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Day Shorter (day + shorter)
Selected AbstractsEffect of Off-Pump Coronary Artery Bypass Grafting on Risk-Adjusted and Cumulative Sum Failure Outcomes After Coronary Artery SurgeryJOURNAL OF CARDIAC SURGERY, Issue 6 2002Richard J. Novick M.D. We therefore applied CUSUM, as well as standard statistical techniques, to analyze a surgeon's experience with off-pump coronary artery bypass grafting (OPCAB) and on-pump procedures to determine whether the two techniques have similar or different outcomes. Methods: In 320 patients undergoing nonemergent, first time coronary artery bypass grafting, preoperative patient characteristics, rates of mortality and major complications, and ICU and hospital lengths of stay were compared between the on-pump and OPCAB cohorts using Fisher's exact tests and Wilcoxon two sample tests. Predicted mortality and length of stay were determined using previously validated models of the Cardiac Care Network of Ontario. Observed versus expected ratios of both variables were calculated for the two types of procedures. Furthermore, CUSUM curves were constructed for the on-pump and OPCAB cohorts. A multivariable analysis of the predictors of hospital length of stay was also performed to determine whether the type of coronary artery bypass procedure had an independent impact on this variable. Results: The predicted mortality risk and predicted hospital length of stay were almost identical in the 208 on-pump patients ( 2.2 ± 3.9% ; 8.2 ± 2.5 days) and the 112 OPCAB patients ( 2.0 ± 2.2% ; 7.8 ± 2.1 days). The incidence of hospital mortality and postoperative stroke were 2.9% and 2.4% in on-pump patients versus zero in OPCAB patients (p= 0.09 and 0.17, respectively). Mechanical ventilation for greater than 48 hours was significantly less common in OPCAB (1.8%) than in on-pump patients (7.7%, p= 0.04). The rate of 10 major complications was 14.9% in on-pump versus 8.0% in OPCAB patients (p= 0.08). OPCAB patients experienced a hospital length of stay that was a median of 1.0 day shorter than on-pump patients (p= 0.01). The observed versus expected ratio for length of stay was 0.78 in OPCAB patients versus 0.95 in on-pump patients. On CUSUM analysis, the failure curve in OPCAB patients was negative and was flatter than that of on-pump patients throughout the duration of the study. Furthermore, OPCAB was an independent predictor of a reduced hospital length of stay on multivariable analysis. Conclusions: OPCAB was associated with better outcomes than on-pump coronary artery bypass despite a similar predicted risk. This robust finding was documented on sensitive CUSUM analysis, using standard statistical techniques and on a multivariable analysis of the independent predictors of hospital length of stay.(J Card Surg 2002;17:520-528) [source] An acute pain service improves postoperative pain management for children undergoing selective dorsal rhizotomyPEDIATRIC ANESTHESIA, Issue 12 2009CHANTAL FRIGON MSC MD Summary Background:, A continuous epidural infusion of morphine is the pain treatment modality for children undergoing selective dorsal rhizotomy (SDR) in our institution. The aim of the study was to evaluate the impact of having an organized acute pain service (APS) on postoperative pain management of these children. Methods:, We conducted a retrospective cohort study using anesthetic records and the APS database to compare the postoperative pain management of children undergoing SDR before and after the introduction of the APS at the Montreal Children's Hospital in April 2001. Ninety-two consecutive children who had their surgery between January 1997 and July 2006 were included. We collected data regarding postoperative pain, opioid-induced side effects, complications (sedation, desaturations < 92%), and hospital length of stay. Results:, Pain scores were documented more frequently after the implementation of the APS (61% vs 48.5%). Sedation scores were documented only after the implementation of the APS. Postoperative desaturation was significantly more frequent in the pre-APS group compared to the APS group (45.5% vs 6.8%, P < 0.001). Despite the fact that the epidural catheter was in place for the same duration for both groups [median of 3 days (3,3 25,75%ile)], the duration of hospitalization was 1 day shorter in the APS group compared to the pre-APS group [median of 5 (5,5 25,75%ile) vs 6 (5,6 25,75%ile) days, P < 0.001]. Conclusions:, Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day. [source] Horizontal resolution impact on short- and long-range forecast errorTHE QUARTERLY JOURNAL OF THE ROYAL METEOROLOGICAL SOCIETY, Issue 649 2010Roberto Buizza Abstract The impact of horizontal resolution increases from spectral truncation T95 to T799 on the error growth of ECMWF forecasts is analysed. Attention