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Jensen S, Gallagher R, Sing R, Torres Fajardo R. Causes and Timing of Unplanned ICU Admissions Among Trauma Patients at a Level 1 Trauma Center. Am Surg 2024:31348241241659. [PMID: 38563045 DOI: 10.1177/00031348241241659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Unexpected ICU admissions are a key quality metric in trauma care. The purpose of this study is to identify the most common causes of unplanned ICU admissions among trauma patients at an ACS-verified level 1 trauma center. METHODS A retrospective review was conducted of all trauma patients with unplanned admission to the ICU at a level 1 trauma center between 2019 and 2021. Unplanned ICU admissions were categorized into (1) "bounce-backs," patients previously admitted to the ICU and (2) "upgrades," patients who had not previously been cared for in the ICU. RESULTS Of 300 unexpected ICU transfers, bounce-backs accounted for 69% and upgrades 31%. The most common injuries were traumatic brain injuries (40%) and rib fractures (41.3%). In-hospital mortality rate was 10% and did not significantly differ between bounce-backs and upgrades (12 vs 5%, P = .92). Respiratory distress was the most common cause of transfer (41.1%), followed by neurologic (29.6%) and cardiovascular decline (21.2%). Patients were on average 928 mL fluid positive 72 hours prior to transfer (t > 0, P < .0001), and 295 mL fluid positive in the 24 hours prior to transfer (t > 0, P .0003). Patients transferred for respiratory distress were no more fluid over-balanced than those transferred for other reasons. CONCLUSION We found a large percent of unplanned transfers occurring within 48 hours of admission or transfer out of the ICU suggesting under-triage as a leading cause of bounce-backs and upgrades. Respiratory distress was the leading cause of transfer. These findings highlight opportunities for targeted interventions.
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Affiliation(s)
- Stephanie Jensen
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Robert Gallagher
- School of Medicine, Des Moines University Medical School, West Des Moines, IA, USA
| | - Ronald Sing
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Burton SW, Riojas C, Gesin G, Smith CB, Bandy V, Sing R, Roomian T, Wally MK, Lauer CW. Multimodal analgesia reduces opioid requirements in trauma patients with rib fractures. J Trauma Acute Care Surg 2022; 92:588-596. [PMID: 34882599 PMCID: PMC8866226 DOI: 10.1097/ta.0000000000003486] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rib fractures are common in trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is essential to avoid the complications associated with rib fractures. Opioids are frequently used for analgesia in these patients. This study compared the effect of a multimodal pain regimen (MMPR) on inpatient opioid use and outpatient opioid prescribing practices in adult trauma patients with rib fractures. STUDY DESIGN A pre-post cohort study of adult trauma patients with rib fractures was conducted at a Level I trauma center before (PRE) and after (POST) implementation of an MMPR. Patients on long-acting opioids before admission and those on continuous opioid infusions were excluded. Primary outcomes were oral opioid administration during the first 5 days of hospitalization and opioids prescribed at discharge. Opioid data were converted to morphine milligram equivalents (MMEs). RESULTS Six hundred fifty-three patients met inclusion criteria (323 PRE, 330 POST). There was a significant reduction in the daily MME during the second through fifth days of hospitalization; and the average inpatient MME over the first five inpatient days (23 MME PRE vs. 17 MME POST, p = 0.0087). There was a significant reduction in the total outpatient MME prescribed upon discharge (322 MME PRE vs. 225 MME POST, p = 0.006). CONCLUSION The implementation of an MMPR in patients with rib fractures resulted in significant reduction in inpatient opioid consumption and was associated with a reduction in the quantity of opiates prescribed at discharge. LEVEL OF EVIDENCE Therapeutic/Care Management; level IV.
