BIRTH, Issue 1 2006
Mona T. Lydon-Rochelle PhD
The study objective was to examine patterns of documented indications for repeat cesarean delivery in women with and without labor. Methods:We conducted a population-based validation study of 19 nonfederal short-stay hospitals in Washington state. Of the 4,541 women who had live births in 2000, 11 percent (n = 493) had repeat cesarean without labor and 3 percent (n = 138) had repeat cesarean with labor. Incidence of medical conditions and pregnancy complications, patterns of documented indications for repeat cesarean delivery, and perioperative complications in relation to repeat cesarean delivery with and without labor were calculated. Results:Of the 493 women who underwent a repeat cesarean delivery without labor, "elective"(36%) and "maternal request"(18%) were the most common indications. Indications for maternal medical conditions (3.0%) were uncommon. Among the 138 women with repeat cesarean delivery with labor, 60.1 percent had failure to progress, 24.6 percent a non-reassuring fetal heart rate, 8.0 percent cephalopelvic disproportion, and 7.2 percent maternal request during labor. Fetal indications were less common (5.8%). Breech, failed vacuum, abruptio placentae, maternal complications, and failed forceps were all indicated less than 5.0 percent. Women's perioperative complications did not vary significantly between women without and with labor. Regardless of a woman's labor status, nearly 10 percent of women with repeat cesarean delivery had no documented indication as to why a cesarean delivery was performed. Conclusions:"Elective" and "maternal request" were common indications among women undergoing repeat cesarean delivery without labor, and nearly 10 percent of women had undocumented indications for repeat cesarean delivery in their medical record. Improvements in standardization of indication nomenclature and documentation of indication are especially important for understanding falling VBAC rates. Future research should examine how clinicians and women anticipate, discuss, and make decisions about childbirth after a previous cesarean delivery within the context of actual antepartum care. (BIRTH 33:1 March 2006) [source]

Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancy

DEPRESSION AND ANXIETY, Issue 8 2010
Lydia Hamama
Abstract Background: Few studies have considered whether elective and/or spontaneous abortion (EAB/SAB) may be risk factors for mental health sequelae in subsequent pregnancy. This paper examines the impact of EAB/SAB on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n=1,581). Methods: Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, and pregnancy wantedness, and religiosity. Results: Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been "a hard time" (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n,51), the rate of depression was 16.8% (n=68), and 5.4% (n,22) met criteria for both disorders. Conclusions: History of sexual trauma predicted appraising the experience of EAB or SAB as "a hard time." Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. Depression and Anxiety, 2010.© 2010 Wiley-Liss, Inc. [source]

Review of the Liposuction, Abdominoplasty, and Face-Lift Mortality and Morbidity Risk Literature

DERMATOLOGIC SURGERY, Issue 7 2005
Robert A. Yoho MD
Background The statistical discrepancies that exist in the mortality and morbidity risk literature are such that surgeons and patients cannot accurately assess the true risk rates associated with plastic surgery procedures. Objectives and Methods To review any relevant literature published to date in which the risk rates from liposuction, abdominoplasty, and rhytidectomy are cited and to reassess these figures alongside those published for both elective and emergency general surgeries. Results and Conclusion Despite the lack of reliable, comprehensive reporting of deaths and complications resulting from cosmetic surgeries, published data demonstrate that the risks associated with liposuction and rhytidectomy compare favorably with those from most general surgical procedures. In contrast, the morbidity and mortality rates from abdominoplasty remain unacceptably high. A significant lack of literature documenting cosmetic breast implant surgery and blepharoplasty risks is observed, which should be of concern to both patients and physicians. Liposuction and face-lift surgery data generally show that surgical centers are statistically safer than hospital operating rooms, although the data have not been standardized for the patients' American Society of Anesthesiologists (ASA) risk class, the health of the patient prior to surgery. General anesthesia may carry a risk roughly equivalent to or perhaps greater than cosmetic surgery, although, again, ASA class variables confound clear comparison between studies. Recent anesthesia literature refutes the many claims that general anesthesia risks are now remote: a landmark study that surveyed the entire scholarly literature showed a mortality rate of 1 in 13,000, roughly similar to overall cosmetic surgery mortality risks. Moreover, a prolonged operating time has been repeatedly implicated in other surgical literature to be related to morbidity and mortality. The latter certainly has relevance to cosmetic surgery. [source]

GASTRIC FUNDIC VARICES: HEMODYNAMICS AND NON-SURGICAL TREATMENT

DIGESTIVE ENDOSCOPY, Issue 3 2005
Seishu Hayashi
The hemodynamics and non-surgical treatment of gastric fundic varices (FV) are reviewed. FV are more frequently supplied by the short and posterior gastric veins than esophageal varices (EV), and are formed mostly by large spontaneous shunts in which the gastric or splenic vein is continuous with the left renal vein via the inferior phrenic veins and the suprarenal vein (so-called gastric-renal shunt). Concomitant collaterals such as EV, para-esophageal vein, and para-umbilical vein were also observed in nearly 60% of FV. Endoscopic injection sclerotherapy (EIS) with Histoacryl is thought to be the most approved treatment for hemorrhage from FV, but repeated treatment for residual FV and care for ensuing hepatic failure are required. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a notable interventional radiological procedure specially developed for the elective or prophylactic treatment of FV. If the procedure is technically successful, long-term eradication of treated FV is found in most patients without recurrence. B-RTO includes another significance, obliteration of the unified portal-systemic shunt. Follow-up abdominal CT scan revealed a high incidence of long-term obliteration of the gastric-renal shunt after B-RTO. Benefits such as elevation of serum albumin, improvement in 15-min retention rate of indocyanine green, decrease in blood ammonia levels, and improvement of encephalopathy are sometimes observed. [source]

