Dissertations / Theses on the topic 'Knee Surgery Risk factors'
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Bottomley, Nicholas J. "Anteromedial osteoarthritis : a surgical perspective of incidence, progression and risk factors." Thesis, University of Oxford, 2014. http://ora.ox.ac.uk/objects/uuid:34c87265-bbae-4018-b120-ef1d6bed73aa.
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Anteromedial osteoarthritis of the knee (AMOA) has been defined anatomically, histologically and radiologically and yet little is known about the epidemiology of the disease or the risk factors involved in the development of the disease. The broad aim of this thesis was to combine clinical insight with the utilisation of modern, large epidemiological datasets to provide information to inform better the clinical management of patients with AMOA. Specifically, the prevalence and incidence of AMOA, the time taken to progress from early disease to severe disease that may require surgical intervention, the radiological characterisation of disease and the assessment of mechanical risk factors implicit in the development of this pattern of disease are investigated. A cross-sectional study of the radiological prevalence of AMOA in a symptomatic cohort in a specialist secondary care knee clinic showed that AMOA was the commonest pattern of knee OA, present in more than 60% of symptomatic subjects. Less than 25% of subjects with AMOA presented with advanced or 'bone-on-bone' disease, emphasising the clinical importance of understanding the progression from earlier stages of disease to this advanced stage. A 20-year longitudinal radiographic study was performed on 1000 women to describe the prevalence, incidence and progression of AMOA. The prevalence of AMOA was 43% and the incidence over 20-years was 0.4. Life table analysis showed that the risk of developing advanced AMOA in a previously normal knee was 2.6%. Of those subjects with early radiological AMOA, 11% progressed to advanced 'bone-on-bone' disease within 10 years and 37% within 20 years. The role of mechanical risk factors in the development of AMOA showed that both anatomical limb and proximal tibial alignment were significantly more varus aligned in those that developed AMOA at 20-years. Assessment of the shape of the medial tibial plateau in a longitudinal MRI study showed that the angle of the upslope at the anterior aspect of the plateau was significantly increased in the group that subsequently developed AMOA. To enable AMOA to be studies in future MRI studies, the MRI description of the disease was defined. In summary, AMOA was shown to be the most common pattern of knee OA both in symptomatic surgical cohorts and in the community. The progression of the disease from an early stage to an advanced stage, which may require surgical intervention, was described for the first time. To enable better the recognition of AMOA in modern epidemiological studies, the MRI description of AMOA was defined and the clinical relevance of modern MRI was discussed. The anatomical alignment of the limb, the alignment of the proximal tibia and the morphology of the tibial plateau were all shown to have a role in the development of AMOA. Addressing these mechanical factors may provide a therapeutic surgical target for the management of patients with AMOA.
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White, Derek A. "Factors affecting changes in joint alignment following knee osteotomy surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/MQ63389.pdf.
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Groll, Dianne L. "Factors influencing patient perceived health status following total knee replacement surgery." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp04/mq22316.pdf.
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Ingham, Sarah Louise. "Knee pain in the community : risk factors, incidence, and outcome." Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/11134/.
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Background: Knee pain affects 1 in 4 people over 55 years, and is a leading cause of disability in the elderly (Peat et al, 2001). Whilst the prevalence of knee pain has been examined, the natural history of knee pain and associated risk factors remain unknown (O’Reilly, 1996). Objectives: to determine in a community sample over a 10 year period: [1] the incidence of knee pain; [2] the outcome of knee pain; and [3] risk factors for both incidence and outcome of knee pain. Materials and method: This was a retrospective cohort study. Baseline data were collected between 1996-1999, and the cohort was reviewed during 2007-2008. Knee pain was defined as pain around the knee for most days of at least a month. Participants without knee pain at baseline who developed knee pain during the subsequent 10 years were defined as incident cases. Participants with knee pain at baseline who reported worsening of symptoms, improvement of symptoms, no change in symptoms, or who underwent TKR during the past 10 years were defined as outcome cases. Other measures included: age of onset and time from baseline to the first episode of knee pain. Putative risk factors measured at baseline included age, gender and body mass index (BMI); risk factors assessed at follow-up included knee malalignment and foot angulation. Relative risk (RR) was estimated using odds ratio (OR) or hazard ratio (HR) depending on outcomes. Confounding factors were adjusted using logistic regression or COX regression. Results: 9,429 participants were questioned at baseline (2,868 knee pain positive/6,397 knee pain negative). After 10 years, 5,479 were eligible for follow-up. Of them 3,109 responded and 424 underwent x-rays at both baseline and follow-up. The baseline age of this cohort ranged between 40-83 years, with a mean age of 57 years old; 1,725 (55.5%) were women. The incident rate for knee pain cases during the 10 year follow-up period was 742/2,156 (34.4%); this was similar in men (32%) and women (35%). During the 10 year period 250 (27.4%) of the 914 people with pain at baseline experienced worsening of their symptoms, with 81 (8.9%) requiring total knee joint replacements (TKR). A number of risk factors were explored. Obesity (OR 2.19; 95%CI 1.49, 3.22) and varus malalignment (OR 2.82; 95%CI 1.57, 5.06) significantly associated with incident knee pain, whereas back pain (aOR 1.47; 95%CI 1.02, 2.10) and physical work (aOR 1.88; 95%CI 1.02, 3.50) were related to poor outcome. Conclusions: For people over the age of 40 years old, 1 in 3 will develop significant knee pain in the next 10 years. Of people with knee pain, 1 in 4 will worsen over a 10 year period and 1 in 11 will require surgery. A number of risk factors were identified including both systemic/constitutional and more local biomechanical factors. This could have practical implications for primary and secondary prevention particularly in relation to modifiable risk factors, such as reduction in BMI, occupational protection of the knees and possible adjustment of knee malalignment.
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Wills, Andrew K. "Gait kinematics and risk factors for overuse anterior knee pain." Thesis, University of Surrey, 2006. http://epubs.surrey.ac.uk/844510/.
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Overuse anterior knee pain (AKP) is precipitated by activity and affects up to 30% of young and active populations. There is little empirical evidence for the multitude of cited risk factors for the condition and a lack of prospective studies. The main aim of this PhD was to examine the role of gait kinematics as a risk factor for AKP. The first study examined variables other than gait that may need to be controlled or statistically adjusted for in future studies to avoid masking true risk factors or effects. A prospective study of military recruits was undertaken into the effect of prior activity levels, aerobic fitness and social and medical history on the development of AKP. The incidence of AKP was high (8.6%; 95% CI: 6.8-10.4) despite the short 12-week exposure to training. Heavy smokers (odds ratio (OR): 6.37) and individuals with a previous ankle injury (OR; 2.48) had an increased risk of AKP that was independent of lifestyle factors. The association between 3D gait kinematics and patellofemoral pain syndrome (PFPS) was then explored prospectively. Principle components analysis was applied to reduce the gait data into its main factors and multivariate logistic regression was used to explore the association between these factors and PFPS. Three factors from treadmill running explained 47% of the variance between individuals who developed PFPS and those that remained injury-free. These factors contained increased hip and tibial internal rotation, increased hip adduction and decreased knee internal rotation during stance. These results contradicted findings from case-control studies. The association between variability in gait movement patterns and PFPS was assessed using the continuous relative phase method. The main risk factor was reduced inter-stride variability in the joint coordination relationships that contained tibial rotation. The main limitation of the gait study was the small sample size of the PFPS group (n=7). A study was thus undertaken to cross-validate the findings in a new sample with PFPS. This new sample was captured using a 3-year follow up study of the original gait cohort. The results were not replicated in the new PFPS group, and there were no other gait characteristics correlated with PFPS. The lack of validation was attributed to differences in the symptom-complex between the case groups of the two studies. To date, all published evidence for an association between gait and AKP originates from case-control studies. The key issue with this design is inferring the correct temporal sequence of a finding. Thus, to assess the effect of PFPS on gait and inform the interpretation of these studies, a repeated measures study of 6 subjects before and after the onset of PFPS was undertaken. Despite the mild symptoms of the group and the absence of pain during testing, the subjects showed some subtle gait inhibition post onset of PFPS. This questions the use of the case-control study to validly quantify risk factors in gait. Future research should cross-validate the significant risk factors found' in these studies, explore other potentially salient variables such as patellofemoral alignment and examine the causes of these risk factors. It is hoped that such work will benefit the prevention and treatment of AKP.
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Jaf, Andersson Victor. "Seroma formation following breast surgery - incidence and risk factors." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-52541.
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Alolayan, Albraa Badr A. "Risk factors of neurosensory disturbance following bimaxillary orthognathic surgery." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B50639511.
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Objectives: To report the incidence of objective and subjective neurosensory disturbance (NSD) after orthognathic surgery in a major orthognathic centre in Hong Kong, and to investigate the risk factors that contributed to the incidence of NSD after orthognathic surgery.
Materials and Methods: A retrospective cross-sectional study on NSD after orthognathic surgery in a local major orthognathic centre. Patients who had bimaxillary orthognathic surgery reviewed at post-operative 6 months, 12 months or 24 months were recruited to undergo a neurosensory test with subjective and 3 objective assessments. Possible risk factors of NSD including subjects’ age and gender, surgical procedures and surgeons’ experience were analyzed.
Results: 238 patients with 476 sides each of maxillary and mandibular procedures were recruited. The incidences of subjective NSD after maxillary procedures were 16.2%, 13% and 9.8% at post-operative 6 months, 12 months and 24 months, respectively; the incidences of subjective NSD after mandibular procedures were 35.4%, 36.6% and 34.6% at post-operative 6 months, 12 months and 24 months, respectively. Objective neurosensory tests showed general reduced sensitivity in subjects with subjective NSD. Increased age was found to be a significant risk factor of NSD after orthognathic surgery at short term (at 6 months and 12 months) but not at 24 months. SSO has a significantly higher risk of NSD when compared to VSSO. SSO in combination with anterior mandibular surgery has a higher risk of NSD when compared to VSSO in combination with anterior mandibular surgery or anterior mandibular surgery alone. Gender of patients a nd surgeons’ experience were not found to be risk factors of NSD after orthognathic surgery.
