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Sample records for perioperative window trials

  1. Perioperative Dextromethorphan as an Adjunct for Postoperative Pain: A Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    King, Michael R; Ladha, Karim S; Gelineau, Amanda M; Anderson, T Anthony

    2016-03-01

    N-methyl-D-aspartate receptor antagonists have been shown to reduce perioperative pain and opioid use. The authors performed a meta-analysis to determine whether the use of perioperative dextromethorphan lowers opioid consumption or pain scores. PubMed, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Pubget, and EMBASE were searched. Studies were included if they were randomized, double-blinded, placebo-controlled trials written in English, and performed on patients 12 yr or older. For comparison of opioid use, included studies tracked total consumption of IV or intramuscular opioids over 24 to 48 h. Pain score comparisons were performed at 1, 4 to 6, and 24 h postoperatively. Difference in means (MD) was used for effect size. Forty studies were identified and 21 were eligible for one or more comparisons. In 848 patients from 14 trials, opioid consumption favored dextromethorphan (MD, -10.51 mg IV morphine equivalents; 95% CI, -16.48 to -4.53 mg; P = 0.0006). In 884 patients from 13 trials, pain at 1 h favored dextromethorphan (MD, -1.60; 95% CI, -1.89 to -1.31; P dextromethorphan (MD, -0.89; 95% CI, -1.11 to -0.66; P dextromethorphan (MD, -0.92; 95% CI, -1.24 to -0.60; P dextromethorphan use perioperatively reduces the postoperative opioid consumption at 24 to 48 h and pain scores at 1, 4 to 6, and 24 h.

  2. Windows

    DEFF Research Database (Denmark)

    Heiselberg, Per; Svidt, Kjeld; Nielsen, Peter V.

    In natural ventilation systems fresh air is often provided through opening of windows. However, the knowledge of the performance of windows is rather limited. Computation of natural ventilation air flow through windows is most commonly made using discharge coefficients, that are regarded as being...... constant. The reported results show that the discharge coefficient for a window opening cannot be regarded as a constant and that it varies considerably with the size of the opening area, the window type and the temperature difference. Therefore, the use of a constant value can lead to serious errors...

  3. Total hip arthroplasty and perioperative oral carbohydrate treatment: a randomised, double-blind, controlled trial.

    Science.gov (United States)

    Harsten, Andreas; Hjartarson, Hjörtur; Toksvig-Larsen, Sören

    2012-06-01

    Perioperative oral carbohydrate intake is beneficial to general surgery patients. Total hip arthroplasty is a common surgical procedure, and even a moderate improvement in patient outcome could have a significant effect on the resources needed for these patients. However, few studies have focused on the effects of carbohydrate intake on orthopaedic patients. The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty. The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate. A randomised, double-blind, controlled trial. This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery. Sixty ASA physical status I-III patients scheduled for elective total hip arthroplasty were included. Exclusion criteria were obesity, diabetes, prior hip surgery to the same hip, ongoing infection, immunological deficiency or age less than 50 or more than 80 years. Patients were given 400 ml of either an oral 12.5% carbohydrate solution or a placebo beverage (flavoured water) 1.5 h before and 2 h after surgery. Visual analogue scales were used to score six discomfort parameters. Immediately prior to surgery, the carbohydrate-treated patients were less hungry (median score 9.5 vs. 22 mm) and experienced less nausea (0 vs. 1.5 mm) (Phip arthroplasty.

  4. Effect of perioperative insulin infusion on surgical morbidity and mortality: systematic review and meta-analysis of randomized trials.7

    DEFF Research Database (Denmark)

    Gandhi, G.Y.; Murad, M.H.; Flynn, D.N.

    2008-01-01

    OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients. PATIENTS AND METHODS: We used 6 search strategies including an electronic database search of MEDLINE, EMBA...

  5. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG)

    International Nuclear Information System (INIS)

    Leong, Trevor; Smithers, B Mark; Michael, Michael; Gebski, Val; Boussioutas, Alex; Miller, Danielle; Simes, John; Zalcberg, John; Haustermans, Karin; Lordick, Florian; Schuhmacher, Christoph; Swallow, Carol; Darling, Gail; Wong, Rebecca