Advanced Opportunities for Student Education in Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 10 2004
Charissa B. Pacella MD
Abstract Many medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the "Undergraduate Rotations" listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow-up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out-of-hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective. [source]

Development of a Gerodontology course in Athens: a pilot study

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2006
A. E. Kossioni
Aim:, To describe the development of an undergraduate Gerodontology course in Athens Dental School. Background:, Because of demographic changes, undergraduate dental curricula should place appropriate emphasis on the oral care of the elderly. Therefore, the Athens Dental School Curriculum Committee authorised the development of a new Gerodontology course. Methods:, The new course was introduced in the 10th (final) semester of undergraduate studies. Teaching responsibilities were shared amongst staff from various Dental School departments and the National Health System. The course was elective and mainly didactic, consisting of seminars within the Dental School, educational visits to hospitals and geriatric day centres and elective clinical work in the comprehensive care clinic. The students evaluated the course at the end of the semester and indicated its strengths and weaknesses from their perspective. Conclusion:, The new course was generally satisfying. Based on the experience and evaluation of the first pilot year and taking into consideration the existing barriers, we plan to improve and expand educational activities, mainly including improved methods of teaching and assessment, and more clinical assignments. [source]

Graduate Medical Education Downsizing: Perceived Effects of Participating in the HCFA Demonstration Project in New York State

ACADEMIC EMERGENCY MEDICINE, Issue 2 2001
Linda L. Spillance MD
Abstract. Objective: Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP),the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. Methods: Structured interviews and surveys of NYS program directors (PDs) were conducted in October,December 1999. Simple frequencies are reported. Results: One hundred percent of 17 PDs completed the interviews and seven of 12 participants in the HCFADP returned surveys. Twelve of 17 programs participated in HCFADP and two programs downsized outside HCFADP. Seven of 12 participants lost EM positions. Six of 12 programs were forced to exclude outside residents from rotating in their ED, leading to a need for one participating program and one non-participating program to find alternative sites for trauma. Five of 12 institutions provided resident staffing data, reporting a reduction in ED resident coverage in year 1 of the project of 9-40%. Programs compensated by increasing the number of shifts worked (4/12), increasing shift length (1/12), decreasing pediatric ED shifts (1/12), decreasing elective or research time (2/12), and decreasing off-service rotations (4/12). Six departments hired physician assistants or nurse practitioners, two hired faculty, and two hired resident moonlighters. Six of 12 programs withdrew from HCFADP and returned to previous resident numbers. Eight of 12 PDs thought that they had decreased time for clinical teaching. Conclusions: A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes. [source]

Selection Criteria for Emergency Medicine Residency Applicants

ACADEMIC EMERGENCY MEDICINE, Issue 1 2000
Joseph T. Crane MD
Abstract: Objectives: To determine the criteria used by emergency medicine (EM) residency selection committees to select their residents, to determine whether there is a consensus among residency programs, to inform programs of areas of possible inconsistency, and to better educate applicants pursuing careers in EM. Methods: A questionnaire consisting of 20 items based on the current Electronic Residency Application Service (ERAS) guidelines was mailed to the program directors of all 118 EM residencies in existence in February 1998. The program directors were instructed to rank each item on a five-point scale (5 = most important, 1 = least important) as to its importance in the selection of residents. Followup was done in the form of e-mail and facsimile. Results: The overall response rate was 79.7%, with 94 of 118 programs responding. Items ranking as most important (4.0-5.0) in the selection process included: EM rotation grade (mean ± SD = 4.79 ± 0.50), interview (4.62 ± 0.63), clinical grades (4.36 ± 0.70), and recommendations (4.11 ± 0.85). Moderate emphasis (3.0-4.0) was placed on: elective done at program director's institution (3.75 ± 1.25), U.S. Medical Licensing Examination (USMLE) step II (3.34 ± 0.93), interest expressed in program director's institution (3.30 ± 1.19), USMLE step I (3.28 ± 0.86), and awards/achievements (3.16 ± 0.88). Less emphasis (<3.0) was placed on Alpha Omega Alpha Honor Society (AOA) status (3.01 ± 1.09), medical school attended (3.00 ± 0.85), extracurricular activities (2.99 ± 0.87), basic science grades (2.88 ± 0.93), publications (2.87 ± 0.99), and personal statement (2.75 ± 0.96). Items most agreed upon by respondents (lowest standard deviation, SD) included EM rotation grade (SD 0.50), interview (SD 0.63), and clinical grades (SD 0.70). Of the 94 respondents, 37 (39.4%) replied they had minimum requirements for USMLE step I (195.11 ± 13.10), while 30 (31.9%) replied they had minimum requirements for USMLE step II (194.27 ± 14.96). Open-ended responses to "other" were related to personal characteristics, career/goals, and medical school performance. Conclusions: The selection criteria with the highest mean values as reported by the program directors were EM rotation grade, interview, clinical grades, and recommendations. Criteria showing the most consistency (lowest SD) included EM rotation grade, interview, and clinical grades. Results are compared with those from previous multispecialty studies. [source]

Routine inclusion of level IV in neck dissection for squamous cell carcinoma of the larynx: Is it justified?