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Affiliation(s)
- Shakira W. Burton
- Acute Care Surgery Division, Atrium Health – Carolinas Medical Center; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Christina Riojas
- Acute Care Surgery Division, Atrium Health – Carolinas Medical Center; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Gail Gesin
- Division of Pharmacy, Atrium Health; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Charlotte B. Smith
- Acute Care Surgery Division, Atrium Health – Carolinas Medical Center; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Vashti Bandy
- Acute Care Surgery Division, Atrium Health – Carolinas Medical Center; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Ronald Sing
- FH Sammy Ross Trauma Center, Atrium Health; 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Tamar Roomian
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Meghan K. Wally
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Boulevard, Charlotte, NC 28203
| | - Cynthia W. Lauer
- Acute Care Surgery Division, Atrium Health – Carolinas Medical Center; 1000 Blythe Boulevard, Charlotte, NC 28203
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Loszko A, Watson M, Khan A, Cunningham K, Thomas B, Ross S, Lauer C, Sing R, Sachdev G. Acute Care Surgeons Spend More Time than General Surgeons on the Electronic Health Record (EHR). Am Surg 2021:31348211061102. [PMID: 34933572 DOI: 10.1177/00031348211061102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The paradigm of Acute Care Surgery (ACS) emerged in response to decreasing operative opportunities for trauma surgeons and increasing need for surgical coverage in disciplines to which the expertise of trauma surgeons naturally extends. While the continued evolution of this specialty remains largely beneficial, unintended consequences may have arisen along the way. One aspect of ACS that remains to be thoroughly investigated is the impact of the electronic health record (EHR). The purpose of this study is to objectively quantify EHR usage for ACS and compare it to other general surgery specialties. METHODS EHR user data were collected for fifteen ACS attendings and thirty-seven general surgery attendings from October 2014 to September 2019. Comparative analysis was conducted using two-tailed t-tests. Subgroup analysis was conducted for subspecialties included in the general surgery group. RESULTS ACS attendings opened almost 3 times as many charts as general surgery attendings per month (180 vs 64 charts/month, P < .0001), and ultimately spent more time on the EHR as a result (10 vs 6.4 hours/month, P < .0001). Documentation was the most time consuming EHR task for both groups. Although ACS attendings spent less overall time per patient chart, the proportion of time spent on certain EHR tasks was similar to that of general surgery colleagues. DISCUSSION The EHR imposes a disproportionate burden on ACS attendings compared to their general surgery counterparts, and additional study is warranted to improve usage. EHR usage burden has workforce implications for trainees considering a career in ACS.
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Affiliation(s)
- Abigail Loszko
- 6797University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Michael Watson
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Ahsan Khan
- 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Kyle Cunningham
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Bradley Thomas
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Samuel Ross
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Cynthia Lauer
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Ronald Sing
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Gaurav Sachdev
- Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
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Braun O, Brambatti M, Shah P, Cipriani M, Veenis J, Bui Q, Hong K, de Heyning C, Perna E, Timmermans P, Cikes M, Gjesdal G, Partida C, Potena L, Masetti M, Loforte A, Jakus N, Nilsson J, De Bock D, Minto J, Brugts J, Sterken C, Van den Bossche K, Rega F, Sing R, Russo C, Pretorius V, Klein L, Frigerio M, Adler E, Ammirati E. ICD Therapy Confers No Survival Advantage in a Global LVAD Population: Insights from the Trans-Atlantic Registry on VAD and Transplant (TRAViATA). J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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McCafferty B, Meh Chu G, Joe W, Larson M, Devane M, Sing R, Madassery S, Gunn A. Abstract No. 733 Bone penetration by inferior vena cava filters: feasibility and safety of percutaneous retrieval. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Sorah AB, Cunningham K, Morgan J, Rinaldi M, Christmas AB, Sing R. STROKE RISK VERSUS FALL RISK: A GROWING CONUNDRUM IN THE ANTICOAGULATION OF GERIATRIC PATIENTS WITH ATRIAL FIBRILLATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32474-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ode G, Sing R, Hsu J, Seymour R, Bosse M. MOPEDS: The high cost of cheap and poorly legislated transportation for negligent drivers. Accid Anal Prev 2018; 117:121-127. [PMID: 29698865 DOI: 10.1016/j.aap.2018.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/18/2018] [Accepted: 03/24/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION This study evaluates the impact of moped crashes in North Carolina, a state with lenient moped legislation by(1) describing the characteristics of moped crashes and (2) estimating the cost burden of moped-related injuries. METHODS Health and public records of moped crash subjects treated at our hospital were reviewed. Direct costs were billed hospital charges. Indirect costs based on age and outcomes were calculated. RESULTS Between 2008-2013, 368 subjects were involved in 373 moped crashes. 52% of drivers were intoxicated. 38% of drivers had prior DWIs and 26% had prior revoked licenses. Hospitalized subjects (n = 305) had a combined 2687 hospital days, 695 ICU days and 449 trips to the operating room for treatment of their injuries. Average hospital charges were $70,561 per subject. Total direct and indirect costs of moped injuries were over $26 million and $81 million respectively. Medicaid absorbed most of the direct cost ($13.7 M). Estimated direct cost of moped crashes across the state totaled $133 million. CONCLUSION Healthcare and financial ramifications of moped collisions are substantial. Laws governing moped drivers and stricter penalties for intoxicated drivers are needed.