Conclusion: The incidence of NSD after maxillary and mandibular orthognathic procedures at post-operative 6 months, 12 months and 24 months was reported. Increased age was identified as a risk factor of short term post-operative NSD but not in long term (24 months or more). Specific mandibular procedures were related to higher incidence of NSD after orthognathic surgery.published_or_final_version
Dental Surgery
Master
Master of Dental Surgery
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Boling, Michelle Clara Padua Darin A. "A prospective investigation of biomechanical risk factors for anterior knee pain." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1740.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Interdisciplinary Human Movement Science School of Medicine." Discipline: Human Movement Science; Department/School: Medicine.
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Barlow, Timothy. "Factors affecting patients' decision-making and the development of a prognostic model in total knee replacement surgery." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/86003/.
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Osteoarthritis of the knee is a common condition, affecting more than 10% of the population aged over 55 years. It can lead to pain, functional loss, and a reduction in the quality of life. Total knee replacement is a common procedure for those with severe osteoarthritis with over 90,000 procedures performed each year in the UK; however, around 20% of patients are dissatisfied with the outcome. How to identify these patients pre-operatively is a research priority, as set out by the British Orthopaedic Association, Arthritis Research U.K., and the National Institute for Health and Care Excellence. The effect such an advance would have on patients’ decision-making is not known. Therefore, in this thesis I set out to understand the factors important to patients when contemplating a knee replacement, how an outcome prediction tool could affect that process, and then go on to develop an prognostic model for use in patients considering a total knee replacement. I first performed a systematic review of factors that influence patient’s decision-making; I then describe two qualitative projects, the first developed a model of decision-making, the second investigated how providing predictions of outcome could affect expectations and decision-making. This information, combined with a systematic review of the factors that affect outcome in knee replacements, allowed me to develop a multicentre cohort study designed to generate a prognostic model. This study recruited 600 patients, and the linear regression model accounts for 36% of the variability in outcome – more than any previous study. This thesis provides a better understanding of patients’ decision-making, which should facilitate doctor-patient communication. I describe a model that can predict more variability in outcome than any previous models. The usefulness of the model in individual prediction and potential future areas of study include how more variability could be incorporated, how to develop such a model into a prediction tool, and other approaches to addressing poor outcomes after total knee replacement.
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Hedberg, Magnus. "Stroke during cardiac surgery : risk factors, mechanisms and survival effects." Doctoral thesis, Umeå universitet, Kirurgi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-38079.
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Introduction: Neurological complications and stroke in association with cardiac surgery is a serious problem. The stroke event can occur during surgery (early stroke) or in the postoperative period with a symptom free interval (delayed stroke). Particle embolization due to aortic manipulation during surgery has been suspected as a mechanism for early stroke. The present thesis address mechanisms and survival effects of stroke both clinically (I-III) and experimentally (IV-V). Methods: Study I) Within a cohort of 2641 consecutive cases, a group of cardiac surgery patients with stroke and evaluated by computed tomography (CT) were studied (n=77). CT-findings were analyzed in relation to stroke symptoms. Study II) Data from 9122 patients undergoing coronary surgery were analyzed. Records of patients with any signs of neurological complications were reviewed to extract 149 subjects with stroke at extubation (early, 1.6%) versus 99 patients having a free interval (delayed, 1.1%). Early and delayed stroke were evaluated separately. Independent risk factors for stroke were analyzed by logistic regression and survival by Cox regression (9.3 years median follow-up). Study III) Patients with early (n=223) and delayed stroke (n=116) were identified among 10809 patients undergoing cardiac and aortic surgery, both groups exposed to cardiopulmonary bypass. Stroke patients were subdivided by the hemispheric location of lesions. Subgroups were compared and their associated pre- and peroperative variables and survival were analyzed. Study IV) Aortic cross-clamp manipulation was studied in a human cadaveric perfusion model. The pressurized aorta was repeatedly cross-clamped and washout samples were collected before and after clamp maneuvers. Particles in the washout samples were evaluated by microscopy and by digital image analysis. Study V) Pig aortas were pressurized and cannulated. Washout samples were collected before and after cannulation (n = 40). Particles were deposited onto a 10-μm filter to be evaluated by microscopy and digital image analysis. Results: Study I) In the group of patients exposed to routine cardiac surgery (i.e., clamping and cannulation) and with early stroke, right-hemispheric lesions were more frequent than of the contra-lateral side (P=0.005). Patients with aortic dissections had a strong dominance of bilateral findings, which was different from the unilateral pattern in the routine-surgery group (P<0.001). Study II) Early and delayed stroke did not share any risk factors. Both early and delayed stroke explained mortality in the early postoperative period (P<0.001, P<0.001 respectively) but also at long term follow-up (P=0.008, P<0.001 respectively). For patients surviving their first postoperative year, delayed but not early stroke influenced long-term mortality (P=0.001 and P=0.695, respectively). Study III) Stroke lesions in association to cardiac surgery were near exclusively ischemic. Early stroke had a preponderance for right-hemispheric lesions (P=0.009). In contrast, patients with early stroke that had undergone surgery of the aorta with circulatory arrest showed a pattern with more bilateral lesions compared to ‘cardiac-type’ operations (P<0.001). Patients with bilateral lesions had a dramatically impaired survival compared to those with unilateral lesions (P<0.001). Study IV) In the cadaveric perfusion model, cross-clamping produced a significant output of particles, which was seen for size intervals of 1 mm and smaller (P=0.002 to P=0.022). In all size intervals the particle output correlated with the degree of overall aortic calcification (P =0.002 to P=0.025). Study V) At cannulation of the pig aorta, more particles were noted after cannulation compared to before the maneuver (P<0.001). This increase included small (<0.1 mm, P<0.001) and intermediate-size particles (0.1-0.5 mm, P< 0.001). Particles above 0.5 mm were few and were not associated with cannulation. Conclusions: The influence of stroke on mortality was devastating, for both early and delayed stroke. These two stroke groups had obvious differences in both their risk factors and their hemispheric distribution. It is here emphasized that early and delayed stroke should be considered as two separate entities with suggested mechanistic differences. Ischemic lesions accounted for near all stroke events seen in association to cardiac surgery. For early stroke, these were mostly located within the right hemisphere. Results from the experimental studies underscore microembolic risks associated with aortic manipulation.
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Piccione, Joseph. "Bronchiectasis in Chronic Pulmonary Aspiration: Risk Factors,Time Course and Clinical Implications." University of Cincinnati / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1292360198.
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Dunbar, Mark Robert. "Patient factors associated with outcome after total knee replacement : research towards the design of a multicenter prospective cohort study." Thesis, University of Warwick, 2008. http://wrap.warwick.ac.uk/2269/.
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This thesis set out to explore the influence of patient factors that may be associated with outcome after total knee replacement for osteoarthritis. It starts with an introduction to the general subject, looking in detail at the methods for measuring the outcome of total knee replacement and also methods of measuring the status of various possible patient factors. This is followed by a systematic review of the evidence currently available on the influence of patient factors on the outcome of total knee replacement. This systematic review highlights a number of deficiencies in the available evidence. The next logical step was to perform an appropriate study to provide better quality evidence. However, there were six areas of uncertainty that presented significant difficulty when designing such a study. These areas of uncertainty became the focus of this thesis and were explored in detail. Through a process of experimentation and careful evaluation of the results these uncertainties were resolved. This thesis has provided the critical information required to design and conduct a multicentre study that would define which patient factors are important in determining outcome for total knee replacement for osteoarthritis.
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Ekegren, Christina Louise. "Agreement and validity of observational risk screening guidelines in evaluating ACL injury risk factors." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/1622.
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Study Design: Methodological study.
Objectives: To examine the agreement and validity of using observational risk screening guidelines to evaluate ACL injury risk factors.
Background: Post-pubescent females have an increased risk of anterior cruciate ligament (ACL) injury compared with their male counterparts partly due to their high-risk landing and cutting strategies. There are currently no scientifically-tested methods to screen for these high risk strategies in the clinic or on the field.
Methods and Measures: Three physiotherapists used observational risk screening guidelines to rate the neuromuscular characteristics of 40 adolescent female soccer players. Drop jumps were rated as high risk or low risk based on the degree of knee abduction. Side hops and side cuts were rated on the degree of lower limb 'reaching'. Ratings were evaluated for intrarater and interrater agreement using kappa coefficients. 3D motion analysis was used as a gold standard for determining the validity of ratings.
Results: Acceptable intrarater and interrater agreement (k≥0.61) were attained for the drop jump and the side hop, with kappa coefficients ranging from 0.64 to 0.94. Acceptable sensitivity (≥0.80) was attained for the side hop and the side cut, with values ranging from 0.88 to 1.00. Acceptable specificity (≥0.50) was attained for the drop jump, with values ranging from 0.64 to 0.72.
Conclusion: Observational risk screening is a practical and cost-effective method of screening for ACL injury risk. Based on levels of agreement and sensitivity, the side hop appears to be a suitable screening task. Agreement was acceptable for the drop jump but its validity needs further investigation.
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Heath, Douglas. "Factors Affecting Occupant Risk of Knee-Thigh-Hip Injury in Frontal Vehicle Collisions." Digital WPI, 2010. https://digitalcommons.wpi.edu/etd-theses/422.
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Every year, millions of people are killed or injured in motor vehicle accidents in the United States. Although recent improvements to occupant restraint systems, such as seatbelts and airbags, have significantly decreased life threatening injuries, which usually occur to the chest or head, they have done little to decrease the occurrence of lower extremity injuries. Although lower extremity injuries are not usually life threatening, they can result in chronic disability and high psychosocial cost. Of all lower extremity injuries, injuries to the knee-thigh-hip (KTH) region have been shown to be among the most debilitating. This project used a finite element (FE) model of the KTH region to study injury. A parametric investigation was conducted where the FE KTH was simulated as a vehicle occupant positioned to a range of pre-crash driving postures. The results indicate that foot contact force and knee kinematics during impact affects the axial force absorbed by the KTH region and the likelihood of injury. The results of the study could be used to reevaluate the lower extremity injury thresholds currently used to regulate vehicle safety standards. Also, the results could be used to provide guidelines to vehicle manufacturers for developing safer occupant compartments.