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2004
Avi Khafif MD
Abstract Background. Dissection of levels II,IV as part of an elective or therapeutic neck dissection is common practice during laryngectomy for laryngeal squamous cell carcinoma (SCC). The necessity of routine dissection at level IV has recently been questioned. The purpose of this study was to find the incidence of level IV metastases in patients with transglottic and supraglottic SCC who underwent neck dissections. Methods. The charts of 71 suitable patients were reviewed. Forty-two had supraglottic primary cancers, and 29 had transglottic primary tumors. Levels II,IV had been removed in them all, and their neck specimens were marked according to the levels of the neck. The surgical specimens were pathologically diagnosed. Results. Of 43 patients who underwent elective lateral neck dissection, the only one (2.3%) with level IV metastases also showed metastases at level II. Nine (32%) of the other 28 patients with clinical adenopathy had level IV metastases. Conclusions. Dissection of level IV as part of a therapeutic neck dissection for supraglottic and transglottic SCC is recommended for patients with clinically enlarged lymph nodes, but its necessity in the absence of detectable adenopathy is challenged. © 2004 Wiley Periodicals, Inc. Head Neck26: 309,312, 2004 [source]

Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension

HEPATOLOGY RESEARCH, Issue 8 2010
Norihito Watanabe
Aim:, The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan. Methods:, A total of 173 cases of ectopic varices were collected. Results:, Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions:, Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future. [source]

In-hospital mortality after resection of biliary tract cancer in the United States

HPB, Issue 1 2010
James E. Carroll Jr
Abstract Objective:, To assess perioperative mortality following resection of biliary tract cancer within the U.S. Background:, Resection remains the only curative treatment for biliary tract cancer. However, current data on operative mortality after surgical resections for biliary tract cancer are limited to small and single-center studies. Methods:, Using the Nationwide Inpatient Sample 1998,2006, a cohort of patient-discharges was assembled with a diagnosis of biliary tract cancer, including intrahepatic bile duct, extrahepatic bile duct, and gall bladder cancers. Patients undergoing resection, including hepatic resection, bile duct resection, pancreaticoduodenectomy, and cholecystectomy, were retained. The primary outcome measure was in-hospital mortality. Categorical variables were analyzed by chi-square. Multivariable logistic regression was performed to identify independent predictors of in-hospital mortality following resection. Results:, 31 870 patient-discharges occurred for the diagnosis of biliary tract cancer, including 36.2% intrahepatic ductal, 26.7% extrahepatic ductal, and 31.1% gall bladder. Of the total, 18.6% underwent resection: mean age was 69.3 years (median 70.0); 60.8% were female; 73.7% were white. Overall inpatient surgical mortality was 5.6%. Independently predictive factors of mortality included patient age ,50 (vs. <50; age 50,59 odds ratio [OR] 5.51, 95% confidence interval [CI] 1.70,17.93; age 60,69 OR 7.25, 95% CI 2.29,22.96; age , 70 OR 9.03, 95% CI 2.86,28.56), the presence of identified comorbidities (congestive heart failure, OR 3.67, 95% CI 2.61,5.16; renal failure, OR 4.72, 95% CI 2.97,7.49), and admission designated as emergent (vs. elective; OR 1.82, 95% CI 1.39,2.37). Conclusion:, Increased in-hospital mortality for patients undergoing biliary tract cancer resection corresponded to age, comorbidity, hospital volume, and emergent admission. Further study is warranted to utilize these observations in promoting early detection, diagnosis, and elective resection. [source]

Quality control in laparoscopic cholecystectomy: operation notes, video or photo print?

HPB, Issue 3 2001
PW Plaisier
Background In 1995 the concept of a ,critical view of safety' (CVS) in Calot's triangle was introduced to prevent bile duct injury in laparoscopic cholecystectomy. The aim of this study was to determine the most reliable method for recording CVS. Methods Operation notes, video images and photo prints from 50 consecutive elective non-converted laparoscopic cholecystectomies were analysed. Results Operation notes alone did not suffice to record CVS. As an adjunct, video proved superior to photo print with regard to quality. Nevertheless, photo prints were practically and logistically much easier to produce than video. Moreover, when good quality images were achieved, photo print recorded CVS more conclusively than video. Discussion Operation notes, video and photo print are complementary, and the combination records CVS conclusively in nearly every case. [source]

Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth

JOURNAL OF ADVANCED NURSING, Issue 11 2009
Zvi Shimoni
Abstract Title.,Empowering surgical nurses improves compliance rates for antibiotic prophylaxis after caesarean birth. Aim., This paper is a report of a study of the effect of empowering surgical nurses to ensure that patients receive antibiotic prophylaxis after caesarean birth. Background., Despite the consensus that single dose antibiotic prophylaxis is beneficial for women have either elective or non-elective caesarean delivery, hospitals need methods to increase compliance rates. Method., In a study in Israel in 2007 surgical nurses were empowered to ensure that a single dose of cefazolin was given to the mother after cord clamping. A computerized system was used to identify women having caesarean births, cultures sent and culture results. Compliance was determined by chart review. Rates of compliance, suspected wound infections, and confirmed wound infections in 2007 were compared to rates in 2006 before the policy change. Relative risks were calculated dividing 2007 rates by those in 2006, and 95% confidence intervals were calculated using Taylor's series that does not assume a normal distribution. Statistical significance was assessed using the chi-square test. Findings., The compliance rate was increased from 25% in 2006 to 100% in 2007 (chi-square test, P < 0·001). Suspected wound infection rates decreased from 16·8% (186/1104) to 12·6% (137/1089) after the intervention (relative risk 0·75, 95% confidence interval, 0·61,0·92). Conclusion., Surgical nurses can ensure universal compliance for antibiotic prophylaxis in women after caesarean birth, leading to a reduction in wound infections. [source]