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Affiliation(s)
- Gabriella Ode
- Carolinas HealthCare System, Charlotte, NC, United States.
| | - Ronald Sing
- Carolinas HealthCare System, Charlotte, NC, United States
| | - Joseph Hsu
- Carolinas HealthCare System, Charlotte, NC, United States
| | - Rachel Seymour
- Carolinas HealthCare System, Charlotte, NC, United States
| | - Michael Bosse
- Carolinas HealthCare System, Charlotte, NC, United States
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Nunn A, Fischer P, Sing R, Templin M, Avery M, Christmas AB. Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience. Am Surg 2017. [DOI: 10.1177/000313481708300429] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004–2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.
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Affiliation(s)
- Andrew Nunn
- Division of Trauma and Surgical Critical Care, Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Peter Fischer
- Division of Trauma and Surgical Critical Care, Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Ronald Sing
- Division of Trauma and Surgical Critical Care, Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Megan Templin
- Dickson Advanced Analytics, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Avery
- Dickson Advanced Analytics, Carolinas Medical Center, Charlotte, North Carolina
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Nunn A, Fischer P, Sing R, Templin M, Avery M, Christmas AB. Improvement of Treatment Outcomes after Implementation of a Massive Transfusion Protocol: A Level I Trauma Center Experience. Am Surg 2017; 83:394-398. [PMID: 28424137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We assessed the effectiveness of the implementation of an institutional massive transfusion protocol (MTP) for resuscitation with a 1:1:1 transfusion ratio of packed red blood cell (PRBC), fresh frozen plasma, and platelet units. In a Level I trauma center database, all trauma admissions (2004-2012) that received massive transfusions (≥10 units PRBCs in the first 24 hours) were reviewed retrospectively. Demographic data, transfusion ratios, and outcomes were compared before (PRE) and after (POST) MTP implementation in May 2008. Age, sex, and mechanism of injury were similar between 239 PRE and 208 POST trauma patients requiring massive transfusion. Transfusion ratios of fresh frozen plasma:PRBC and platelet:PRBC increased after MTP implementation. Among survivors, MTP implementation shortened hospital length of stay from 31 to 26 days (P = 0.04) and intensive care unit length of stay from 31 to 26 days (P = 0.02). Linear regression identified treatment after (versus before) implementation of MTP as an independent predictor of decreased ventilator days after adjusting for age, Glasgow Coma Scale, and chest Abbreviated Injury Score (P < 0.0001). Modest improvement in ratios likely does not account for all significant improvements in outcomes. Implementing a standardized protocol likely impacts automation, efficiency, and/or timeliness of product delivery.
