Incidence, Risk Factors, and Trends of Motor Peripheral Nerve Injury After Colorectal Surgery: Analysis of the National Surgical Quality Improvement Program Database.
Dis Colon Rectum. 2017 Mar;60(3):318-325
Authors: Al-Temimi MH, Chandrasekaran B, Phelan MJ, Pigazzi A, Mills SD, Stamos MJ, Carmichael JC
BACKGROUND: Motor peripheral nerve injury is a rare but serious event after colorectal surgery, and a nationwide study of this complication is lacking.
OBJECTIVE: The purpose of this study was to report the incidence, trends, and risk factors of motor peripheral nerve injury during colorectal surgery.
DESIGN: The National Surgical Quality Improvement Program database was surveyed for motor peripheral nerve injury complicating colorectal procedures. Risk factors for this complication were identified using logistic regression analysis.
SETTINGS: The study used a national database.
PATIENTS: Patients undergoing colorectal resection between 2005 and 2013 were included.
MAIN OUTCOME MEASURES: The incidence, trends, and risk factors for motor peripheral nerve injury complicating colorectal procedures were measured.
RESULTS: We identified 186,936 colorectal cases, of which 50,470 (27%) were performed laparoscopically. Motor peripheral nerve injury occurred in 122 patients (0.065%). Injury rates declined over the study period, from 0.025% in 2006 to <0.010% in 2013 (p < 0.001). Patients with motor peripheral nerve injury were younger (mean ± SD; 54.02 ± 15.41 y vs 61.56 ± 15.95 y; p < 0.001), more likely to be obese (BMI ≥30; 43% vs 31%; p = 0.003), and more likely to have received radiotherapy (12.3% vs 4.7%; p < 0.001). Nerve injury was also associated with longer operative times (277.16 ± 169.79 min vs 176.69 ± 104.80 min; p < 0.001) and was less likely to be associated with laparoscopy (p = 0.043). Multivariate analysis revealed that increasing operative time was associated with nerve injury (OR = 1.04 (95% CI, 1.03-1.04)), whereas increasing age was associated with a protective effect (OR = 0.80 (95% CI, 0.71-0.90)).
LIMITATIONS: This study was limited by its retrospective nature.
CONCLUSIONS: Motor peripheral nerve injury during colorectal procedures is uncommon (0.065%), and its rate declined significantly over the study period. Prolonged operative time is the strongest predictor of motor peripheral nerve injury during colorectal procedures. Instituting and documenting measures to prevent nerve injury is imperative; however, special attention to this complication is necessary when surgeons contemplate long colorectal procedures.
PMID: 28177995 [PubMed - indexed for MEDLINE]
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Impact of blue-light filtering intraocular lens implantation on the quality of sleep in patients after cataract surgery.
Medicine (Baltimore). 2016 Dec;95(51):e5648
Authors: Feng X, Xu K, Hao Y, Qi H
BACKGROUND: There are 2 main types of intraocular lens (IOL) currently implanted in patients after cataract surgery. Till now, we do not know exactly what the effect of intraocular lens implantation will be on the quality of sleep after cataract surgery.
METHODS: The binocular BF-IOL (BF-IOL Groups) and UVB-IOL (UVB-IOL Groups) implantations were performed in 60 and 59 cataract patients, respectively. Pittsburgh Sleep Quality Index (PSQI) questionnaires were administered to evaluate the quality of sleep in patients preoperatively, 1 month (1 m) and 12 months (12 m) postoperatively. Independent sample test and χ test were used to evaluate the difference between the 2 groups; one-way ANOVA was used to evaluate the difference preoperatively and postoperatively in each group. The rank sum test was used for statistical analysis of 7 independent sleep components in PSQI.
RESULTS: As compared to preoperatively, the PSQI overall scores in both groups improved significantly postoperatively (P = 0.00 at 1 m and 12 m). Among the 7 components of PSQI, 2 of them (sleep latency and daytime dysfunction) improved greatly postoperatively in both groups (P< 0.05). Although the improvement of PSQI overall score in the UVB-IOL group was greater than that in the BF-IOL Group only at early time (1 m) postoperatively (P = 0.00), but not late time (12 m, P > 0.05) after the cataract surgery.
CONCLUSION: The sleep quality of cataract patients improved after IOL implantation, regardless of the type of IOL, suggesting that BF-IOL might serve as an alternative to conventional UVB-IOL without a detrimental effect on quality of sleep after cataract surgery.