A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department,The DEED II Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004
FRACP, Gideon A. Caplan MBBS
Objectives: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED). Design: Prospective, randomized, controlled trial with 18 months of follow-up. Setting: Large medical school,affiliated public hospital in an urban setting in Sydney, Australia. Participants: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups. Intervention: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care. Measurements: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)). Results: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: ,0.25 vs ,0.75; P<.001; mental status questionnaire change from baseline at 12 months: ,0.21 vs ,0.64; P<.001). Conclusion: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit. [source]

Coronary Artery Bypass Surgery in Patients with Malignancy: A Single-Center Study with Comparison to Patients Without Malignancy

JOURNAL OF CARDIAC SURGERY, Issue 2 2009
Nezihi Kucukarslan M.D.
In this study, we compared the outcome of coronary artery bypass graft (CABG) in such patients with those without malignancy. Methods: The patients were selected from those who had undergone coronary artery bypass surgery in the last decade. The study group (group I) included the patients with malignancy in remission. The control group comprised those patients who were selected randomly from those without any malignancy. The patients were retospectively examined with regard to preoperative, operative, and postoperative data from personal files, computerized recording system, and operation reports. Results: Group I included 48 patients (age 48 to 69; 29 male) while group II included 50 patients (age = 38 to 73; 35 male). In group I, comorbidity rates were: renal dysfunction in 12 (25%), obstructive lung disease 10 (21%), congestive failure in four (8%) patients. The malignancy rates were: lung in 15 (31%), breast in 10 (21%), stomach in five (10%), colon in four (8%), renal in one (2%), Hodgkin's lyphoma in three (6%), leukemia in two (4%), ovarian in three (6%), and prostate in five (10%) patients. In group II, the comorbidity rates were: diabetes mellitus 18 (36%), renal dysfunction in five (10%) and obstructive lung disease in 13 (26%) patients. In group I, chemotherapy and radiotherapy were performed in 38 and 34 patients, respectively. In groups I and II, the CABG was elective in 47 (98%) and in 45 patients (90%); the off-pump surgery was performed in 27 (56%) and 12 (24%) patients, respectively. The total duration of bypass was 37 ± 6 minutes and 44 ± 5 minutes; the duration of aortic clamp was 26 ± 4 and 29 ± 7 minutes, respectively, in groups I and II. Posoperative complication rates were: infection in 12 (25%), bleeding in eight (17%), acute renal insufficiency in eight (17%), prolonged air escape in five (10%), and prolonged entubation in 17 (35%) patients in group I and atrial fibrillation in 11 (22%) patients in group II. Mortality rates in both groups were two (4%). Conclusion: CABG in patients with comorbid malignancy is as safe as the other patients. In patients with full remission of malignancy, the surgeons should be encouraged about the safety of CABG. [source]

Long-Term Results of Cardiac Transplantation

JOURNAL OF CARDIAC SURGERY, Issue 3 2003
Alberto Juffe M.D.
From April 1991 to December 2000, 345 patients underwent heart transplantation at the Juan Canalejo Hospital. The mean age of recipients was54.5 ± 11.4 years; 286 (83%) were male patients. Idiopathic (52.2%) and ischemic (34.9%) end-stage cardiomyopathy were the main causes leading to transplantation. Ninety-four patients had undergone a previous heart operation. The mean left ventricular ejection fraction was22.8 ± 11.4. Forty patients (11.5%) were transplanted in urgent (status I) condition. The mean time spent on the waiting list was 35.9 days. In-hospital mortality was 10.6% and 24% for transplantations performed on an elective and urgent basis, respectively. Operative (30-day), one-year and six-year survival was 87.2%, 81.3% and 64%, respectively. In terms of actuarial survival, there were no significant differences with regard to the recipient's age, sex, previous cardiac surgery, and the etiology of the end-stage cardiomyopathy. The six-year actuarial survival for recipients receiving hearts from female donors was 59% compared with 72% for male donors(p = 0.05). There has been a low incidence of rejection, as well as cardiac graft vasculopathy. Actuarial survival at six years was 66% for patients transplantated on an elective basis compared with 57% for patients transplanted on an urgent basis(p = 0.04). The aim of the study was to evaluate long-term results for patients who underwent orthotopic heart transplantation. In our experience, status I is associated with a higher mortality.(J Card Surg 2003;18:183-189) [source]

Preoperative Electrocardiographic Risk Assessment of Atrial Fibrillation After Coronary Artery Bypass Grafting