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Voors, Adriaan Alexander. "Risk factors, endothelial function, and clinical outcome after coronary bypass surgery." [S.l. : [Groningen] : s.n.] ; [University Library Groningen] [Host], 1997. http://irs.ub.rug.nl/ppn/157840069.
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Tannenbaum, Rebecca L. "Risk Factors Associated with Prematurity in Patients Diagnosed with Hypospadias." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1368024479.
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Hanke, Samuel P. M. D. "Readmission within 30 Days of Pediatric Cardiac Surgery: Incidence, Risk Factors and Resource Utilization." University of Cincinnati / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869980.
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Jamison, Steven T. "The Association between the Core and Anterior Cruciate Ligament Injury Risk Factors." The Ohio State University, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=osu1343697914.
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Reilly, Jacqueline. "Surgical wound infection : addressing the risk factors within a change theory framework." Thesis, Glasgow Caledonian University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322215.
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Norvell, Daniel C. "Knee pain and symptomatic osteoarthritis after traumatic unilateral lower extremity amputation : prevalence and risk factors /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/10863.
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Haddad, Sleiman. "Surgical site infections in spinal surgery: from risk factors to surgical outcomes." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/665823.
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Durante la última década ha aumentado significativamente el volumen de cirugías de columna, además de la complejidad tanto médica como quirúrgica de los pacientes tratados. Esto ha dado lugar a un aumento de complicaciones asociadas. Los profesionales de la salud son ahora más conscientes del impacto de ciertas complicaciones prevenibles, especialmente la infección de la herida quirúrgica (IHQ), cosa que ha provocado un aumento de los esfuerzos para reducir su incidencia. Se han descrito factores de riesgo generales para las IHQ. No obstante, el rol del estado neurológico y del traumatismo no se han analizado específicamente. Además, el impacto de las IHQ en los resultados clínicos tras la cirugía de deformidad espinal del adulto (DEA) aún no está claro.
El objetivo de esta tesis doctoral es revisar los factores de riesgo de la IHQ en la cirugía del raquis así como su impacto sobre el resultado final. Se centra principalmente en el diagnóstico (traumático vs. degenerativo) y el estado neurológico (Lesión medular LM o mielopatía MP) como predictores de la IHQ. También informa de las morbilidades y los costes asociados y evalúa los resultados quirúrgicos después de una IHQ.
La National Inpatient Survey (NIS) y la base de datos del Thomas Jefferson University Hospital (TJUH) se usaron para analizar la infección en la cirugía cervical primaria. Mediante un análisis multivariante, se analizaron los posibles factores de riesgo incluyendo el trauma y la lesión neurológica. Luego se procedió a un análisis de costes. La base de datos del European Spine Study Group (ESSG) sirvió para evaluar su impacto sobre los resultados funcionales y clínicos en pacientes con fusión posterior para la DEA mediante la comparación de cohortes emparejadas.
Un total de 1.247.281 (NIS) y 5.540 (TJUH) pacientes cumplieron los criterios de inclusión. La incidencia de la IHQ fue de 0.73% (NIS) y 1.75% (TJUH). Aumentó progresivamente desde 0,52% en pacientes sin MP hasta 1,97% en el grupo con LM traumática en la muestra del NIS y desde 0,88% a 5,54% en TJUH. Hubo diferencias significativas en las tasas de IHQ entre muestras. El estado neurológico (Odds Ratio [OR] 1,69, p<.0001) y el trauma (OR 1.30, p=.0003) fueron asociados a IHQ en la muestra del NIS. En la muestra del TJUH, solo el trauma (OR 2.11, p=.03) era significativo cuando se tuvieron en cuenta las otras comorbilidades. Los costes de la infección variaron entre los grupos diagnósticos y alcanzaron $184060 en el grupo LM traumática. Los pacientes con IHQ utilizaron con más frecuencia las instituciones especializadas al alta.
Se identificaron 444 pacientes con DEA tratados quirúrgicamente y con más de 2 años de seguimiento. 20 padecieron una IHQ aguda y fueron emparejados a 60 controles. No se observaron diferencias basales entre grupos tanto en variables radiológicas como calidad de vida. Los pacientes con IHQ tuvieron una estancia hospitalaria más prolongada y más complicaciones mecánicas. La infección se asoció a más complicaciones y revisiones no relacionadas. La corrección de la deformidad se mantuvo indiferentemente de la infección a lo largo del seguimiento. Hubo una muerte relacionada con IHQ. Los pacientes con IHQ presentaban peor calidad de vida al año y tenían menos probabilidades de experimentar mejoría. Sin embargo, no se registraron diferencias significativas a partir del año.
Como conclusión, tanto el diagnóstico primario (trauma vs. degenerativo) como el estado neurológico (MP o LM) son predictores de la IHQ en cirugía cervical. La infección afecta significativamente el primer año después de la cirugía de la DEA, se asocia con más complicaciones, revisiones no relacionadas y peor calidad de vida. Sin embargo, su impacto negativo parece diluirse en el segundo año.Over the last decade there has been a significant increase in volume of spinal surgeries performed as well as in medical and surgical complexity of patients. This was accompanied by an increased overall morbidity and volume of complications. At the same time, health care professionals have become more aware of the impact of specific preventable complications such as surgical site infections (SSI) and huge efforts have been directed to reduce SSI incidence. Although the general risk factors for SSI have been discussed, the relationship of neurologic status and trauma to SSI has not been explicitly explored. In addition, the direct and indirect impact of deep SSI on surgical outcomes especially after adult spinal deformity (ASD) surgery is still unclear. The aim of this doctoral thesis is to review the risk factors for developing a SSI after spine surgery, as well as how SSI affects clinical outcome. It mainly focuses on diagnosis (Traumatic vs. Degenerative) and neurological status (Spinal Cord Injury SCI or Myelopathy MP) as predictors for SSI. It also reports the associated morbidities and costs of SSI and evaluates the surgical outcomes after SSI. The National Inpatient Survey (NIS) and the Thomas Jefferson University Hospital (TJUH) databases were probed to analyse infection in patients with primary cervical surgery. Using a multivariate analysis, all interplaying comorbidities and risk factors have been. A subsequent resource utilization analysis has been done. The European Spine Study Group (ESSG) prospective database was used to study the functional and clinical outcomes of SSI in patients with posterior fusion for Adult Spinal Deformity (ASD) through the comparison of matched cohorts. Readmissions, reoperations, deformity correction and fusion rates were also studied. A total of 1,247,281 and 5,540 patients met inclusion criteria in the NIS and TJUH databases respectively. SSI incidence was 0.73% (NIS) versus 1.75% (TJUH). It increased steadily from 0.52% in patients without MP to 1.97% in the traumatic SCI group in the NIS data and from 0.88% to 5.54% in the TJUH. Differences between diagnostic groups and cohorts reached statistical significance. SSI was predicted significantly by neurological status (odds ratio [OR] 1.69, p<.0001) and trauma (OR 1.30, p=.0003) in the NIS data. Other significant predictors included: approach, number of levels fused, female gender, black race, medium size hospital, rural hospital, large hospital, western US hospital and Medicare coverage. In TJUH, only trauma (OR 2.11, p=.03) reached significance when accounting for comorbidities. Costs of infection varied among diagnostic groups and summed $184060 in the SCI group. Patients with SSI were also more likely to be discharged to specialized institutions. 444 surgical ASD patients with more than 2 years of follow-up were identified. 20 sustained an acute SSI and 60 controls were accordingly matched. No differences were observed between groups in preoperative radiological and HRQoL variables confirming comparable groups. SSI patients had longer hospital stay and more mechanical complications including proximal junctional kyphosis. Infection was associated with more unrelated complications and revisions. Deformity correction was maintained equally at the different time intervals. One death was related to SSI. SSI patients had worse overall HRQoL status at 1 year and were less likely to experience improvement. However, no significant differences were recorded thereafter. As a conclusion, both primary diagnosis (trauma vs. degenerative) and neurologic status (MP or SCI) were found to be strong and independent predictors of SSI in cervical spine surgery. Also, SSI significantly affects the first postoperative year after posterior ASD surgery. It is associated with more complications, unrelated revisions, and worst quality of life. However it's negative impact seems to be diluted by the second postoperative year.
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Mariscalco, Giovanni. "Atrial fibrillation after cardiac surgery : an analysis of risk factors, mechanisms, and survival effects." Doctoral thesis, Umeå universitet, Kirurgi, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1798.