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10
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Groene SA, Prasad T, Lincourt AE, Augenstein VA, Sing R, Heniford BT. Prospective, multi-institutional surgical and quality-of-life outcomes comparison of heavyweight, midweight, and lightweight mesh in open ventral hernia repair. Am J Surg 2016; 212:1054-1062. [DOI: 10.1016/j.amjsurg.2016.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 09/05/2016] [Accepted: 09/06/2016] [Indexed: 10/20/2022]
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Sachdev G, Clark K, Sorvillo A, Soloff T, Fischer P, Christmas A, Sing R, Huynh T. 34. Crit Care Med 2015. [DOI: 10.1097/01.ccm.0000473862.77040.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cox T, Blair L, Huntington C, Lincourt A, Sing R, Heniford BT. Systematic Review of Randomized Controlled Trials Comparing Manual Compression to Vascular Closure Devices for Diagnostic and Therapeutic Arterial Procedures. Surg Technol Int 2015; 27:32-44. [PMID: 26680377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE A multitude of vascular closure devices (VCDs) are currently on the market for femoral arteriotomy closure after diagnostic and interventional angiography. Randomized, controlled trials (RCTs) comparing these devices to manual compression (MC) and their effect on time to hemostasis, time to ambulation, time to discharge, and immediate as well as long term complications have been studied. A systematic and through review of these evaluations and outcomes has not previously been performed. MATERIALS AND METHODS A systematic review was completed to include all available RCTs comparing vascular closure device use to manual compression. Devices meeting inclusion criteria were as follows: VasoSeal® (Datascope Corporation, Montvale, NJ), AngioSeal™ (Sherwood-Davis & Geck, St Louis, MO/St Jude Medical, St Paul, MN), ProGlide® (Abbott Vascular, Abbott Park, IL), ProStar® (Abbot Vascular, Menlo Park, CA), StarClose SE® (Abbott Vascular, Redwood City, CA), ExoSeal™ (Cordis, Warren, NJ), Boomerang™ Wire (Cardiva Medical, Mountainview, CA), FemoSeal™ (St Jude Medical Systems, Uppsala, Sweden), EVS™ (expanded vascular stapling, Angiolink Co, Taunton, MA), X-PRESS™ (X-Site Medical, Blue Bell, PA), Duett™ (Vascular Solutions, Minneapolis, MN), EpiClose-T® (CardioDex Ltd., Tirat Ha Carmel, Israel), and FISH™ (femoral introducer sheath and hemostasis, FISH Device, Bloomington, IN). Vascular closure devices were compared both to manual compression and across all devices used for the following outcomes: time to hemostasis, time to ambulation, time to discharge, and outcomes such as bleeding, hematoma, pseudoaneurysm, limb ischemia, and overall major and minor complications, as well as impact on quality of life, cost analysis, and trends over time. Both diagnostic and interventional procedures were included. RESULTS PUBMED and MEDLINE searches were carried out for VCDs identifying 1,363 articles. Manuscripts that included manual compression in the study numbered 176. Of these, 34 randomized controlled trials were included. Studies that met inclusion criteria were published from 1992-2015 and described a total of 14,401 patients, 5,659 patients undergoing MC, and 8,742 patients undergoing VCD placement. Overall, the rate of procedural success for VCD patients was 95.7%. The highest rate of unsuccessful device deployment was seen in the ExoSeal™ subset, which averaged 37.9% failure. The overall median time to hemostasis for manual compression was 22.9 minutes compared to VCDs at 5.95 minutes; FemoSeal™ had the shortest median time to hemostasis of 0.75 minutes. When comparing the type of procedure and its median time to hemostasis, MC versus VCD was 17 minutes versus 3.7 minutes for diagnostic procedures and 29.1 minutes versus 7.6 minutes for interventional procedures with similar sheath sizes at 6 and 7 French, respectively. Similarly, median time to ambulation for MC was eight hours compared to 3.5 hours for patients who received a VCD. Median time to discharge was similar at 1.6 days. However, time to discharge has diminished over the last decade comparing MC to VCD, with a median time to discharge of 3.1 versus 2.2 days compared to current trends at 0.8 versus 0.5 days, respectively. The overall rates of complications were similar between MC at 13.1% versus VCDs at 12.2% but varied significantly according to the VCD that was selected. For patients randomized to the vascular closure device who had undergone prior angioplasty, 94.4% of these patients preferred the use of VCD if a further angioplasty were to be performed in the future. A 13% reduction in overall costs with VCD was demonstrated due to earlier discharge and less required time with physician and nursing staff. CONCLUSION Overall, the review of 34 RCTs demonstrates the utility of VCDs has shortened time to hemostasis, ambulation, and discharge compared to patients receiving MC. Over the last decade, with emphasis on and implementation of same-day procedures, use of VCDs has resulted in a reduction in time to discharge to half a day and a significant decrease in cost. Overall complication rates are similar, but vary between different devices on the market. Better short-term quality of life has also been described with the use of VCDs compared to MC. Further clinical and financial improvements may be found as newer technological advances of VCDs become available.