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2004
Ph.D., YI GANG M.D.
Introduction: This study evaluated the role of surface ECG in assessment of risk of new-onset atrial fibrillation (AF) after coronary artery bypass grafting surgery (CABG). Methods and Results: One hundred fifty-one patients (126 men and 25 women; age 65 ± 10 years) without a history of AF undergoing primary elective and isolated CABG were studied. Standard 12-lead ECGs and P wave signal-averaged ECG (PSAE) were recorded 24 hours before CABG using a MAC VU ECG recorder. In addition to routine ECG measurements, two P wave (P wave complexity ratio [pCR]; P wave morphology dispersion [PMD]) and six T wave morphology descriptors (total cosine R to T [TCRT]; T wave morphology dispersion of ascending and descending part of the T wave [aTMD and dTMD], and others), and three PSAE indices (filtered P wave duration [PD]; root mean square voltage of terminal 20 msec of averaged P wave [RMS20]; and integral of P wave [Pi]) were investigated. During a mean hospital stay of 7.3 ± 6.2 days after CABG, 40 (26%) patients developed AF (AF group) and 111 remained AF-free (no AF group). AF patients were older (69 ± 9 years vs 64 ± 10 years, P = 0.005). PD (135 ± 9 msec vs 133 ± 12 msec, P = NS) and RMS20 (4.5 ± 1.7 ,V vs 4.0 ± 1.6 ,V, P = NS) in AF were similar to that in no AF, whereas Pi was significantly increased in AF (757 ± 230 ,Vmsec vs 659 ± 206 ,Vmsec, P = 0.007). Both pCR (32 ± 11 vs 27 ± 10) and PMD (31.5 ± 14.0 vs 26.4 ± 12.3) were significantly greater in AF (P = 0.012 and 0.048, respectively). TCRT (0.028 ± 0.596 vs 0.310 ± 0.542, P = 0.009) and dTMD (0.63 ± 0.03 vs 0.64 ± 0.02, P = 0.004) were significantly reduced in AF compared with no AF. Measurements of aTMD and three other T wave descriptors were similar in AF and no AF. Significant variables by univariate analysis, including advanced age (P = 0.014), impaired left ventricular function (P = 0.02), greater Pi (P = 0.012), and lower TCRT (P = 0.007) or dTMD, were entered into multiple logistic regression models. Increased Pi (P = 0.038), reduced TCRT (P = 0.040), and lower dTMD (P = 0.014) predicted AF after CABG independently. In patients <70 years, a linear combination of increased pCR and lower TCRT separated AF and no AF with a sensitivity of 74% and specificity of 62% (P = 0.005). Conclusion: ECG assessment identifies patients vulnerable to AF after CABG. Combination of ECG parameters assessed preoperatively may play an important role in predicting new-onset AF after CABG. [source]

Assessing the Effects of Age, Gestation, Socioeconomic Status, and Ethnicity on Labor Inductions

JOURNAL OF NURSING SCHOLARSHIP, Issue 3 2007
Barbara L. Wilson
Purpose: To evaluate the likelihood of cesarean births, related to race, ethnicity, socioeconomic status (SES), maternal education and age, and gestational status for labor inductions on primiparous and multiparous women. Design and Methods: A retrospective descriptive correlational design was used with 1,325 women scheduled for induction at a large tertiary hospital in a southwestern U.S. state from January 1 through December 31, 2005. Birth outcomes were matched against inpatient hospital scheduling induction logs to verify the reason for induction, whether elective or clinically indicated. Findings: Age and gestation had nonlinear and significant associations with cesarean birth. Elective inductions for primiparous women significantly increased the likelihood of cesarean delivery. The independent effect of being a primiparous woman with an elective induction increased the probability of a cesarean birth by 50%, but this association was not significant for multiparous women. Mother's educational level was a significant predictor for cesarean births with multiparous women being induced. Ethnicity and SES did not increase the odds of cesarean delivery following labor induction for either primiparous women or multiparous women. Conclusions: Elective inductions for primiparous women increased the probability of cesarean births. Elective labor induction for primiparous women should be offered with caution, particularly for women with advanced maternal age. [source]

The Learning Curve of Resident Physicians Using Emergency Ultrasonography for Obstructive Uropathy

ACADEMIC EMERGENCY MEDICINE, Issue 9 2010
Timothy B. Jang MD
Abstract Background:, Given the time, expense, and radiation exposure associated with computed tomography (CT), ultrasonography (US) is considered an alternative imaging study that could expedite patient care in patients with suspected obstructive uropathy. However, there is a paucity of literature regarding bedside US for obstructive uropathy in the emergency department (ED), and it is unknown how much experience is required for competency in such exams. Objectives:, The objective was to assess the learning curve for the detection of obstructive uropathy of resident physicians training in ED bedside US (EUS) during a dedicated EUS elective. Methods:, This was a prospective cohort study of residents participating in an EUS elective. Patients presenting with acute abdominal or flank pain suggestive of an obstructive uropathy were enrolled and underwent EUS prior to noncontrast CT. Physicians who had previously performed at least 10 EUS exams for obstructive uropathy recorded results on a standardized data sheet, which was subsequently compared to the results of noncontrast CT read by board-certified radiologists blinded to the results of the EUS. In addition to an unadjusted chi-square test for trend, a multivariable logistic regression analysis, adjusting for stone size and operator, was performed. Finally, generalized estimating equations were used to describe test characteristics while accounting for potential clustering between exams by operator. Results:, Twenty-three resident physicians participated and enrolled a convenience sample of 393 patients. A total of 157 patients (40%) were diagnosed with an obstructing ureterolith, and three (1%) were diagnosed with nonobstructing ureterolithiasis. An unadjusted chi-square test for trend demonstrated a statistically significant increase in both sensitivity (,2 = 11.4, p = 0.02) and specificity (,2 = 6.4, p = 0.04) for each level of increase in number of exams. On multivariable regression analysis, when adjusting for size of stone and operator, for every five additional exams after the first 10 EUS exams, the odds ratio for a true positive for obstruction increased by 1.7 (95% confidence interval [CI] = 1.2 to 2.5, p = 0.003). After accounting for clustering of exams by operator, overall EUS sensitivity and specificity for obstructive uropathy were 82% (95% CI = 77% to 87%) and 88% (95% CI = 85% to 92%). Stratifying by number of exams, the sensitivity was 72% (95% CI = 62% to 80%) for the 11th through 20th exams, 90% (95% CI = 83% to 96%) for the 21st through 30th exams, and 95% (95% CI = 91% to 99%) for the 31st through 43rd exams. Likewise, specificity was 82% (95% CI = 75% to 89%) for the 11th through 20th exams, 90% (95% CI = 85% to 95%) for the 21st through 30th exams, and 92% (95% CI = 86% to 98%) for the 31st through 50th exams. Conclusions:, Physicians training in EUS may be able to accurately assess for obstructive uropathy after 30 exams. ACADEMIC EMERGENCY MEDICINE 2010; 17:1024,1027 © 2010 by the Society for Academic Emergency Medicine [source]