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Background: Despite the recent improvements in surgical techniques and postoperative patient care, atrial fibrillation (AF) remains the most frequent complication after cardiac surgery. Although postoperative AF is often regarded as a benign clinical condition, this arrhythmia has significant adverse effects on patient recovery and postoperative survival. Its exact pathophysiology has not yet been elucidated. The present thesis aims to analyze AF risk factors and their interaction, pre-existing histological explanatory alterations of the atrium, the AF impact on postoperative survival and the compliance of a prophylactic drug regimen. Methods: During a 10-year period, consecutive cardiac surgery cases with complete data on AF occurrence and postoperative survival were extracted. All patients were operated on for coronary or valvular surgery, with cardiopulmonary bypass (CPB). Hospital and long-term survival data were obtained from Swedish population registry. Study I) Isolated coronary artery bypass grafting (CABG, n=7056), aortic valve replacement (n=690) and their combination (n=688) were considered. Independent AF risk factors and AF effects on early and 1 year mortality were investigated. Study II) Patients affected by postoperative AF among isolated CABG patients (n=7621), valvular surgeries (n=995) and their combination (n=879) were studied. Long-term survival was obtained and prognostic factors identified. Study III) Seventy patients were randomized to on-pump (n=35) or off-pump (n=35) CABG. Samples from the right atrial appendage were collected and histology was evaluated by means of light and electronic microscopy with reference to preexistent alterations related to postoperative AF. Study IV) Cardiac surgery patients with complete data on smoking status (n=3245) were reviewed. Effects of smoking on AF development and interaction among variables were explored. Study V) CABG patients without clinical contraindications to receive oral sotalol (80 mg twice daily) and magnesium were prospectively enrolled (n = 49) and compared with a matched contemporary control CABG group (n = 844). The clinical compliance to the AF prophylactic drug regimen was tested. Results: The overall AF incidence was around 26%, subdivided into 23%, 40% and 45% for isolated CABG, valve procedures and their combined surgeries, respectively. Age was the strongest predictor of postoperative AF. Coronary disease superimposed risk factors with reference to myocardial conditions at CPB weaning. Considering the preoperative smoking condition, smokers demonstrated a reduced AF incidence compared to non-smokers (20% versus 27%, p<0.001). An interaction between smoking status and inotropic support was observed: without this interaction smoking conferred a 46% risk reduction of AF (p=0.011). At the histological level, myocyte vacuolization and nuclear derangement represented anatomical independent AF predictors (p=0.002 and p=0.016, respectively). CPB exposure was not associated to postoperative AF nor histological changes. Although, postoperative AF increases the length of hospitalization in all patient groups, it did not affect the hospital survival. However, AF independently impaired the late survival, a phenomenon seen in the CABG group only. With reference to the tested sotalolmagnesium drug regimen, only 55% of CABG patients were compliant to the treatment, with marginal effects on AF occurrence. Conclusions: In addition to age, details at the CPB weaning period, pre-existing histopathological changes, the hyperadrenergic state and catecholamines are key mechanisms in the pathophysiology of postoperative AF. In particular, the CPB period hides valuable information for timely AF prophylactic stratifications. Further, compliance effects due to patient selection should also be considered in a prophylactic therapy model. Postoperative AF increases late mortality after isolated CABG surgery, but not after valvular procedures. Although the mechanisms are unclear, our results draw the attention to possible AF recurrence after hospital discharge, indicating a strict postoperative surveillance.
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Shoair, Osama. "Risk Factors for Postoperative Cognitive Dysfunction in Older Adults Undergoing Major Noncardiac Surgery." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/503.
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Background: Postoperative cognitive dysfunction (POCD) is a deterioration in cognitive function that occurs after surgery as measured by neuropsychological tests. The purpose of this study was to determine the incidence and risk factors for POCD in older adults three months after major noncardiac surgery. Methods: This is a prospective study of patients aged 65 years and older who underwent major noncardiac surgery. Patients’ cognitive function was assessed before and three months after surgery using a computerized neurocognitive battery. Blood samples were withdrawn from patients before surgery to identify patients with high level of C-reactive protein (CRP), and patients who had the apolipoprotein-E4 (ApoE4) allele, as potential inflammatory and genetic biomarkers for POCD, respectively. A nonsurgical control group, that is similar to patients in age, education level, and computer familiarity, was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Patients were classified as having POCD if they had less than -1.96 in the individual Z-scores of two or more tests or in the composite Z-score. Results: A total of 69 patients and 54 controls completed the study. The mean age for patients was 71 ± 5.4 (65–88) years old and 66.7% of them were females. The majority of patients (78.3%) had above high school education. There was no difference between the surgical and nonsurgical groups in demographics except for age which was marginally higher in the nonsurgical group [73 ± 6.3 (65-92)]. The incidence of POCD was 15.9% three months after surgery. Multivariable logistic regression showed that carrying the ApoE4 allele (OR = 4.74, 95% CI = 1.09 – 22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35 – 30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49 – 34.66) were risk factors for POCD. Conclusion: The incidence of POCD in older adults is 15.9% three months after major noncardiac surgery. Risk factors for POCD were carrying the ApoE4 allele, using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery, and receiving sevoflurane for anesthesia.
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Nikolis, Andreas. "Assessment of risk factors in the development of thromboembolism in a trauma population." Thesis, McGill University, 2002. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29577.
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The aim of this study was to: (a) identify risk factors for the development of venothromboembolism in a trauma population, (b) evaluate whether risk factors vary with increasing Injury Severity Score (ISS), and (c) assess the predictive ability of the Risk Assessment Profile for Thromboembolism (RAPT) in this trauma population. There were 7532 admissions for trauma between 1993 and 1998 to the Montreal General Hospital trauma center. A nested case-control design was used. Cases were defined as all patients with radiological evidence of either a deep venous thrombosis or pulmonary embolus during their admission. Controls were patients satisfying the same inclusion criteria who did not suffer a symptomatic deep venous thrombosis or pulmonary embolism while in hospital, did not have evidence of deep venous thrombosis prior to the traumatic event, and found to be free of any symptomatic thromboembolic events on consequent follow up. Patients were divided into three categories, ISS 1--24 (mild-moderate injuries), ISS 25--59 (moderate-severe injuries), and ISS 60--75 (severe-fatal injuries). (Abstract shortened by UMI.)
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Jidéus, Lena. "Atrial Fibrillation after Coronary Artery Bypass Surgery : A Study of Causes and Risk Factors." Doctoral thesis, Uppsala University, Department of Surgical Sciences, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1488.
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The aim was to study pathophysiological mechanisms and risk factors for developing atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and the effect of thoracic epidural anaesthesia (TEA).
The study comprised 141 patients undergoing CABG, including 45 patients randomised for TEA intra- and postoperatively. All patients underwent 24-hour Holter monitoring pre- and postoperatively for the analysis of arrhythmias and heart rate variability (HRV). Catecholamines and neuropeptides (reflecting sympathetic and parasympathetic activity), atrial peptides and echocardiographically assessed atrial arias were obtained pre- and postoperatively.
Logistic regression analysis identified body mass index (BMI), maximum supraventricular beats (SPB) per minute, and total amount of cardioplegia as independent predictors of postoperative AF. Patients developing AF showed limited diurnal variation of HRV preoperatively. All HRV parameters decreased significantly in all patients postoperatively. The significant postoperative increase in atrial areas and atrial peptides did not differ between patients developing AF and those who did not. TEA had no effect on the incidence of postoperative AF, but resulted in lower heart rate, less increase in adrenaline levels, and decreased neuropeptide levels (reflecting sympathetic and parasympathetic activity). AF was initiated by an SPB in 72.4% of non-TEA and 100% of TEA treated patients, whereas changes in heart rate only, before onset, were seen in 17.2% non-TEA patients.
The observed risk factors, SPB and cardioplegia, may both induce electrophysiological changes known to increase the susceptibility to AF. The observed postoperative atrial dilatation and autonomic imbalance, indicated by HRV and neuropeptide levels, may further favour the development of AF. The observation that a majority of postoperative AF was initiated by a premature atrial contraction supports our hypothesis that latent atrial foci may be a major trigger mechanism of postoperative AF.
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Froemke, Cecily Corrine. "Enhancing Value-Based Healthcare with Reconstructability Analysis: Predicting Risk for Hip and Knee Replacements." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3772.
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Legislative reforms aimed at slowing growth of US healthcare costs are focused on achieving greater value, defined specifically as health outcomes achieved per dollar spent. To increase value while payments are diminishing and tied to individual outcomes, healthcare must improve at predicting risks and outcomes.
One way to improve predictions is through better modeling methods. Current models are predominantly based on logistic regression (LR). This project applied Reconstructability Analysis (RA) to data on hip and knee replacement surgery, and considered whether RA could create useful models of outcomes, and whether these models could produce predictions complimentary to or even stronger than LR models.
RA is a data mining method that searches for relations in data, especially non-linear and higher ordinality relations, by decomposing the frequency distribution of the data into projections, several of which taken together define a model, which is then assessed for statistical significance. The predictive power of the model is expressed as the percent reduction of uncertainty (Shannon entropy) of the dependent variable (the DV) gained by knowing the values of the predictive independent variables (the IVs).
Results showed that LR and RA gave the same results for equivalent models, and showed that exploratory RA provided better models than LR. Sixteen RA predictive models were then generated across the four DVs: complications, skilled nursing discharge, readmissions, and total cost. While the first three DVs are nominal, RA generated continuous predictions for cost by calculating expected values. Models included novel comorbidity variables and non-hypothesized interaction terms, and often resulted in substantial reductions in uncertainty.
Predictive variables consisted of both delivery system variables and binary patient comorbidity variables. Complications were predicted by the total number of patient comorbidities. Skilled nursing discharges were predicted both by patient-related factors and delivery system variables (location, surgeon volume), suggesting practice patterns influence utilization of skilled nursing facilities. Readmissions were not well predicted, suggesting the data used in this project lacks the right variables or that readmissions are simply unpredictable. Delivery system variables (surgeon, location, and surgeon volume) were found to be the predominant predictors of total cost.
Risk ratios were generated as an additional measure of effect size. These risk ratios were used to classify the IV states of the models as indicating higher or lower risk of adverse outcomes. Some IV states showed nearly 25% of patients at increased risk, while other IV states showed over 75% of patients at decreased risk. In real time, such risk predictions could support clinical decision making and custom-tailored utilization of services.
Future research might address the limitations of this project's data and employ additional RA techniques and training-test splits. Implementation of predictive models is also discussed, with considerations for data supply lines, maintenance of models, organizational buy-in, and the acceptance of model output by clinical teams for use in real-time clinical practice.
If outcomes and risk are adequately predicted, areas for potential improvement become clearer, and focused changes can be made to drive improvements in patient care. Better predictions, such as those resulting from the RA methodology, can thus support improvement in value--better outcomes at a lower cost. As reimbursement increasingly evolves into value-based programs, understanding the outcomes achieved, and customizing patient care to reduce unnecessary costs while improving outcomes, will be an active area for clinicians, healthcare administrators, researchers, and data scientists for many years to come.
