ABSTRACT
BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.
Subject(s)
General Surgery , Surgical Procedures, Operative , Adult , Aged , Benchmarking , Cohort Studies , Emergencies , Female , Hospital Mortality , Humans , Middle Aged , Postoperative Complications , Prospective Studies , Quality Improvement , Retrospective StudiesABSTRACT
Bertolotti's syndrome is a little-known and little-discussed pathology. We report the case of a 13-year-old child diagnosed with Bertolotti's syndrome after several years of functional complaints. Conventional radiography was used to diagnose the transverse mega-apophysis of L5, while sectional and functional imaging confirmed a lumbosacral-iliac impingement. In view of the transient efficacy of medical management, surgical resection of the transverse mega-apophysis was performed. The medium-term decline in symptoms was excellent and the patient resumed physical activities without limitation or pain.
Subject(s)
Low Back Pain/surgery , Lumbosacral Region/surgery , Adolescent , Humans , Image Processing, Computer-Assisted , Lumbar Vertebrae/surgery , Lumbosacral Region/diagnostic imaging , Male , Neurosurgical Procedures , Treatment OutcomeABSTRACT
EIGER is a single-photon-counting hybrid pixel detector developed at the Paul Scherrer Institut, Switzerland. It is designed for applications at synchrotron light sources with photon energies above 5â keV. Features of EIGER include a small pixel size (75â µm × 75â µm), a high frame rate (up to 23â kHz), a small dead-time between frames (down to 3â µs) and a dynamic range up to 32-bit. In this article, the use of EIGER as a detector for electrons in low-energy electron microscopy (LEEM) and photoemission electron microscopy (PEEM) is reported. It is demonstrated that, with only a minimal modification to the sensitive part of the detector, EIGER is able to detect electrons emitted or reflected by the sample and accelerated to 8-20â keV. The imaging capabilities are shown to be superior to the standard microchannel plate detector for these types of applications. This is due to the much higher signal-to-noise ratio, better homogeneity and improved dynamic range. In addition, the operation of the EIGER detector is not affected by radiation damage from electrons in the present energy range and guarantees more stable performance over time. To benchmark the detector capabilities, LEEM experiments are performed on selected surfaces and the magnetic and electronic properties of individual iron nanoparticles with sizes ranging from 8 to 22â nm are detected using the PEEM endstation at the Surface/Interface Microscopy (SIM) beamline of the Swiss Light Source.
ABSTRACT
The case of a 71-year-old patient who had respiratory disorders for more than 11 years is reported. Direct microscopy was negative in 4 sputum samples and finally, on five occasions, the culture gave rise to a strain biochemically labeled as Mycobacterium scrofulaceum. The case corresponded to a mycobacteriosis.
Subject(s)
Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium scrofulaceum/isolation & purification , Aged , Anti-Bacterial Agents , Drug Resistance, Microbial , Drug Therapy, Combination/therapeutic use , Humans , Male , Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium Infections, Nontuberculous/drug therapy , Mycobacterium scrofulaceum/drug effects , Sputum/microbiologyABSTRACT
We have evaluated the new ELISA test (ANDA-Tb) for the serological diagnosis of tuberculosis in serum samples from 343 individuals: 160 were from blood donors, 152 from patients with nontuberculous diseases, most of them respiratory, and 31 from tuberculous patients diagnosed by positive culture. Using a cutoff value in 350 serounits we had a positive predictive value of 57% and a negative predictive value of 98% in blood donors, and 43% and 97%, respectively, in control patients. Sensitivity was 68%. There was a higher false positive rate in patients with respiratory diseases, particularly acute pneumonia. We conclude that this particular ELISA is very useful as a supportive test for the diagnosis of tuberculosis, with a lower specificity in hospital nontuberculous patients.
Subject(s)
Antibodies, Bacterial/analysis , Enzyme-Linked Immunosorbent Assay , Mycobacterium tuberculosis/immunology , Reagent Kits, Diagnostic , Tuberculosis/diagnosis , Blood Donors , Evaluation Studies as Topic , Humans , Mycobacterium tuberculosis/isolation & purification , Predictive Value of Tests , Respiration Disorders/immunology , Tuberculosis/microbiologyABSTRACT
Se realizó un estudio con el objeto de conocer el estado clínico psicológico de un grupo de adolescentes con cáncer, en lo que refiere a detectar algunas características de su personalidad, mediante el "Inventario multifásico de la Personalidad de Minnesota" (MMPI). Se formó un grupo de 54 adolescentes con cáncer (36 hombres y 18 mujeres), que acudían al Instituto Nacional de Cancerología y al Hospital de Oncología del Centro Médico Nacional, del Instituto Mexicano del Seguro Social y se comparó a estos con un grupo de adolescentes sin cáncer. Adicionalmente se buscó la relación que podía existir entre: los diferentes tipos de diagnóstico (leucemia-linfoma), el estado clínico (en actividad-en remisión), la duración de la enfermedad (menos de un año-más de un año) y la edad (de 13 a 17 años 11 meses-de 18 a 21 años). Se presentan los resultados de esta investigación, los cuales ponen a descubierto la imperiosa necesidad que existe de brindar a estos pacientes un adecuado apoyo clínico psicológico, así como de tomar en cuenta la interrelación existente entre el tratamiento médico y la respuesta emocional ante la enfermedad