Patterns in current anaesthesiological peri-operative practice for colonic resections: a survey in five northern-European countries

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2006
P. Hannemann
Background:, For colorectal surgery, evidence suggests that optimal management includes: no pre-operative fasting, a thoracic epidural analgesia continued for 2 days post-operatively, and avoidance of fluid overload. In addition, no long-acting benzodiazepines on the day of surgery and use of short-acting anaesthetic medication may be beneficial. We examined whether these strategies have been adopted in five northern-European countries. Methods:, In 2003, a questionnaire concerning peri-operative anaesthetic routines in elective, open colonic cancer resection was sent to the chief anaesthesiologist in 258 digestive surgical centres in Scotland, the Netherlands, Denmark, Sweden and Norway. Results:, The response rate was 74% (n = 191). Although periods of pre-operative fasting up to 48 h were reported, most (> 85%) responders in all countries declared to adhere to guidelines for pre-operative fasting and oral clear liquids were permitted until 2,3 h before anaesthesia. Solid food was permitted up to 6,8 h prior to anaesthesia. In all countries more than 85% of the responders indicated that epidural anaesthesia was routinely used. Except for Denmark, long-acting benzodiazepines were still widely used. Short-acting anaesthetics were used in all countries except Scotland where isoflurane is the anaesthetic of choice. With the exception of Denmark, intravenous fluids were used unrestrictedly. Conclusion:, In northern Europe, most anaesthesiologists adhere to evidence-based optimal management strategies on pre-operative fasting, thoracic epidurals and short-acting anaesthetics. However, premedication with longer-acting agents is still common. Avoidance of fluid overload has not yet found its way into daily practice. This may leave patients undergoing elective colonic surgery at risk of oversedation and excessive fluid administration with potential adverse effects on surgical outcome. [source]

Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy?

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010
R. HAZAZI
Aliment Pharmacol Ther,31, 523,533 Summary Background, Common reasons for elective screening and surveillance colonoscopy, at predetermined intervals, are family or personal history of colorectal cancer (CRC) or advanced adenoma (AAP). Quantified, human haemoglobin (Hb)-specific, immunochemical faecal occult blood tests (I-FOBT) detect bleeding. Aim, To determine I-FOBT sensitivity for CRC or AAP before elective colonoscopy in patients at high-risk of cancer or advanced adenoma. Methods, Prospective double-blind study of 1000 ambulatory asymptomatic high-risk patients (555 family history of CRC, 445 surveillance for past neoplasm), who prepared three I-FOBTs before elective colonoscopy. I-FOBTs quantified as ngHb/mL of buffer by OC-MICRO instrument and results ,50 ngHb/mL considered positive. Results, At colonoscopy, eight patients had CRC, 64 others had AAP. Sensitivity for CRC and/or AAP was the highest, 65.3% (95% CI 54.3, 76.3), when any of the three I-FOBTs was ,50 ngHb (15.4%), with specificity of 87.5% (95% CI 86.4, 90.5) identifying all CRCs and 62% of AAPs. Conclusions, All cancers or an AAP were detected every third I-FOBT-positive colonoscopy (47/154), so colonoscopy was potentially not needed at this time in 84.6% (846 patients). I-FOBT screening might provide effective supervision of high-risk patients, delaying unnecessary elective colonoscopies. This favourable evaluation needs confirmation and cost,benefit study by risk-group. [source]

Diverticular disease hospital admissions are increasing, with poor outcomes in the elderly and emergency admissions

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11-12 2009
S. JEYARAJAH
Summary Background, Diverticular disease has a changing disease pattern with limited epidemiological data. Aim, To describe diverticular disease admission rates and associated outcomes through national population study. Methods, Data were obtained from the English ,Hospital Episode Statistics' database between 1996 and 2006. Primary outcomes examined were 30-day overall and 1-year mortality, 28-day readmission rates and extended length of stay (LOS) beyond the 75th percentile (median inpatient LOS = 6 days). Multiple logistic regression analysis was used to determine independent predictors of these outcomes. Results, Between the study dates 560 281 admissions with a primary diagnosis of diverticular disease were recorded in England. The national admission rate increased from 0.56 to 1.20 per 1000 population/year. 232 047 (41.4%) were inpatient admissions and, of these, 55 519 (23.9%) were elective and 176 528 (76.1%) emergency. Surgery was undertaken in 37 767 (16.3%). The 30-day mortality was 5.1% (n = 6735) and 1-year mortality was 14.5% (n = 11 567). The 28-day readmission rate was 9.6% (n = 21 160). Increasing age, comorbidity and emergency admission were independent predictors of all primary outcomes. Conclusions, Diverticular disease admissions increased over the course of the study. Patients of increasing age, admitted as emergency and significant comorbidity should be identified, allowing management modification to optimize outcomes. [source]