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Aderem, Jodi. "The biomechanical risk factors associated with preventing and managing iliotibial band syndrome in runners : a systematic review." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/96803.
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Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
AFRIKAANSE OPSOMMING: Inleiding: Iliotibiale-band-sindroom (ITBS), ’n besering vanweë oormatige gebruik, is die tweede algemeenste hardloopbesering en die hoofoorsaak van laterale kniepyn by hardlopers. Namate die getal hardlopers wêreldwyd toeneem, neem die voorkoms van hierdie toestand ook toe. Hardlopers met ITBS ervaar tipies simptome ná die hakslag met die knie ongeveer 20-30° gebuig (die wrywingsone of “impingement zone”) gedurende die staanfase van hardloop. Verskeie intrinsieke en ekstrinsieke risikofaktore kan ’n rol speel in waarom sommige hardlopers meer geneig is as ander om gedurende die wrywingsone simptome te ervaar. Abnormaliteite in hardloopbiomeganika is ’n intrinsieke risikofaktor wat reeds omvattend in die literatuur beskryf is. Tog is weinig bekend oor presies hoe dit met ITBS verband hou. Oogmerke: Die doel van hierdie stelselmatige ondersoek was om ’n sintese te bied van die jongste bewyse van die biomeganiese risikofaktore van ITBS. Hierdie risikofaktore kan dalk oorweeg word om ITBS by hardlopers te voorkom of te bestuur. ’n Kliniese algoritme word ook aangebied. Metodes: ’n Stelselmatige ondersoek is met behulp van meta-ontleding onderneem. PubMed, PEDro, SPORTSDisc en Scopus is elektronies deurgesoek vir literatuur wat tot en met Mei 2014 verskyn het. Deursnee en kohortstudies is ingesluit indien dit gehandel het oor die biomeganika in die onderste ledemate van hardlopers wat ITBS het of later ontwikkel het. Alle studies wat deel was van die ondersoek is metodologies geëvalueer. Bewyse is aan die hand van bewysvlak, bewyskonsekwentheid en kliniese impak beoordeel. Data is narratief beskryf met behulp van tabelle of narratiewe opsommings waar dit toepaslik was. ’n Meta-ontleding is onderneem waar biomeganiese risikofaktore in minstens twee studies aangemeld is, mits daar homogeniteit in die uitkomste sowel as die steekproewe was. Resultate: Altesaam 11 studies is ingesluit (een prospektief en tien deursnee). Die metodologiese telling van die studies was oorwegend gemiddeld. Verhoogde spitsheupadduksie en interne knierotasie gedurende die staanfase kan op die ontwikkeling van ITBS by vrouehardlopers dui. Hierdie biomeganiese risikofaktore kan dalk nagegaan word vir ITBS-voorkoming, al was die bewysbasis beperk tot ’n enkele studie. Daar is tans geen afdoende bewys dat enige van die biomeganiese parameters oorweeg behoort te word in die bestuur van langafstandatlete met ITBS nie. Gevolgtrekking: Daar bestaan dalk biomeganiese verskille tussen hardlopers wat ITBS het of kan ontwikkel en gesonde hardlopers. Hoewel ’n groot verskeidenheid biomeganiese risikofaktore beoordeel is, is die bewysbasis vir die toets of bestuur daarvan by atlete met ITBS beperk. Dít is vanweë die klein hoeveelheid bewyse, die klein kliniese impak, en heterogeniteit tussen studie-uitkomste en bevindinge. Verdere prospektiewe en deursneenavorsing word vereis om te bepaal of abnormaliteite in hardloopbiomeganika ’n rol kan speel in waarom langafstandhardlopers ITBS ontwikkel, of om vas te stel watter risikofaktore ter sprake kan wees in die bestuur van hierdie hardlopers.
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Afif, Waqqas. "Risk factors for lymphoma in patients with inflammatory bowel disease: a case-control study." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107621.
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Background: Subgroups of patients with inflammatory bowel disease (IBD) may have an increased risk of developing lymphoma. We sought to identify factors that were associated with lymphoma in IBD patients. Methods: Cases and controls were identified though a centralized diagnostic index. We identified 80 adult IBD patients who subsequently developed biopsy-proven lymphoma between 1980 and 2009. For each case, two controls were matched for subtype of IBD, geographic location, and length of IBD follow-up at our institution prior to lymphoma diagnosis. Medical records were abstracted for demographic and clinical information. Conditional logistical regression was used to assess associations between risk factors and the development of lymphoma. Results: Sixty cases were males (75%) vs. 77 controls (48%). Median age at index date was 59 years for cases and 42 years for controls. Twenty cases (25%) and 23 controls (14%) were receiving immunosuppressive medications at the index date. Four cases (5%) and six controls (4%) were receiving anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents at the index date. In multivariate analysis, age per decade (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.37-2.43), male gender (OR, 4.05; 95% CI, 1.82-9.02) and immunosuppressive exposure at the index date (OR, 4.20; 95% CI, 1.35-13.11) were significantly associated with increased odds of developing lymphoma. Disease severity and use of anti-TNF-alpha agents were not independently associated with developing lymphoma. Conclusions: In this case-control study, increasing age, male gender and use of immunosuppressive medications were associated with an increased risk of lymphoma in patients with IBD, whereas disease severity and anti-TNF-alpha use were not associated with increased odds.Cadre de l'étude: Certains sous-groupes de patients atteints de maladies inflammatoires de l'intestin (MII) peuvent courir un risque accru de développer un lymphome. Nous avons chercher à identifier les facteurs associés avec le lymphome chez les patients avec des MII. Méthodologie: Les cas et les témoins ont été identifiés à partir d'un répertoire de diagnostics centralisé. Nous avons identifié 80 patients adultes atteints de MII et qui ont dévelopé un lymphome confirmé par biopsie entre les années 1980-2009. Deux témoins étaient appariés pour chaque cas sur le sous-type de MII, la localisation géographique et la durée du suivi pour les MII dans notre centre jusqu'au diagnostic de lymphome. Les dossiers médicaux ont été consultés afin d'obtenir les données démographiques et cliniques. Un modèle de régression logistique conditionel a été utilisé pour évaluer les associations entre les facteurs de risque et le développement d'un lymphome. Résultats: Parmi les cas retenus, 60 étaient des hommes (75%) vs 77 dans le groupe de témoins (48%). L'âge médian à la date index était de 59 ans pour les cas et de 42 ans pour les témoins. Vingt cas (25%) et 23 témoins (14%) recevaient des médicaments immunosuppresseurs à la date index. Quatre cas (5%) et six témoins (4%) recevaient des anticorps antagonistes du TNF-alpha à la date index. Lors d'une analyse multivariée, l'age par décennie (rapport de cotes [RC]:1,83, intervalle de confiance à 95%[IC]: 1,37-2,43), le sexe masculin (RC:4,05, IC 95%:1,82-9,02) et l'exposition aux médicaments immunosuppresseurs à la date index (RC:4,20, IC 95%: 1,35-13,11) ont été associés, de façon significative, à un risque accru de developper un lymphome. La sévérité de la maladie et l'utilisation d'anticorps antagonistes du TNF-alpha n'ont pas été associés de manière indépendante au developpement d'un lymphome. Conclusion: Dans cette étude de cas-témoin, l'age avancé, le sexe masculin et l'tilisation de médicaments immunosuppresseurs ont été associés à un risque supérieur de lymphome chez les patients atteints de MII. Par contre, la sévérité de la maladie et l'utilisation des anticorps antagonistes du TNF-alpha n'ont pas été associés à un risque plus élevé.
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Guerra, Stefano. "Risk factors for incidence and persistence of asthma-like symptoms." Diss., The University of Arizona, 2003. http://hdl.handle.net/10150/280354.
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Asthma represents the most common chronic disease in childhood. Children with asthma are at increased risk for developing long-term irreversible airway obstruction in adult life, the fourth leading cause of death in USA. Our aims were to: (1) Determine whether reduced IFNgamma production and plasma soluble CD14 (sCD14) levels in early life are significant risk factors for the development of wheezing in the first year of life; (2) Estimate rates of persistence and remission of childhood wheezing after puberty; (3) Study risk factors affecting persistence of childhood wheezing after puberty. We used data from the two large ongoing birth cohorts of the Tucson Infant Immune Study (IIS) and the Tucson Children's Respiratory Study (CRS). Among 238 children from IIS, we found the odds of developing recurrent wheezing in the first year of life to be 4.5 times higher for children in the lowest quartile of IFNgamma production at 3 months (p = .0005) and 3.2 times higher for children in the lowest quartile of sCD14 levels at birth (p = .004) as compared with children in the other 3 combined quartiles of IFNgamma and sCD14, respectively. We studied persistence and remission of wheezing after puberty among 732 children from the CRS cohort. We found that 29% of children with infrequent wheezing during childhood experienced persistent wheezing after contrast, the proportion of persistent wheezing was much higher (60%) among children meeting the for asthma during childhood. Frequency of wheezing during childhood, obesity, an early onset of puberty, bronchial hyperresponsiveness, and skin test sensitization were significant predictors of persistent asthma after puberty. By looking at genetic factors, we also found that the homozygous status for Gly in codon 16 of the beta2 Adrenoceptor doubled the risk for persistent wheezing after puberty among boys (RR 2.01, p = .0008) but not girls. Our findings from two population-based longitudinal cohorts provide the first evidence that altered immunological markers precede the onset of wheezing early in life, challenge the commonly held view that most asthma cases remit during adolescence, and provide a profile of risk.
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Jidéus, Lena. "Atrial fibrillation after coronary artery bypass surgery : a study of causes and risk factors /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5151-9/.
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Stone, Hillarey. "Enrichment of Transcriptional Regulators at Steroid Sensitive Nephrotic Syndrome Genetic Risk Loci." University of Cincinnati / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=ucin160199291391191.