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Affiliation(s)
- Tiffany Cox
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
| | - Laurel Blair
- ivision of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
| | - Ciara Huntington
- ivision of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
| | - Amy Lincourt
- ivision of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
| | - Ronald Sing
- ivision of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
| | - B Todd Heniford
- ivision of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, North Carolina
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Brintzenhoff R, Rucho P, Stefanidis D, Sing R, Heniford B. Optimizing Operating Room Time Efficiency- Additional Obstacles to Efficient Case Flow. J Surg Res 2010. [DOI: 10.1016/j.jss.2009.11.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Yurko Y, Stefanidis D, Lincourt A, Sing R, Heniford TB. Low-molecular-weight heparin prophylaxis does not affect perioperative venous thromboembolism. J Am Coll Surg 2009. [DOI: 10.1016/j.jamcollsurg.2009.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Sing R, Hugo M. Werkzeuge zur Verbesserung der Prozess-Sicherheit aus der Praxis. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Hope WW, Lincourt A, Lang N, Stewart A, Sing R, Greene F, Heniford TB. Association of demographic and treatment variables in longterm rectal cancer survival. J Am Coll Surg 2007. [DOI: 10.1016/j.jamcollsurg.2007.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Newcomb W, Lincourt A, Hope W, Schmelzer T, Sing R, Kercher K, Heniford BT. Prospective, double-blinded, randomized, placebo-controlled comparison of local anesthetic and nonsteroidal anti-inflammatory drugs for postoperative pain management after laparoscopic surgery. Am Surg 2007; 73:618-24; discussion 624-5. [PMID: 17658101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.
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Affiliation(s)
- William Newcomb
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Newcomb W, Lincourt A, Hope W, Schmelzer T, Sing R, Kercher K, Heniford BT. Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery. Am Surg 2007. [DOI: 10.1177/000313480707300615] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and prein cision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.
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Affiliation(s)
- William Newcomb
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Amy Lincourt
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - William Hope
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Thomas Schmelzer
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Ronald Sing
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Kent Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B. Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina
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19
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Christmas B, Burris G, Schiffern L, Sing R. ORGAN DONATION: ARE FAMILY MEMBERS HONORING PATIENT WISHES? Crit Care Med 2006. [DOI: 10.1097/00003246-200612002-00504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Heniford B, Lincourt A, Harrell A, Cristiano J, Sing R, Kercher K. Retained foreign bodies after surgery. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Novitsky Y, Kercher K, Harrell A, Cobb W, Michael R, Sing R, Heniford TB. Laparoscopic expertise increases hospital volume of adrenal surgery. J Am Coll Surg 2005. [DOI: 10.1016/j.jamcollsurg.2005.06.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Sing R, Rosen M, Burns J, Mostafa G, Heniford BT. ASYMPTOMATIC VENA CAVA FILTER THROMBUS TRAPPING. Crit Care Med 2004. [DOI: 10.1097/00003246-200412001-00667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Sangwan SS, Siwach RC, Sing R, Singh P. Leeds procedure--a treatment modality for scoliosis. Indian J Med Sci 2002; 56:207-15. [PMID: 12649941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The present study comprises of forty patients of scoliosis in growing age group (10-25 years) with Cobbs angles ranging from 52"-98". They were treated with Leeds procedure which is by anterior loosening followed by Posterior Harrington fixation + Luque derotation + Fusion and Costoplasty. Majority of the curves were thoracic (60%), and right sided (72%). Average correction of the deformity after surgery was 45%. Satisfaction level of patients and parents was good in 60% of the cases. The modality of treatment was decided on the basis of personality of each case, its demand and requirement, time of presentation and the potential for increasing severity. Anterior spinal surgery for scoliosis is an effective procedure in hands of experienced surgeons and it reduces stiffness of the curve, shorten the anterior column, decreases thoracic lordosis which leads to some improvement of pulmonary function. But there is greater risk of damage to vital structures with higher risks of cardiorespiratory failure. The potential risks have to be balanced with the expected rewards. The optimum method of correction has to be decided by careful preoperative evaluation. Combined procedure of anterior and posterior surgery causes lesser decrease in pulmonary functions than costoplasty alone, and achieving better cosmetic correction. This study reaffirms the role of anterior spinal surgery in India as the patients due to lower levels of health awareness present late and with severe deformities.