Thrombin generation during reperfusion after coronary artery bypass surgery associates with postoperative myocardial damage

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 7 2006
P. RAIVIO
Summary.,Background: Cardiopulmonary bypass and coronary artery bypass grafting (CABG) result in significant thrombin generation and activation of fibrinolysis. Thrombin contributes to myocardial ischemia,reperfusion injury in animal studies, but the role of thrombin in myocardial damage after CABG is unknown. Objectives: We measured thrombin generation and fibrin turnover during reperfusion after CABG to evaluate their associations with postoperative hemodynamic changes and myocardial damage. Methods: One hundred patients undergoing primary, elective, on-pump CABG were prospectively enrolled. Plasma prothrombin fragment F1+2 and D-dimer were measured preoperatively and at seven time points thereafter. Mass of the Mb fraction of creatine kinase (Ck-Mbm) and troponin T (TnT) were measured on the first postoperative day. Results: Reperfusion induced an escalation of thrombin generation and fibrin turnover despite full heparinization. F1+2 during early reperfusion associated with postoperative pulmonary vascular resistance index. F1+2 at 6 h after protamine administration correlated with Ck-Mbm (r = 0.40, P < 0.001) and TnT (r = 0.44, P < 0.001) at 18 h postoperatively. Patients with evidence of myocardial damage (highest quintiles of plasma Ck-Mbm and TnT) had significantly higher F1+2 during reperfusion than others (P < 0.002). Logistic regression models identified F1+2 during reperfusion to independently associate with postoperative myocardial damage (odds ratios 2.5,4.4, 95% confidence intervals 1.04,15.7). Conclusions: Reperfusion caused a burst in thrombin generation and fibrin turnover despite generous heparinization. Thrombin generation during reperfusion after CABG associated with pulmonary vascular resistance and postoperative myocardial damage. [source]

Initial experience with factor-Xa inhibition in percutaneous coronary intervention: the XaNADU-PCI Pilot

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 2 2004
J. H. Alexander
Summary.,Background:,Direct factor (F)Xa inhibition is an attractive method to limit thrombotic complications during percutaneous coronary intervention (PCI). Objectives:,To investigate drug levels achieved, effect on coagulation markers, and preliminary efficacy and safety of several doses of DX-9065a, an intravenous, small molecule, direct, reversible FXa inhibitor during PCI. Patients and methods:,Patients undergoing elective, native-vessel PCI (n = 175) were randomized 4 : 1 to open-label DX-9065a or heparin in one of four sequential stages. DX-9065a regimens in stages I,III were designed to achieve concentrations of >,100 ng mL,1, >,75 ng mL,1, and >,150 ng mL,1. Stage IV used the stage III regimen but included patients recently given heparin. Results:,At 15 min median (minimum) DX-9065a plasma levels were 192 (176), 122 (117), 334 (221), and 429 (231) ng mL,1 in stages I,IV, respectively. Median whole-blood international normalized ratios (INRs) were 2.6 (interquartile range 2.5, 2.7), 1.9 (1.8, 2.0), 3.2 (3.0, 4.1), and 3.8 (3.4, 4.6), and anti-FXa levels were 0.36 (0.32, 0.38), 0.33 (0.26, 0.39), 0.45 (0.41, 0.51), and 0.62 (0.52, 0.65) U mL,1, respectively. Stage II enrollment was stopped (n = 7) after one serious thrombotic event. Ischemic and bleeding events were rare and, in this small population, showed no clear relation to DX-9065a dose. Conclusions:,Elective PCI is feasible using a direct FXa inhibitor for anticoagulation. Predictable plasma drug levels can be rapidly obtained with double-bolus and infusion DX-9065a dosing. Monitoring of DX-9065a may be possible using whole-blood INR. Direct FXa inhibition is a novel and potentially promising approach to anticoagulation during PCI that deserves further study. [source]

Peace-building through an international child health elective

MEDICAL EDUCATION, Issue 11 2005
Shannon Wires
No abstract is available for this article. [source]

Anesthetic experience of 100 pediatric tracheostomies

PEDIATRIC ANESTHESIA, Issue 7 2009
FIONA WRIGHTSON MB ChB FRCA
Summary Background:, Tracheostomy is more hazardous in the pediatric population than in adults (Paediatr Nurs, 17, 2005, 38; Int J Pediatr Otorhinolaryngol, 67, 2003, 7; J R Soc Med, 89, 1996, 188). Airway management in these children and infants is potentially challenging. Previous case series of pediatric tracheostomy published in the surgical journals make little mention of anesthetic techniques used and do not describe airway management. The aim of this study was to review the anesthetic, and in particular the airway management of children undergoing tracheostomy at Great Ormond Street Hospital (GOSH). Methods:, Between September 2004 and December 2007, the ENT surgical database showed that 109 children had a surgical tracheostomy performed at GOSH. We were only able to locate the notes of 100 of these cases. The anesthetic records of these 100 patients undergoing tracheostomy were analyzed retrospectively. Results:, Ninety-four percent (94/100) of tracheostomies were elective, and 6% (6/100) were emergency. In this study, 26% (26/100) of children were recorded as difficult to intubate. These difficult airways were managed as follows: 10/26 used a laryngeal mask airway (LMA), 5/26 were managed with facemask alone, 3/26 had fiber-optic intubation, 5/26 had surgical intubation and 2/26 were intubated with the aid of a bougie and cricoid pressure. Conclusions:, This case series demonstrates that intubation is difficult in up to 26% of children presenting for tracheostomy. While intubation of the trachea remains the preferred option when anesthetizing children for tracheostomy, the LMA or facemask can provide a successful airway where intubation is not possible. The use of the LMA or facemask may therefore be life saving in the unintubatable child. [source]