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Kon, Chee Hing. "Proliferative vitreoretinopathy : a study of biological and clinical risk factors and new pharmacological therapies." Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266110.
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Shepherd, J. "Factors affecting perceived exertion and task duration during intermittent isometric fatiguing exercise and their implications for rehabilitation following knee surgery." Thesis, Nottingham Trent University, 2012. http://irep.ntu.ac.uk/id/eprint/132/.
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It has been theorised that self-perception is integral to the regulation of exercise and production of an optimal performance. This concept has not been examined in an anterior cruciate ligament (ACL) reconstructed population where the consequences of injury and surgery may provide a substantive perturbation to perceptual capabilities. Ratings of perceived exertion (RPE) have previously been shown to enable prediction of exercise task duration (TD) during running and cycling activities in healthy individuals, but this has yet to be explored in intermittent and isolated muscle exercise that is typically utilised during resistance training and ACL rehabilitation. Accordingly, this thesis investigated: i) the relationship between self-perceived knee function and objective measures of musculoskeletal performance at a range of time-points across the ACL-rehabilitation period; ii) the relationship between two paradigms of self-perception (RPE; perceived TD) and TD in healthy individuals during an intermittent isometric fatigue task (IIF) under various conditions of increasing exercise stress. Self-perceived knee function measured via subjective rating scales was only moderately correlated with objective performance towards the latter stages of the rehabilitation period, highlighting a disparity between perceived and actual capabilities during the early to intermediate stages of recovery (pre-surgery to 24 weeks). In contrast to previous research in running and cycling exercise, the investigation of self-perception and TD during an IIF revealed evidence of both linear and curvilinear trends in perceptual response. Linear trends were observed at exercise intensities of 60% to 80% of baseline volitional peak force, whilst curvilinear patterns of response were apparent at intensities of 60% peak force, and under conditions of exercise-induce muscle damage. Evidence of a negatively accelerating curvilinear response may reflect an underestimation of performance, and questions the utility of self-perception to predict TD in isolated muscle exercise. These combined findings highlight a need for further research before confirming the efficacy of self-perception with regard to regulating exercise during rehabilitative-type activities.
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Trojan, Daria A. (Daria Anna). "A Case-control study of risk factors for post-poliomyelitis syndrome /." Thesis, McGill University, 1992. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=56985.
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Post-poliomyelitis syndrome (PPS) is a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. The primary objective of this study was to identify factors which predict subsequent PPS. Among patients with prior polio, cases were those with new weakness and fatigue, and controls were those without these complaints. A chart review of 353 patients evaluated at the Montreal Neurological Institute post-polio clinic identified 127 cases and 39 controls. In univariate analyses, significant risk factors for PPS were a greater current age (odds ratio of 1.8 per decade, 95% confidence interval 1.3 to 2.6), a longer time since acute polio (odds ratio of 1.6 per decade, 95% confidence interval 1.1 to 2.3), more weakness at acute polio (odds ratio 1.5, 95% confidence interval 1.1 to 2.0), a recent weight gain (odds ratio 3.8, 95% confidence interval 1.6 to 9.4), muscle pain with exercise (odds ratio 3.8, 95% confidence interval 1.5 to 9.5), muscle pain (odds ratio 2.6, 95% confidence interval 1.3 to 5.5), and joint pain (odds ratio 2.3, 95% confidence interval 1.1 to 5.3). The multivariate analyses revealed that a model containing current age (odds ratio 1.7 per decade, 95% confidence interval 1.1 to 2.6), weakness at acute polio (odds ratio 1.6, 95% confidence interval 1.1 to 2.5), muscle pain with exercise (odds ratio 4.9, 95% confidence interval 1.6 to 15.6), recent weight gain (odds ratio 6.4, 95% confidence interval 2.02 to 20.3), and joint pain (odds ratio 2.33, 95% confidence interval 0.8 to 7.1) was the most effective in predicting who would develop PPS. Age at acute polio, degree of recovery after polio, weakness at best point after polio, physical activity, and sex were not contributing factors.
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Swenne, Christine Leo. "Wound Infection Following Coronary Artery Bypass Graft Surgery : Risk Factors and the Experiences of Patients." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7168.
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Alzhrani, M. M. "Biomechanical measures of lower limb variability, and prediction of non-contact knee injuries risk factors in male athletes." Thesis, University of Salford, 2018. http://usir.salford.ac.uk/46330/.
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Introduction: Football is one of the most popular sports played globally. Male players constitute 82% of football players around the world. As the number of football players increases, we expect more sports injuries to occur. Knee ligament injuries, such as Anterior Cruciate Ligament (ACL), are considered one of the most devastating injuries because of the consequences from the resulting damage. A large proportion of these injuries result from a non-contact mechanism. Some of the biomechanical risk factors in non-contact injuries are considered modifiable, therefore it is important to understand the mechanism of injury to modify it to be able to reduce or prevent the injuries. Also, recent studies have suggested that movement variability should be considered a potential source of information for analysis in monitoring athletes’ biomechanical performance. The aims of this thesis are to assess the performance and performance-variability of frontal plane projection angle (FPPA) and hip adduction angle difference between legs and over season, and its relationship with injury. Methodology: After assessing the validity and reliability of FPPA and hip adduction angle during single leg squat (SLS) and single leg landing (SLL) tasks, in a separate study with 15 healthy subjects, using the 2D technique, both tasks were found to be adequately valid and reliable in examining the lower limb kinematics. The main study then was done on 90 male professional footballers with the average age of 18.8±4 years, height 179.2±6 cm, and weight 73.3±6 kg, using SLS and SLL tasks to assess the performance and performance-variability of FPPA and hip adduction angle. The difference of performance and performance-variability of individual lower-limb kinematics (FPPA and hip angle) between legs and throughout the sports season (one year) were examined. Non-contact knee ligament injuries were also recorded. Then, the relationship between lower-limb kinematics (FPPA and hip angle) and injuries were investigated prospectively. Results: The performance of the dominant leg was found to be significantly more valgus (greater FPPA) than the non-dominant leg for both tasks in all screening sessions (-1.69° to -5.02° vs. 2.54° to -2.30°), but there was no difference in the hip adduction angle between legs (SLS, 73.15° to 73.47° vs. 74.53° to 75.85°; SLL, 80.91° to 83.55° vs. 81.58° to 85.39°). The overall performance of SLL FPPA (p = 0.01–0.0005) and hip angle (p = 0.0005) changed significantly over the collection time points. The difference in performance-variability between legs was not statistically significant for either FPPA or hip adduction angle in all of the screening sessions (p = 0.08–0.89), except for FPPA in the start-of-season screening. The performance-variability in FPPA and hip adducting angle were consistent over time (throughout the season) in both SLS and SLL (p = 0.13–0.61). Seven non-contact knee ligament injuries out of 75 total lower-limb injuries were reported. Therefore, a prediction analysis was not reported due to the limited obtained injuries. A descriptive analysis was carried out alternatively where injured legs performance and performance-variability showed similar actual scores in both tasks. However, after injury, a statistical test showed that the injured group’s performance of SLS and SLL did not change (p = 0.38–1), whereas the uninjured group’s performance of SLL did change significantly (p = 0.0005). The performance-variability of SLS and SLL did not change for both groups (p = 0.27–1), injured and uninjured. Conclusion: The difference of FPPA performance between legs in both tasks suggests that both legs need to be examined independently when assessing the lower-limb kinematics, rather than one leg alone or using bilateral tasks. Also, the change in FPPA and hip adduction angle over the sports season during SLL suggests that examining the lower-limb kinematics should be done regularly throughout the sport season due to the change of performance, rather than at one occasion. Also, it suggests that the SLL task is more sensitive than that of the SLS in detecting performance change. With regard to the performance-variability, it is unlikely to have a significant impact on overall performance. Finally, in light with predicting the non-contact knee ligament injuries using the 2D technique, larger number of injuries is needed to study this point.
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Nuby, Sona. "Risk factors associated with acute kidney injury in patients who underwent cardiac surgery : a retrospective review." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/79322.
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Background: Acute kidney injury occurs in one out of ten cardiac surgery patients. Cardiac surgery-associated acute kidney injury not only increases patients’ mortality rate but the length of stay in intensive care unit and hospital. Cardiac surgery patients’ long- term risk for chronic kidney disease and heart failure increases with the incidence of acute kidney injury. Various preoperative, intraoperative and postoperative risk factors are associated with the development of cardiac surgery-associated acute kidney injury.
Aim: The aim of the study was to identify the risk factors associated with acute kidney injury in patients who underwent cardiac surgery. The identified risk factors were categorized into modifiable, partially modifiable and non-modifiable risks. The frequency of acute kidney injury among cardiac surgery patients was also assessed.
Research design: The researcher chose a quantitative correlational retrospective design and conducted a retrospective chart review to assess the risk factors associated with AKI in patients that had undergone cardiac surgery.
Methods: Non-probability purposive sampling was used to select the records of patients that underwent cardiac surgery between January 2014 and December 2018. Data collection was done using a self-developed audit tool. Descriptive and inferential statistics were used for data analysis.
Significance: The study enabled the researcher to identify and categorize the risk factors into modifiable, partially modifiable and non-modifiable categories. Early recognition and mitigation of risk factors could prevent patients from developing cardiac surgery- associated acute kidney injury.
Research findings: The study found a 22.7% frequency of CSA-AKI. Anaemia, hypoalbuminemia, hyperglycaemia, use of N-acetylcysteine and fluid overload were identified as modifiable risk factors. Bicarbonate level <22mmol/L, use of diuretics, use of antibiotics, longer duration of surgery, fresh frozen plasma use >500ml on the day of surgery, red blood cell transfusion >1L on the day of surgery and prolonged use of mechanical ventilation were partially modifiable risk factors. No non-modifiable risk factors were identified.
Keywords: Cardiac surgery-associated acute kidney injury; risk factors; modifiable, partially modifiable and non-modifiable.Dissertation (MCur (Critical Care Nursing))--University of Pretoria, 2020.