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Affiliation(s)
- S S Sangwan
- Department of Orthopaedic Surgery, Pt. B.D.S. Post Graduate Institute of Medical Sciences, Rohtak, 124 001
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25
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Meera V, Pal H, Sing R. Discriminative value of lipids and apolipoproteins in alcoholics. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25:1011-22. [PMID: 11444674 DOI: 10.1016/s0278-5846(01)00176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
1. It is important to detect alcohol use in its early stages so that interventions can be planned effectively. In a bid to screen for alcohol use disorders various biochemical assessments have been advocated. 2. It has been seen that moderate to heavy alcohol consumption appears to elevate ApoA1 though the effect of alcohol consumption on ApoB is not well defined. 3. Present study was planned to evaluate the contribution of lipid profile and lipoprotein measures for the diagnosis of alcohol use disorder in 75 alcohol dependent and 45 normal healthy controls. 4. Based on the TC, TG, HDL/LDL-c, HDL-c/TC, ApoA1, ApoB, and ApoA1/ApoB a discriminant equation was developed for classification of alcohol dependent users (alcoholics) and non-users (non-alcoholics) 5. The discriminant equation resulted in 84.7% of subjects being correctly classified. (94.7% in non-users and 81.1% in alcohol dependent users as alcoholics).
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Affiliation(s)
- V Meera
- De-addiction Centre, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi
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26
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Perron AD, Sing R. An effective salvage technique for severed endotracheal cuff pilot tubes and incompetent pilot balloon valves. Ann Emerg Med 1999. [DOI: 10.1016/s0196-0644(99)80344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Paquette DM, Sing R, Banks PR, Waldron KC. Capillary electrophoresis with laser-induced native fluorescence detection for profiling body fluids. J Chromatogr B Biomed Sci Appl 1998; 714:47-57. [PMID: 9746234 DOI: 10.1016/s0378-4347(98)00118-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laser-induced native fluorescence detection with a KrF excimer laser (lambda=248 nm) was used to investigate the capillary electrophoretic (CE) profiles of human urine, saliva and serum without the need for sample derivatization. All separations were carried out in sodium phosphate and/or sodium tetraborate buffers at alkaline pH in a 50-microm I.D. capillary. Sodium dodecyl sulfate was added to the buffer for micellar electrokinetic chromatography (MEKC) analysis of human urine. Although inherently a pulsed source, the KrF excimer laser was operated at a high pulse repetition rate of 553, 1001 or 2009 Hz to simulate a continuous wave excitation source. Detection limits were found to vary with pulse rate, as expected, in proportion to average excitation power. The following detection limits (3sigma) were determined in free solution CE: tryptophan, 4 nM; conalbumin, 10 nM; alpha-lactalbumin, 30 nM. Detection limits for indole-based compounds and catecholamine urinary metabolites under MEKC separation conditions were in the range 7-170 nM.
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Affiliation(s)
- D M Paquette
- Department of Chemistry and Biochemistry, Concordia University, Montréal, Québec, Canada
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28
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Sing R, Emerson L, Morales A. Prostatic microwave therapy: A pilot study for technology assessment. Urologia 1997. [DOI: 10.1177/039156039706400116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. The Genemed Genetherm S 150 is an easy to use and comparatively inexpensive device for administering prostatic microwave therapy. This study was aimed at testing the efficacy and safety of this machine in a pilot study. Methods. Sixteen patients with benign prostatic hypertrophy participated in the study, but only fourteen were evaluable. All received one hour of microwave therapy where the mean temperature was 45.7±0.2 °C. Symptom scores (International Prostate Symptom Score and Quality of Life Assessment), peak flow rates and post void residuals were used to evaluate participants prior to and three months following their treatment. Results. The results of this study show a statistically significant improvement in mean symptom scores. There was no significant change in mean peak flow rates while a statistically significant increase in mean post void residual occurred. Individually, however, only one patient experienced an improvement in all of the above parameters. There were no undesirable side effects during or after treatment. Conclusions. We conclude that the results of this pilot study do not warrant further study of this device, despite its practicality and safety.