PMID: 28002333 [PubMed - indexed for MEDLINE]
Quality of sweat test (ST) based on the proportion of sweat sodium (Na) and sweat chloride (Cl) as diagnostic parameter of cystic fibrosis: are we on the right way?
Diagn Pathol. 2016 Oct 26;11(1):103
Authors: Faria AG, Marson FA, Gomez CC, Ribeiro MÂ, Morais LB, Servidoni MF, Bertuzzo CS, Sakano E, Goto M, Paschoal IA, Pereira MC, Hessel G, Levy CE, Toro AA, Peixoto AO, Simões MC, Lomazi EA, Nogueira RJ, Ribeiro AF, Ribeiro JD
BACKGROUND: To assess the quality of sweat test (ST) based on the proportion of sweat sodium and sweat chloride as diagnostic parameter of cystic fibrosis (CF).
METHODS: A retrospective study of 5,721 sweat samples and subsequent descriptive analysis were carried out. The test was considered "of good quality" (correct) when: (i) sweat chloride was lower than 60 mEq/L, and sweat sodium was higher than sweat chloride; (ii) sweat chloride was higher than 60 mEq/L, and sweat sodium was lower than sweat chloride.
RESULTS: The study included 5,692/5,721 sweat samples of ST which had been requested due to clinical presentations compatible with CF and/or neonatal screenings with altered immunoreactive trypsinogen values. Considering the proportion of sweat sodium and sweat chloride as ST quality parameter, the test was performed correctly in 5,023/5,692 (88.2 %) sweat samples. The sweat chloride test results were grouped into four reference ranges for chloride (i) chloride < 30 mEq/L: 3,651/5,692 (64.1 %); (ii) chloride ≥ 30 mEq/L to < 40 mEq/L: 652/5,692 (11.5 %); (iii) ≥ 40 mEq/L to < 60 mEq/L: 673/5,692 (11.8 %); (iv) ≥ 60 mEq/L: 716/5,692 (12.6 %). In the comparative analysis, there was no association between ST quality and: (i) symptoms to indicate a ST [respiratory (p = 0.084), digestive (p = 0.753), nutritional (p = 0.824), and others (p = 0.136)], (ii) sweat weight (p = 0.416). However, there was a positive association with: (i) gender, (ii) results of ST (p < 0.001), (iii) chloride/sodium ratio (p < 0.001), (iv) subject's age at the time of ST [grouped according to category (p < 0.001) and numerical order (p < 0.001)]. For the subset of 169 patients with CF and two CFTR mutations Class I, II and/or III, in comparative analysis, there was a positive association with: (i) sweat chloride/sodium ratio (p < 0.001), (ii) sweat chloride values (p = 0.047), (iii) subject's age at the time of the ST grouped by numerical order (p = 0.001).
CONCLUSIONS: Considering that the quality of ST can be assessed by levels of sweat sodium and sweat chloride, an increasing number of low-quality tests could be observed in our sweat samples. The quality of the test was associated with important factors, such as gender, CF diagnosis, and subjects' age.
PMID: 27784314 [PubMed - indexed for MEDLINE]
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Cluster-randomized trial to improve the quality of diabetes management: The study for the efficacy assessment of the standard diabetes manual (SEAS-DM).
J Diabetes Investig. 2016 Jul;7(4):539-43
Authors: Noto H, Tanizawa Y, Aizawa T, Sone H, Yoshioka N, Terauchi Y, Inagaki N, Noda M
AIMS/INTRODUCTION: 'The Standard Diabetes Manual' has been developed by clinical researchers from multiple major institutions in Japan, such as the National Center for Global Health and Medicine, as a comprehensive disease management program, including collaboration between primary care physicians (PCPs) and specialist services. The present study evaluated the efficacy of the manual as a quality improvement strategy in diabetes care by PCPs.
MATERIALS AND METHODS: A total of 42 PCPs in eight domestic districts of the Japan Medical Association were allocated to either the intervention group or the control group in a cluster-randomized design. The PCPs in both groups were provided with a copy of the Diabetes Treatment Guide published by the Japan Diabetes Society, and the PCPs in the intervention group additionally received a copy of the manual and a 30-min relevant seminar at the inception of the intervention. The primary end-point was the adherence to the following performances as quality indicators: evaluation of retinopathy, and urinary albumin excretion measurements and serum creatinine measurements, as recommended by the Japan Medical Association.