Nursing Science
MCur (Critical Care Nursing)
Unrestricted
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Abraham, Elizabeth C. M. D. "Focal Segmental Glomerulosclerosis in Children: An Emerging Epidemic and Risk Factors for Disease Recurrence in Transplants." University of Cincinnati / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320172013.
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Sörensen, Duppils Gill. "Delirium during Hospitalisation : Incidence, Risk Factors, Early Signs and Patients' Experiences of Being Delirious." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3814.
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Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.
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Mendizabal, Brenda M. D. "Racial Differences in the Influence of Risk Factors in Childhood on Left Ventricular Mass in Young Adulthood." University of Cincinnati / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1504794323476548.
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Stranne, Johan. "Inguinal hernia after urologic surgery in males with special reference to radical retropubic prostatectomy : a clinical, epidemiological and methodological study /." Göteborg : Department of Urology, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, Sahlgrenska University Hospital, 2006. http://hdl.handle.net/2077/706.
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Goodman, Helen. "Randomised controlled trial of a programme to reduce risk factors in patients waiting for coronary artery bypass surgery." Thesis, Imperial College London, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.486586.
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The thesis is a report of a randomised controlled trial with 188 patients to evaluate a nurseled education and support programme in terms of outcomes, process and context. The 'Fit For Surgery' programme was based on previous studies suggesting substantial benefit in controlling anxiety and risk factors contributing to coronary disease while patients wait for coronary artery bypass surgery. Patients listed for coronary artery bypass surgery with at least one poorly controlled risk factor were randomised to standard care or the intervention which provided lifestyle management counselling, and physical and psychological preparation for surgery in monthly visits to the patients' homes. The trial measured progress from baseline to 3 months after discharge. Primary outcome measurements were anxiety, blood pressure, cholesterol, body mass index and length of stay. Secondary outcomes were quality of life (measured t>y the HAD scale, SF-36 form and Coronary Artery Revascularisation Questionnaire) and complications during admission. Costs of the intervention were calculated. Views of patients and staff were collected by 'Discovery Interviews', a quality improvement tool devised by the NHS Modernisation agency, and focus groups. For both Intervention and Control groups blood pressure and total cholesterol improved (Blood pressure (Control -9.11mmHg (CI -4.89, -13.33); Intervention -13.02mmHg (CI -8.76, 17.29) both p<0.01); total cholesterol (Control -0.20mmoJlI (CI -0.03, -0.37) p=0.02, Intervention -0.18mmolll (CI -0.02, -0.34) p=0.03). However there were no significant differences between the groups in the primary outcome measures at any of the measurement points. Qualitative data suggested the patients appreciated support from the nurses but varied in their understanding of the programme and degree of motivation to improve their health. Cost minimization analysis showed the total costs were less in the intervention group due to less in-patient admissions during the waiting period (Total costs ��?���£9898 (3234) v 11427 (5400), CI-2813, -244; P= 0.02).
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Capela, Mafalda Felício. "Risk factors and prognostic indicators following removal of oesophageal and gastric foreign bodies in dogs and cats." Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2021. http://hdl.handle.net/10400.5/21437.
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Dissertação de Mestrado Integrado em Medicina VeterináriaABSTRACT - Gastrointestinal foreign bodies are a common reason for presentation in small animal practice. The clinical presentation is often variable, different therapeutic interventions are available, and complications affecting the outcome may be observed. This retrospective multicentric study aimed to characterise a sample of dogs and cats with upper gastrointestinal foreign bodies and evaluate the clinical presentation, removal techniques and findings, the success rate of endoscopic removal, identify factors that could predict the need for surgery, assess the complication rate, hospitalisation period and identify potential risk factors for complications and outcome. Medical records at the Kingston Veterinary Group Hospital (UK) and Anjos de Assis Veterinary Medicine Centre (PT) were reviewed and a total of 73 dogs and cats with non-linear foreign bodies located in the upper gastrointestinal tract from the cervical oesophagus to the duodenum, and patients with linear foreign bodies anchored anywhere from the oral cavity to the duodenum were included in the study. Results showed that patients whose owners did not witness ingestion of the foreign body were significantly more likely to have reported clinical signs (p < 0.001). Furthermore, witnessed ingestion was associated with a significantly shorter duration of clinical signs or time since ingestion (p < 0.001). Foreign objects were categorised as linear in 20.5% of the cases reported and, compared to dogs, cats were significantly more likely to have ingested a linear foreign body (p < 0.001). Results showed a significant association between linear foreign bodies and painful abdominal palpation (p < 0.05). The overall success rate of endoscopic removal was 76.9%. Successful endoscopy was not significantly associated with linear or non-linear objects, or the duration of clinical signs (p > 0.05). Nevertheless, when surgery was required, the removal of linear foreign bodies was significantly associated with the need for multiple surgical techniques (p < 0.001). The overall complication rate was 28.8%. The presence of a linear foreign body, the surgical procedure performed, and prompt versus delayed removal were not significantly associated with the occurrence of complications or a worse outcome (p > 0.05). An abnormal patient mentation and painful abdominal palpation were significantly associated with the occurrence of complications (p < 0.05). In conclusion, even though undergoing surgery and the occurrence of complications were significantly associated with increased hospitalisation; performing surgery did not appear to increase the risk of complications nor affect the overall outcome. An abnormal mentation and painful abdominal palpation may be potential indicators for the occurrence of complications, thus possibly affecting the overall outcome.
RESUMO - Fatores de risco e indicadores de prognóstico após remoção de corpos estranhos esofágicos e gástricos em cães e gatos - Corpos estranhos gastrointestinais são frequentes na clínica de pequenos animais. Este estudo retrospetivo multicêntrico teve como objetivo caracterizar uma amostra de cães e gatos com corpos estranhos de localização gastrointestinal superior, quanto à sua apresentação clínica, técnicas cirúrgicas, bem como avaliar a taxa de sucesso de endoscopia, identificar fatores que permitissem prever a necessidade de cirurgia, avaliar a taxa de complicações, o período de hospitalização e identificar possíveis fatores de risco para a ocorrência de complicações e prognóstico. Foram revistos os registos clínicos do Kingston Veterinary Group Hospital (UK) e do Centro de Medicina Veterinária Anjos de Assis (PT) e um total de 73 cães e gatos com corpos estranhos não-lineares no trato gastrointestinal superior, e animais que tinham corpos estranhos lineares ancorados em qualquer localização desde a cavidade oral até ao duodeno foram incluídos neste estudo. Os resultados obtidos demonstraram que pacientes em que a ingestão não foi testemunhada tinham uma maior susceptibilidade para apresentar sinais clínicos (p < 0.001). Adicionalmente, a ingestão testemunhada mostrou estar significativamente associada com uma duração inferior dos sinais clínicos (p < 0.001). Em 20.5% dos casos os corpos estranhos foram classificados como lineares e os gatos mostraram maior susceptibilidade para ingerir um corpo estranho linear (p < 0.001). Verificou-se uma associação significativa entre a presença de um corpo estranho linear e dor à palpação abdominal (p < 0.05). A taxa de sucesso de endoscopia foi de 76.9%. Não se observou uma associação significativa entre a presença de corpos lineares ou a duração dos sinais clínicos, e o sucesso da endoscopia (p > 0.05). Casos em que cirurgia foi indispensável, a remoção de corpos estranhos lineares mostrou estar significativamente associada à necessidade de múltiplas técnicas cirúrgicas (p < 0.001). A taxa de complicações observada foi de 28.8%. Não se verificou uma associação significativa entre a presença de um corpo estranho linear, o procedimento cirúrgico realizado, ou a intervenção precoce versus tardia e a ocorrência de complicações, ou um prognóstico desfavorável (p > 0.05). Um comportamento alterado e palpação abdominal dolorosa mostraram estar significativamente associados com a ocorrência de complicações (p < 0.05). Em conclusão, embora a realização de cirurgia e a ocorrência de complicações estivessem significativamente associadas a um maior período de hospitalização; a realização de cirurgia não aparentou aumentar o risco de complicações, nem afectar o prognóstico. Um comportamento alterado do paciente e palpação abdominal dolorosa poderão ser potenciais indicadores da ocorrência de complicações, possivelmente afetando o prognóstico.
N/A
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Ross, Nicolette Hayley. "The effects of IPPB on ventilation distribution in high risk adults following open upper abdominal surgery using electrical impedance tomography." Thesis, Stellenbosch : Stellenbosch University, 2015. http://hdl.handle.net/10019.1/97086.
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Thesis (MScPhysio)--Stellenbosch University, 2015.ENGLISH ABSTRACT: Question: What are the effects of Intermittent Positive Pressure Breathing (with and without a Positive End Expiratory Pressure [PEEP] Valve), compared to deep breathing exercises, on ventilation distribution in high-risk adults following open upper abdominal surgery (UAS)? Design: This study comprised an observational descriptive component as well as a prospective triple blind randomised controlled crossover trial with concealed allocation and patient, assessor and statistician blinding Participants: Seven patients at high risk for postoperative pulmonary complications following UAS Intervention: Deep breathing exercises (DBExs) were compared to Intermittent Positive Pressure Breathing (IPPB), with IPPB further applied with and without a PEEP Valve, using a randomised cross-over design with 30 minute washout duration between periods. Outcome measures: Global and regional impedance changes in the lungs were measured using Electrical Impedance Tomography. Vital signs, visual analogue pain scale (VAS) and modified Borg scale (MBS) were measured pre– and post-intervention. Results: A greater mean global lung impedance change ( Z) was detected with IPPB compared to DBExs (mean difference in Z 2803.8; 95% CI 5189.9 to 8512.5 and 2046 to 96047.9; P<0.01). These changes in lung impedance lasted 30 minutes before returning to baseline. There was no difference in Z when patients received IPPB with 5cmH20 PEEP compared to IPPB with no PEEP. No specific regional ventilation changes were noted. IPPB did not increase VAS, MBS scores or adversely affect vital signs. Conclusion: IPPB is an effective technique to improve lung volumes compared to deep breathing exercises. Further studies are required to investigate the effect of IPPB on clinical outcome.