is focused on instantaneous, synoptic-scale features represented by the 500 and 1000 hPa geopotential height and the 850 hPa temperature. Error growth is investigated by applying a three-parameter model, and improvements in forecast skill are assessed by computing the time limits when fractions of the forecast-error asymptotic value are reached. Forecasts are assessed both in a realistic framework against T799 analyses, and in a perfect-model framework against T799 forecasts. A strong sensitivity to model resolution of the skill of instantaneous forecasts has been found in the short forecast range (say up to about forecast day 3). But sensitivity has shown to become weaker in the medium range (say around forecast day 7) and undetectable in the long forecast range. Considering the predictability of ECMWF operational, high-resolution T799 forecasts of the 500 hPa geopotential height verified in the realistic framework over the Northern Hemisphere (NH), the long-range time limit ,(95%) is 15.2 days, a value that is one day shorter than the limit computed in the perfect-model framework. Considering the 850 hPa temperature verified in the realistic framework, the time limit ,(95%) is 16.6 days for forecasts verified in the realistic framework over the NH (cold season), 14.1 days over the SH (warm season) and 20.6 days over the Tropics. Although past resolution increases have been providing continuously better forecasts especially in the short forecast range, this investigation suggests that in the future, although further increases in resolution are expected to improve the forecast skill in the short and medium forecast range, simple resolution increases without model improvements would bring only very limited improvements in the long forecast range. Copyright © 2010 Royal Meteorological Society [source] Influence of delayed cooling on storability and postharvest quality of European plumsJOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE, Issue 6 2009Marcos Guerra Abstract BACKGROUND: Delayed cooling has been tested to delay the development of internal breakdown (IB) in other stone fruits, but the influence of delayed cooling on IB has not been studied to date in European plums. A controlled delayed treatment of 48 h at 20 °C was applied in order to study the storability and postharvest quality of European plum (Prunus domestica L.) cv. ,Green Gage'. RESULTS: Market life of ,Green Gage' plums after shelf life was 10 days shorter in delayed fruits than in control fruits at earlier harvest dates. Sensory attributes affected by delayed cooling treatment at harvest were astringency and aroma. Prompt cooling was essential to lower the rate of physiological deterioration of plums, helping to maintain fruit quality and prolong market life. CONCLUSION: Delayed cooling increased IB symptoms in ,Green Gage' plums, so, when storability is needed, rapid cooling of fruits is necessary in order to extend their market life. Delayed cooling modified the total soluble solids/titratable acidity (TSS/TA) ratio and the sensory properties aroma and astringency at harvest, so it is desirable to deliver fruits directly to market in order to improve TSS/TA, the instrumental property best correlated with sensory characteristics. Copyright © 2009 Society of Chemical Industry [source] The benefit of geriatric intervention in surgery,increased throughput does not necessarily need more bedsCOLORECTAL DISEASE, Issue 6 2000R. B. Dunn Objective Three years ago a consultant geriatrician began regular visits to the coloproctology and general surgery wards of an acute Trust every weekday, to assist staff with the medical management, rehabilitation and discharge planning of patients aged 65 years and above. The length of stay of these patients in the first 10 months of the appointment was compared with younger concurrent controls and with historical controls in the preceding 10 months. Results The mean length of stay for the 4146 patients aged 16 years and above in a 10-month intervention period was 1.3 days shorter (95% confidence interval (CI) 0.86,1.74 days) than for the 4002 patients in the 10-month control period. This pattern was consistent across all ages and types of surgery, including major colorectal resection. Conclusion There was an important benefit to the availability of coloproctology and general surgical beds in this acute Trust. More efficient rehabilitation of elderly patients reduces ,bed blockage' post-operatively, and allows more effective use of available resources. Co-ordination of the geriatric service with the specialized stoma support service allows earlier discharge of the elderly, and their relocation to appropriate premises where long-term changes in bowel habit and problems with stoma care can be managed away from the acute surgical unit. [source] | ||||||||||