RESULTS: A total of 416 patients were enrolled by 36 PCPs. During the 1-year follow-up period, the proportion of PCPs who adhered to recommendation-concordant measurements of urinary albumin excretion was significantly higher in the intervention group than in the control group (adherence: 17.9% vs 5.3%, P = 0.016). The other parameters were not statistically different between the two groups.
CONCLUSIONS: Implementation of 'The Standard Diabetes Manual' potentially leads to an improved quality of diabetes management by PCPs.
PMID: 27181755 [PubMed - indexed for MEDLINE]
Diet Quality and Change in Blood Lipids during 16 Years of Follow-up and Their Interaction with Genetic Risk for Dyslipidemia.
Nutrients. 2016 May 09;8(5):
Authors: Sonestedt E, Hellstrand S, Drake I, Schulz CA, Ericson U, Hlebowicz J, Persson MM, Gullberg B, Hedblad B, Engström G, Orho-Melander M
A high diet quality according to the Swedish nutrition recommendations is associated with a reduced risk of cardiovascular disease in the population-based Malmö Diet and Cancer cohort. To further clarify this protective association, we examined the association between high diet quality and change in triglycerides, high density lipoprotein-cholesterol (HDL-C), and low density lipoprotein-cholesterol (LDL-C) after 16 years of follow-up in 3152 individuals (61% women; 46-68 years at baseline). In addition, we examined if genetic risk scores composed of 80 lipid-associated genetic variants modify these associations. A diet quality index based on intakes of saturated fat, polyunsaturated fat, sucrose, fiber, fruit and vegetables, and fish was constructed. A high diet quality was associated with lower risk of developing high triglycerides (p = 0.02) and high LDL-C (p = 0.03) during follow-up compared with a low diet quality. We found an association between diet quality and long-term change in HDL-C only among those with lower genetic risk for low HDL-C as opposed to those with higher genetic risk (p-interaction = 0.04). Among those with lower genetic risk for low HDL-C, low diet quality was associated with decreased HDL-C during follow-up (p = 0.05). In conclusion, individuals with high adherence to the Swedish nutrition recommendation had lower risk of developing high triglycerides and LDL-C during 16 years of follow-up.
PMID: 27171109 [PubMed - indexed for MEDLINE]
The relations between marital quality, social support, social acceptance and coping strategies among the infertile Iranian couples.
Eur J Obstet Gynecol Reprod Biol. 2016 May;200:58-62
Authors: Yazdani F, Kazemi A, Fooladi MM, Samani HR
OBJECTIVE: Researchers aimed to assess marital quality among the infertile couples undergoing assistive reproductive treatments and their coping strategies, social support and social acceptance.
METHODS: In a cross-sectional study, 133 infertile couples undergoing assisted reproductive treatments were assessed for marital satisfaction, conflict resolution and marital communication, and coping strategies, using a self-report questionnaire. Also, the level of perceived social support and social acceptance as moderator variables were measured. Data were analyzed using independent t test, Pearson correlation coefficient, and linear regressions, after adjusting for age, cause of infertility and the duration of infertility.
RESULTS: No significant difference was found in the use of various coping strategies between couples. The correlation for marital satisfaction, marital communication and conflict resolution by using some coping strategy and the level of perceived social acceptance were significantly positive among women. Also, marital relationships had a positive and significant correlation with the level of perceived social support for men. But, unlike women, the couples' scales were significant for the perceived social support. The use of different coping strategies by men and women had a positive correlation with their perceived social support.
CONCLUSION: Coping strategies used by the infertile couples had an important role in different aspects of their married life in search of marital satisfaction, and intermediates by the perceived social acceptance for women and social support for men.
PMID: 26972768 [PubMed - indexed for MEDLINE]
Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES - Australia.
Psychol Health. 2016 05;31(5):592-604
Authors: Tregea H, Lee C, Browne JL, Pouwer F, Speight J
OBJECTIVE: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.
DESIGN: Diabetes MILES-Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (age: M = 52.1, SD = 13.9) with type 1 (T1D; n = 680) or type 2 diabetes (T2D; n = 944), who responded to a version of the survey containing key measures.
MAIN OUTCOME MEASURES: self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA1c, medication/insulin adherence.
RESULTS: We used Preacher and Hayes' bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes < .06).
CONCLUSION: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.
PMID: 26647643 [PubMed - indexed for MEDLINE]