AFRIKAANSE OPSOMMING: Vraag: Watter uitwerking het onderbroke positiewe-drukasemhaling (met én sonder ’n positiewe-endekspiratoriesedruk-[PEEP-]klep) in vergelyking met diepasemhalings-oefeninge op ventilasieverspreiding by hoërisikovolwassenes ná bo-buikchirurgie? Ontwerp: ’n Waarnemingsgegronde, vergelykende en ondersoekende, driedubbelblinde, verewekansigde gekontroleerde oorskakelproef, met verborge toewysing en blinding van pasiënte, die assesseerder en statistikus Deelnemers: Sewe pasiënte met ’n hoë risiko vir post-operatiewe pulmonêre komplikasies na bo-buikchirurgie Intervensie: Diepasemhalingsoefeninge (DBEx) is vergelyk met onderbroke positiewedrukasemhaling (IPPB), wat op sy beurt met én sonder ’n PEEP-klep toegepas is, met behulp van ’n verewekansigde oorskakelstudie met ’n halfuur lange uitspoeling tussen oorskakelings. Uitkomsmetings: Algehele en regionale impedansieveranderinge in die longe is met behulp van elektriese impedansietomografie gemeet. Vitale tekens, die visuele analoogskaal (VAS) en die aangepaste Borg-skaal (MBS) is voor, sowel as na die intervensie afgeneem. Resultate: ’n Groter gemiddelde algehele impedansieverandering ( Z) is opgemerk met IPPB in vergelyking met DBEx (gemiddelde verskil 2803.8; 95% CI 5189.9: 8512.5 en 2046: 96047.9; P<0.01). Hierdie veranderinge in longimpedansie het ’n halfuur of langer geduur voordat dit na die basislyn teruggekeer het. Daar was geen verskil in Z toe pasiënte IPPB met ’n PEEP-klep van 5cmH20 ontvang het teenoor IPPB sonder ’n PEEP-klep nie. Geen spesifieke regionale voorkeure is opgemerk nie. IPPB het nie die VAS- of MBS-tellings verhoog of vitale tekens verswak nie. Stellenbosch University https://scholar.sun.ac.za iv Gevolgtrekking: In vergelyking met DBEx, is IPPB ’n doeltreffende tegniek om longvolumes te verbeter. Verdere studies word vereis om die uitwerking van IPPB op kliniese uitkomste te ondersoek.
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Hida, Koya. "Risk factors for complications after laparoscopic surgery in colorectal cancer patients : experience of 401 cases at a single institution." Kyoto University, 2009. http://hdl.handle.net/2433/126452.
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Van, Der Spuy Karen. "A multicentre, cross-sectional study investigating the prevalence of hypertensive disease in patients presenting for elective surgery in the Western Cape, South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29678.
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Background: Hypertension is common, affecting over one billion people worldwide. Importantly, in Sub-Saharan Africa hypertensive disease not only affects the older population group, but is becoming increasingly prevalent in younger patients. In South Africa, over 30% of the adult population has hypertension, making it the single most common cardiovascular risk factor and the predominant contributor to cardiovascular disease and mortality. In non-cardiac surgical patients, elevated blood pressure is the most common perioperative comorbidity encountered with an overall prevalence of 20-25%, and it remains poorly controlled in low and middle-income countries. Furthermore, hypertension in the perioperative setting may adversely affect patient outcome. It thus not only flags possible perioperative challenges to anaesthesiologists, but also identifies patients at risk of long-term morbidity and mortality. Objectives: The primary objective of this study was to determine the prevalence and severity of hypertension in elective adult surgical patients in the Western Cape. Results: The study population included all non-cardiac, non-obstetric, elective surgical patients from seven hospitals in the Western Cape during a one-week period. Hypertension, defined as having had a previous diagnosis of hypertension or meeting the blood pressure criteria of more than 140/90 mmHg, was identified in 51.8% of patients during the preoperative assessment. Significantly, newly diagnosed hypertension was present in 9.6% of all patients presenting for elective surgery. Although 98.1% of the known hypertensive patients were on antihypertensive therapy, 36.9% were inadequately controlled. Numerous reasons exist for this but notably 32% of patients admitted to forgetting to take their medication, making patient factors the most common cause for treatment non-compliance. Conclusion: This study suggests that the perioperative period may be an important opportunity to identify undiagnosed hypertensive patient. The perioperative encounter may have a significant public health implication in facilitating appropriate referral and treatment of hypertension to decrease long-term cardiovascular complications in South Africa.
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Chatila, Nadwa. "Postoperative oral surgical pain : Incidence, clinical characteristics and risk factors Jury." Thesis, Clermont-Ferrand 1, 2015. http://www.theses.fr/2015CLF1DD03.
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Les objectifs de cette thèse étaient de1/ carctériser la douleur post-opératoire chez des patients ayant reçu un implant dentaire mandibulaire. 2/examiner la relation entre facteurs individuels, facteurs chirurgicaux et douleurs post-operatoire chez patients ayant reçuun implant dentaire mandibulaire. 3/déterminer les incidences de la douleur neuropathique chez des patients ayant reçu un implant dentaire mandibulaire.Cette thèse a montré que la douleur post-opératoire aigüe après un implant dentaire allait d'une intensité douce à modérée((inférieur à 3 sur l'échelle visuelle analogique) et de courte durée. Une anlyse univariée a montré que l' intensité de la douleur post-operatoire était en lien avec l'âge, le souvenir de la douleur ayant fait suite à une précédente chirurgie orale, le nombre d'implants et la distance entre la fraise et le canal neurologique alvéolaire inférieur(IAN). En revanche aucun lien n'a été démontré avec le sexe, des facteurs psychologiques ou le procédé chirurgical. Une analyse multivariée a montré une association significative entre une douleur post-opératoie aigüe et la distance entre l'implant et le canal neurologique alvéolaire inférieur mémoire de la douleur après une précédente chirurgie oraleThis prospective study investigates the clinical characteristics and time course of postoperative pain after placement of dental implants in the mandible over a 6-month period. We also examined the influence of preoperative physical and psychological factors, as well as surgical factors, on acute postoperative pain. Postal questionnaires built to assess the existence neuropathic features of pain at the site of surgery (with the Douleur Neuropathique 4 Questions [DN4]) were sent two weeks, and one, three and six months after surgery.Acute postoperative pain was of mild-to-moderate intensity and had a short duration. Univariate analyses showed that the intensity of postoperative pain was related to age, remembrance of pain after a previous oral surgery, the number of implants, and the distance between the drill and the inferior alveolar nerve (IAN) canal. But, there was no relationship with gender, psychological factors, or surgical procedure (buccal flap). Besides the number of implants (P=0.013), and the distance between the end of the drill and the IAN canal (P=0.004), multivariate analyses showed a significant interaction between the acute postoperative pain and: i) the distance between the implant and the IAN canal (P=0.0005), ii) remembrance of pain after a previous oral surgery (P=0.003), iii) previous oral surgical pain (P=0.005). Among the patients who completed follow-up, only 0.7% (n = 1) scored positive on neuropathic symptoms (DN4 ≥ 3).This prospective observational study provides the characteristics of acute postoperative pain after placement of dental implants in the mandible and the risk factors for developing severe oral postoperative pain. It also provides the incidence rate of neuropathic pain occurring within the 6 months after dental implant surgery
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Persson, Per-Erik. "Heterotopic Ossification : Clinical and Experimental Studies on Risk Factors, Etiology and Inhibition by Non-steroidal Anti-inflammatory Drugs." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3908.
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Salmon, Becky A. "Differences between men and women in compliance with risk factor reduction : pre and post coronary artery bypass surgery." Virtual Press, 1993. http://liblink.bsu.edu/uhtbin/catkey/865938.
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Coronary Artery Bypass Graft(CABG) Surgery increases blood flow to the endangered myocardium but does not slow the process of atherosclerosis. The only way to slow the process of coronary artery disease is to acknowledge the risk factors present and minimize or totally eliminate them from an individual's lifestyle. Men and women respond differently to stress and lifestyle modifications. The purpose of this study was to determine if there was a difference between genders in compliance to a heart healthy lifestyle pre and post CABG surgery.Thirty men and thirty women who had CABG surgery at least one year earlier were interviewed to assess coronary artery disease risk. The procedure for the protection of human subjects were followed. The instrument used was the RISKO Heart Hazard Appraisal Tool. This instrument was developed in 1985 by the American Heart Association and scored individuals on systolic blood pressure, weight, serum cholesterol level and cigarette smoking habits. Pre-operative records were also reviewed using the same tool to assess individuals preoperative risk. The research design used was 2 x 2 repeated measures. Data were analyzed using 2 x 2 repeated measures analysis of variance (ANOVA).Two findings were discovered. First there was a statistically significant difference between men and women (F=5.82 p=0.019) with men scoring lower RISKO scores than women, indicating lower risk and better compliance to a heart healthy lifestyle, both pre- and postoperatively. Second there was a significant difference between preand postoperative RISKO scores in the total population (F=8.77 p=0.004). Postoperative RISKO scores were lower indicating an improvement in heart healthy lifestyle. There was no statistically significant difference between genders in the difference of pre- and postoperative RISKO scores (F=2.56 p<.115). The significance of this study was that it looked specifically at gender differences and assessed disparities in cardiovascular risk factors and the impact of surgery on men and women.This study found that overall, men had lower RISKO scores than women. Both genders also had improved RISKO scores postoperatively from preoperatively. No statistically significant difference between genders of the RISKO scores from preoperatively to postoperatively was found. Education needs to continue to play a big part in the cardiac rehabilitation process for both genders and specifically women need to become the target of further research and education to improve compliance to a heart healthy lifestyle.School of Nursing
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Field, Stephanie Eileen. "The influence of age at menarche and hamstrings fatigue on knee biomechanics." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1479732062258916.
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