Adverse drug reaction-related hospitalisations: a population-based cohort study

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2008
Cornelis S. van der Hooft MD
Abstract Purpose To evaluate the extent, characteristics and determinants of adverse drug reaction (ADR)-related hospitalisations on a population-based level in 2003. Methods We performed a cohort study in the Integrated Primary Care Information (IPCI) database, a general practitioners (GPs) research database with longitudinal data from electronic patient records of a group of 150 GP throughout the Netherlands. Hospital discharge letters and patient records were reviewed to evaluate ADR-related hospitalisations applying WHO causality criteria. The prevalence of ADR-related hospitalisations per total admissions and the incidence per drug group were calculated. Avoidability and seriousness of the ADRs causing admission were assessed applying the algorithm from Hallas. Results We identified 3515 hospital admissions, 1277 elective and 2238 acute. Of the acute admissions, 115 were caused by an ADR giving a prevalence of 5.1% (95% confidence intervals (CI): 4.3,6.1%). The prevalence of ADR-related acute admissions increased with age up to 9.8% (95%CI: 7.5,12.7) for persons >75 years. The ADRs that most frequently caused hospitalisations were gastro-intestinal bleeding with anti-thrombotics, bradycardia/hypotension with cardiovascular drugs and neutropenic fever with cytostatics. The incidence rate of ADR-related hospitalisations per drug group was highest for anti-thrombotics and anti-infectives and was relatively low for cardiovascular drugs. Fatality as a direct consequence of the ADR-related admission was 0.31%. In elderly patients 40% of the ADRs causing hospitalisation were judged to be avoidable. Conclusions The extent and potential avoidability of ADR-related hospitalisations is still substantial, especially in elderly patients. Measures need to be put into place to reduce the burden of ADRs. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Mixed methods research in school psychology: A mixed methods investigation of trends in the literature

PSYCHOLOGY IN THE SCHOOLS, Issue 4 2008
Heather Powell
This article illustrates the utility of mixed methods research (i.e., combining quantitative and qualitative techniques) to the field of school psychology. First, the use of mixed methods approaches in school psychology practice is discussed. Second, the mixed methods research process is described in terms of school psychology research. Third, the current state of affairs with respect to mixed methods designs in school psychology research is illustrated through a mixed methods analysis of the types of empirical studies published in the four leading school psychology journals between 2001 and 2005. Only 13.7% of these studies were classified as representing mixed methods research. We conclude that this relatively small proportion likely reflects the fact that only 3.5% of graduate-level school psychology programs appear to require that students enroll in one or more qualitative and/or mixed methods research courses, and only 19.3% appear to offer one or more qualitative courses as an elective. Finally, the utility of mixed methods research is illustrated by critiquing select monomethod (i.e., qualitative or quantitative) and mixed methods studies conducted on the increasingly important topic of bullying. We demonstrate how using mixed methods techniques results in richer data being collected, leading to a greater understanding of underlying phenomena. © 2008 Wiley Periodicals, Inc. [source]

Category-1 caesarean section: a survey of anaesthetic and peri-operative management in the UK,

ANAESTHESIA, Issue 4 2010
S. M. Kinsella
Summary A national survey of anaesthetic and peri-operative management of category-1 caesarean section was sent to 245 consultant-led maternity units. There was a 70% response rate. The median (IQR [range]) general anaesthetic rate was 51% (29%,80% [6%,100%]), 12% (9%,16% [3%,93%]), 4% (2%,5% [<1%,18%]), for category-1 caesarean section, categories 1,3 (non-elective/emergency) and category-4 (elective) caesarean section, respectively. The main operating theatre for caesarean section is on the delivery suite in 151 (88%) units, and 112 (66%) units also have a second theatre in the same location. One hundred and thirty-nine (81%) use the standard urgency classification described in the NICE caesarean section guideline. However, only 72 (42%), 24 (14%), and 16 (9%) units comply with this guideline's recommended decision-delivery intervals for category-1 (, 30 min), category-2 (, 30 min) and category-3 (, 75 min) caesarean sections, respectively. Practice in the smaller units was similar to that in the larger units, although there was less availability of a dedicated anaesthetist, intra-uterine resuscitation guidelines and operating theatres on the delivery suite in the smaller units. [source]

Risk index for peri-operative atrial fibrillation in patients undergoing open intracranial neurosurgical procedures

ANAESTHESIA, Issue 5 2009
F. Bilotta
Summary The aim of this prospective study was to determine the prevalence of pre-operative atrial fibrillation and the incidence of postoperative atrial fibrillation in patients undergoing elective or emergency intracranial neurosurgical procedures and the relation to survival and neurological outcome at 6-months follow-up compared to patients with sinus rhythm. A total of 2020 patients were enrolled; 1540 patients underwent elective procedures and 480 underwent emergency procedures. Prevalence of pre-operative atrial fibrillation was 3.7% in elective and 7.2% in emergency procedures (p = 0.0012). In patients undergoing elective cerebral procedures with pre-operative atrial fibrillation, compared to patients with sinus rhythm, 6-month neurological outcome and survival rate are similar. In patients undergoing emergency neurosurgical cerebral procedures, the presence of pre-operative atrial fibrillation is related to an increased risk of poor neurological outcome but with similar survival rate. [source]