Safety and Efficiency Outcomes of Ambulatory Gynaecologic Procedures in Canadian Surgical Centres Adopting a Common Model.

OBJECTIVE: The present study aims to compare the safety and efficiency outcomes of ambulatory gynaecologic procedures performed under conscious sedation and/or local anaesthetic at 2 Canadian institutions. METHODS: A retrospective cohort study was completed over 1-year on patients presenting to the ambulatory care centres at 2 Canadian institutions that shared a common care model. Outcomes of interest were lead time (registration to discharge), procedural time, and intraoperative complications. Surgical data was derived from a retrospective chart review and outcomes were compared using the independent t test and one-way analysis of variance. RESULTS: A total of 1495 and 1098 patients presented to the 2 sites. The average age of patients was 35.5 ± 12.3 years and 41.7 ± 10.2 years. The most commonly performed procedures were dilatation and curettages at the first centre and operative hysteroscopies at the second centre. Average lead times were similar: 170.3 ± 35.8 minutes and 171.6 ± 45.4 minutes (P = 0.45). There was a significant difference in mean procedural time being 9.8 ± 5.5 minutes and 17.0 ± 10.0 minutes (P < 0.001). The rate of minor intraoperative complications was 3.8% and 6.6% (P = 0.002); whereas the rate of major complications was 2.7% and 3.3% (P = 0.43). CONCLUSION: In Canada, the majority of gynaecologic procedures are performed under general anesthesia. By comparing outcomes at 2 separate Canadian centres, we demonstrated the reproducibility of a common ambulatory model for minor gynaecologic procedures, supporting the implementation of similar care models across Canada.

Multimodal Photoplethysmography-Based Approaches for Improved Detection of Hypertension.

Elevated blood pressure (BP) is a major cause of death, yet hypertension commonly goes undetected. Owing to its nature, it is typically asymptomatic until later in its progression when the vessel or organ structure has already been compromised. Therefore, noninvasive and continuous BP measurement methods are needed to ensure appropriate diagnosis and early management before hypertension leads to irreversible complications. Photoplethysmography (PPG) is a noninvasive technology with waveform morphologies similar to that of arterial BP waveforms, therefore attracting interest regarding its usability in BP estimation. In recent years, wearable devices incorporating PPG sensors have been proposed to improve the early diagnosis and management of hypertension. Additionally, the need for improved accuracy and convenience has led to the development of devices that incorporate multiple different biosignals with PPG. Through the addition of modalities such as an electrocardiogram, a final measure of the pulse wave velocity is derived, which has been proved to be inversely correlated to BP and to yield accurate estimations. This paper reviews and summarizes recent studies within the period 2010-2019 that combined PPG with other biosignals and offers perspectives on the strengths and weaknesses of current developments to guide future advancements in BP measurement. Our literature review reveals promising measurement accuracies and we comment on the effective combinations of modalities and success of this technology.

Cuffless Single-Site Photoplethysmography for Blood Pressure Monitoring.

One in three adults worldwide has hypertension, which is associated with significant morbidity and mortality. Consequently, there is a global demand for continuous and non-invasive blood pressure (BP) measurements that are convenient, easy to use, and more accurate than the currently available methods for detecting hypertension. This could easily be achieved through the integration of single-site photoplethysmography (PPG) readings into wearable devices, although improved reliability and an understanding of BP estimation accuracy are essential. This review paper focuses on understanding the features of PPG associated with BP and examines the development of this technology over the 2010-2019 period in terms of validation, sample size, diversity of subjects, and datasets used. Challenges and opportunities to move single-site PPG forward are also discussed.

Multi-Site Photoplethysmography Technology for Blood Pressure Assessment: Challenges and Recommendations.

Hypertension is one of the most prevalent diseases and is often called the "silent killer" because there are usually no early symptoms. Hypertension is also associated with multiple morbidities, including chronic kidney disease and cardiovascular disease. Early detection and intervention are therefore important. The current routine method for diagnosing hypertension is done using a sphygmomanometer, which can only provide intermittent blood pressure readings and can be confounded by various factors, such as white coat hypertension, time of day, exercise, or stress. Consequently, there is an increasing need for a non-invasive, cuff-less, and continuous blood pressure monitoring device. Multi-site photoplethysmography (PPG) is a promising new technology that can measure a range of features of the pulse, including the pulse transit time of the arterial pulse wave, which can be used to continuously estimate arterial blood pressure. This is achieved by detecting the pulse wave at one body site location and measuring the time it takes for it to reach a second, distal location. The purpose of this review is to analyze the current research in multi-site PPG for blood pressure assessment and provide recommendations to guide future research. In a systematic search of the literature from January 2010 to January 2019, we found 13 papers that proposed novel methods using various two-channel PPG systems and signal processing techniques to acquire blood pressure using multi-site PPG that offered promising results. However, we also found a general lack of validation in terms of sample size and diversity of populations.