 2022 in our institute was done. Based on the audit, six strategies were implemented, namely, (1) dynamic multiparameter-based IVF therapy to aggressively correct the hyperlactatemia, (2) initiation of IV 20% human albumin infusion from POD-0, (3) correction of serum iCa
2+
levels, (4) initiation of diuresis from POD-1, (5) prophylactic use of HFNO immediately post-extubation and (6) serum procalcitonin level-based empiric escalation of IV antibiotics. Patients were divided into two cohorts, pre-protocol group of 145 patients (from June 2017 to December 2020) and post-protocol group comprising of 99 patients (from January 2021 to July 2022), and were analysed for compliance and patient-related outcomes. Implementation of these strategies improved the patient-related outcomes among the two cohorts with significant reduction of Clavien-Dindo grade III/IV complications and improvement in failure to rescue (FTR) index (
p
< 0.05). There was highly significant reduction in median ICU and hospital stay among the two cohorts (
p
< 0.001). The formulated protocols of management strategies especially multiparameter-based dynamic fluid therapy, planned diuresis and prophylactic HFNO have improved the outcomes in our patients undergoing CRS and HIPEC.
This article aims to provide an overview of the iron deficiency anemia (IDA) in different trimesters of pregnancy and laboratory diagnosis with hematological parameters and serum ferritin ...concentration. It is a laboratory leadership and quality management-based time bound prospective study that explains about IDA in different trimesters of pregnancy, causes of IDA, response to treatment, preventing IDA during pregnancy, lab leadership, and quality management.
IMPORTANCE: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about ...patients in high-risk groups. OBJECTIVE: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. DESIGN, SETTING, AND PATIENTS: A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. INTERVENTIONS: Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. RESULTS: Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events. CONCLUSIONS AND RELEVANCE: Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN87171227
AbstractObjectiveTo evaluate the effectiveness of telephone health coaching delivered by a nurse to support self management in a primary care population with mild symptoms of chronic obstructive ...pulmonary disease (COPD).DesignMulticentre randomised controlled trial.Setting71 general practices in four areas of England.Participants577 patients with Medical Research Council dyspnoea scale scores of 1 or 2, recruited from primary care COPD registers with spirometry confirmed diagnosis. Patients were randomised to telephone health coaching (n=289) or usual care (n=288).InterventionsTelephone health coaching intervention delivered by nurses, underpinned by Social Cognitive Theory. The coaching promoted accessing smoking cessation services, increasing physical activity, medication management, and action planning (4 sessions over 11 weeks; postal information at weeks 16 and 24). The nurses received two days of training. The usual care group received a leaflet about COPD.Main outcome measuresThe primary outcome was health related quality of life at 12 months using the short version of the St George’s Respiratory Questionnaire (SGRQ-C).ResultsThe intervention was delivered with good fidelity: 86% of scheduled calls were delivered; 75% of patients received all four calls. 92% of patients were followed-up at six months and 89% at 12 months. There was no difference in SGRQ-C total score at 12 months (mean difference −1.3, 95% confidence interval −3.6 to 0.9, P=0.23). Compared with patients in the usual care group, at six months follow-up, the intervention group reported greater physical activity, more had received a care plan (44% v 30%), rescue packs of antibiotics (37% v 29%), and inhaler use technique check (68% v 55%).ConclusionsA new telephone health coaching intervention to promote behaviour change in primary care patients with mild symptoms of dyspnoea did lead to changes in self management activities, but did not improve health related quality of life.Trial registrationCurrent controlled trials ISRCTN 06710391
In the present scenario of increasing energy crisis Interest in ac module strategy for PV based microinverter has grown in recent years because of its improved energy harvest, improved system ...efficiency, lower installation costs, plug-N-play operation, and enhanced flexibility and modularity .Microinverters avoid the drastic reduction in power produced by PV panels due to shading effect. In this paper a three-port microinverter topology is being studied which is connected to single phase grid. The proposed topology is basically a flyback converter with an extra switch and diode. This arrangement allows the use of a low capacitance film capacitor, with long lifespan, as decoupling capacitor instead of E-caps, with short lifespan. Thus proposed three-port microinverter has longer lifespan.The operation principles and design considerations are explained in this paper. The MATLAB/SIMULINK based simulation of the microinverter is also performed
This study explores the impact of design, information, and usefulness of travel websites on travel purchase intention. Utilizing a quantitative research design, data from 177 respondents were ...collected via a structured questionnaire administered through Google Forms. Regression analysis revealed that design, information, and usefulness significantly and positively influenced travel purchase intention with each predictor variable exhibiting a substantial effect on travel purchase decisions. These findings corroborate existing research emphasizing the importance of website design, information quality, and usefulness in shaping consumer purchase intention in the online travel domain. For instance, Kim & Lennon, (2008) found that visually appealing design positively influences purchase intention, while Ruiz Mafe Sanz Blas, (2006) demonstrated the significant impact of informative content on purchase intention, aligning with the positive coefficients observed in this study. KEYWORDS- Travel website design, Information and usefulness of travel website and travel purchase intention
The Internet AS topology can be represented by AS graphs where nodes represent ASes and edges represent business relationships between ASes. AS relationship can be broadly classified into two types: ...provider-to-customer (p2c) and peer-to-peer (p2p). In this paper we present a machine learning approach to edge type inference in AS graphs. Given an AS graph derived from publicly available data source, we use the Gentle AdaBoost machine learning algorithm to train a classifier that classifies the edge types (p2c and p2p) based on a set of node features. We use our method to train classifiers for three AS graphs derived from different data sources-a BGP graph, a traceroute graph, and an IRR graph. The three classifiers achieve 93.97%-97.73% accuracy when validated against ground truth and achieve 81.76%-95.66% accuracy when validated against CAIDA's AS relationship inference dataset. We merge the three individual graphs to obtain a combined graph and propose a method to compute edge types in the combined graph. We analyze the characteristics of the three individual graphs and the combined graph and show that combining the three individual graphs gives us a significantly more complete view of both the p2p and p2c ecosystems in the Internet.
The prevalence of diagnosed chronic obstructive pulmonary disease (COPD) in the UK is 1.8%, although it is estimated that this represents less than half of the total disease in the population as much ...remains undiagnosed. Case finding initiatives in primary care will identify people with mild disease and symptoms. The majority of self-management trials have identified patients from secondary care clinics or following a hospital admission for exacerbation of their condition. This trial will recruit a primary care population with mild symptoms of COPD and use telephone health coaching to encourage self-management.
In this study, using a multi-centred randomised controlled trial (RCT) across at least 70 general practices in England, we plan to establish the effectiveness of nurse-led telephone health coaching to support self-management in primary care for people who report only mild symptoms of their COPD (MRC grade 1 and 2) compared to usual care. The intervention focuses on taking up smoking cessation services, increasing physical activity, medication management and action planning and is underpinned by behavioural change theory. In total, we aim to recruit 556 patients with COPD confirmed by spirometry with follow up at six and 12 months. The primary outcome is health related quality of life using the St Georges Respiratory Questionnaire (SGRQ). Spirometry and BMI are measured at baseline. Secondary outcomes include self-reported health behaviours (smoking and physical activity), physical activity measured by accelerometery (at 12 months), psychological morbidity, self-efficacy and cost-effectiveness of the intervention. Longitudinal qualitative interviews will explore how engaged participants were with the intervention and how embedded behaviour change was in every day practices.
This trial will provide robust evidence about the effectiveness of a novel telephone health coaching intervention to promote behaviour change and prevent disease progression in patients with mild symptoms of dyspnoea in primary care.
Current controlled trials ISRCTN06710391 .
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