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Affiliation(s)
- R. Sing
- Department of Urology - Queen's University - Kingston - Ontario (Canada)
| | - L Emerson
- Department of Urology - Queen's University - Kingston - Ontario (Canada)
| | - A. Morales
- Department of Urology - Queen's University - Kingston - Ontario (Canada)
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Hubert J, Bordeleau S, Tran KC, Michaud S, Milette B, Sing R, Jalbert J, Boudreau D, Moisan M, Margot J. Atomic spectroscopy with surface wave plasmas. Anal Bioanal Chem 1996; 355:494-500. [PMID: 15045307 DOI: 10.1007/s0021663550494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/1995] [Revised: 11/16/1995] [Accepted: 11/29/1995] [Indexed: 10/26/2022]
Abstract
The use of microwave induced plasmas, particularly of surface wave plasmas, as detectors in atomic emission spectrometry for elemental analysis is reviewed. Surface wave plasmas have been produced at low HF power and used as gas chromatographic detectors. The analytical performances for the detection of non-metals with a Fourier transform spectrometer and a two-channel filter unit are reported. The excitation behavior of non-metals in helium-based mixed gas-plasmas has also be studied. In particular, the effect of power and of nitrogen concentration on the bromine emission has been systematically investigated. A nine-fold improvement of the detection limits for bromine can be obtained in a high power (900 W) helium-nitrogen (0.1-0.2%) plasma.
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Affiliation(s)
- J Hubert
- Départment de Chimie and Départment de Physique, Université de Montréal, C.P. 6128, Succursale Centre Ville, H3C 3J7, Montréal, Qc, Qc, Canada
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Soyannwo MA, Khan N, Kommajosyula S, Abdel Rahman AR, Khadaji M, Sing R, Laithy SU, Ladha A, Azzam A, Desmukh S. Hepatitis C antibodies in haemodialysis and pattern of end-stage renal failure in Gassim, Saudi Arabia. Afr J Med Med Sci 1996; 25:13-22. [PMID: 9110050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
As by the end of 1992, 96 (47 females; 49 females) patients were on regular dialysis treatment for end stage renal failure (ESRF) in 5 haemodialysis HD units, the Gassim region of Saudi Arabia. Because of lack of facilities, paediatric patients were under-represented, age range being 11 to 80 years. Systemic hypertension (47%), followed by hereditary/congenital conditions (23%) and non-insulin dependent diabetes mellitus NIDDM (19%) were the most common causes of ESRF in the region. One patients developed ESRF 14 years after donor nephrectomy. Overall prevalence of HCAb was 50% with a range of 17.24% to 83%. Based, especially, on the findings in two of the units which between them handle 57% (55/96) of the patients, we believe that the practice of machine isolation policy (MIP) rather than blood transfusion is largely responsible for this wide variation in prevalence between the centres. Considering the very high overall prevalence of the Kingdom, we suggest the MIP should no longer be optional and should be part of the universal infection precautions for HD patients. Comparing Gassim with findings from Taif, there may be some variation in the pattern of ESRF between different parts of the Kingdom. More reports will be needed to document this. Donor nephrectomy as a cause of ESRF is being recorded for the first time in the Kingdom. Vigilance is important. Similarly, we believe that sexual intercourse as a probable route of hepatitis C virus HCV transmission is being recorded for the first time in the Kingdom.
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Affiliation(s)
- M A Soyannwo
- Nephrology unit, King Fahd specialist hospital, Buraidah, Gasim, Saudi Arabia
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Rumpf B, Kurz F, Sing R, Maurer G. 35. Untersuchungen zur simultanen Löslichkeit von Ammoniak und Kohlendioxid in salzhaltigen wäßrigen Lösungen. CHEM-ING-TECH 1994. [DOI: 10.1002/cite.330660936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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