    2015-01-01

    The optimal management of patients with resectable gastric cancer continues to evolve in Western countries. Following publication of the US Intergroup 0116 and UK Medical Research Council MAGIC trials, there are now two standards of care for adjuvant therapy in resectable gastric cancer, at least in the Western world: postoperative chemoradiotherapy and perioperative epirubicin/cisplatin/fluorouracil (ECF) chemotherapy. We hypothesize that adding chemoradiation to standard perioperative ECF chemotherapy will achieve further survival gains. We also believe there are advantages to administering chemoradiation in the preoperative rather than postoperative setting. In this article, we describe the TOPGEAR trial, which is a randomised phase III trial comparing control arm therapy of perioperative ECF chemotherapy with experimental arm therapy of preoperative chemoradiation plus perioperative ECF chemotherapy. Eligible patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either perioperative chemotherapy alone (3 preoperative and 3 postoperative cycles of ECF) or perioperative chemotherapy plus preoperative chemoradiation. In the chemoradiation arm, patients receive 2 cycles of ECF plus chemoradiation prior to surgery, and then following surgery 3 further cycles of ECF are given. The trial is being conducted in two Parts; Part 1 (phase II component) has recruited 120 patients with the aim of assessing feasibility, safety and preliminary efficacy of preoperative chemoradiation. Part 2 (phase III component) will recruit a further 632 patients to provide a total sample size of 752 patients. The primary endpoint of the phase III trial is overall survival. The trial includes quality of life and biological substudies, as well as a health economic evaluation. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of

  6. Perioperative hyperoxia - Long-term impact on cardiovascular complications after abdominal surgery, a post hoc analysis of the PROXI trial

    DEFF Research Database (Denmark)

    Fonnes, Siv; Gogenur, Ismail; Sondergaard, Edith Smed

    2016-01-01

    BACKGROUND: Increased long-term mortality was found in patients exposed to perioperative hyperoxia in the PROXI trial, where patients undergoing laparotomy were randomised to 80% versus 30% oxygen during and after surgery. This post hoc follow-up study assessed the impact of perioperative hyperoxia...... included myocardial infarction, other heart disease, and acute coronary syndrome or death. Data were analysed in the Cox proportional hazards model. RESULTS: The primary outcome, acute coronary syndrome, occurred in 2.5% versus 1.3% in the 80% versus 30% oxygen group; HR 2.15 (95% CI 0.96-4.84). Patients...

  7. Influence of perioperative oxygen fraction on pulmonary function after abdominal surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Staehr Anne K

    2012-07-01

    Full Text Available Abstract Background A high perioperative inspiratory oxygen fraction (FiO2 may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO2. Our aim was to assess if a high FiO2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC. Methods Thirty-five patients scheduled for laparotomy for ovarian cancer were randomized to receive either 30% oxygen (n = 15 or 80% oxygen (n = 20 during and for 2 h after surgery. The oxygenation index (PaO2/FiO2 was measured every 30 min during anesthesia and 90 min after extubation. FRC was measured the day before surgery and 2 h after extubation by a rebreathing method using the inert gas SF6. Results Five min after intubation, the median PaO2/FiO2 was 69 kPa [53-71] in the 30%-group vs. 60 kPa [47-69] in the 80%-group (P = 0.25. At the end of anesthesia, the PaO2/FiO2 was 58 kPa [40-70] vs. 57 kPa [46-67] in the 30%- and 80%-group, respectively (P = 0.10. The median FRC was 1993 mL [1610-2240] vs. 1875 mL [1545-2048] at baseline and 1615 mL [1375-2318] vs. 1633 mL [1343-1948] postoperatively in the 30%- and 80%-group, respectively (P = 0.70. Conclusion We found no significant difference in oxygenation index or functional residual capacity between patients given 80% and 30% oxygen for a period of approximately 5 hours. Trial registration ClinicalTrials.gov Identifier: NCT00637936.

  8. Perioperative intravenous acetaminophen attenuates lipid peroxidation in adults undergoing cardiopulmonary bypass: a randomized clinical trial.

    Directory of Open Access Journals (Sweden)

    Frederic T Billings

    Full Text Available Cardiopulmonary bypass (CPB lyses erythrocytes and induces lipid peroxidation, indicated by increasing plasma concentrations of free hemoglobin, F2-isoprostanes, and isofurans. Acetaminophen attenuates hemeprotein-mediated lipid peroxidation, reduces plasma and urine concentrations of F2-isoprostanes, and preserves kidney function in an animal model of rhabdomyolysis. Acetaminophen also attenuates plasma concentrations of isofurans in children undergoing CPB. The effect of acetaminophen on lipid peroxidation in adults has not been studied. This was a pilot study designed to test the hypothesis that acetaminophen attenuates lipid peroxidation in adults undergoing CPB and to generate data for a clinical trial aimed to reduce acute kidney injury following cardiac surgery.In a prospective double-blind placebo-controlled clinical trial, sixty adult patients were randomized to receive intravenous acetaminophen or placebo starting prior to initiation of CPB and for every 6 hours for 4 doses. Acetaminophen concentrations measured 30 min into CPB and post-CPB were 11.9 ± 0.6 μg/mL (78.9 ± 3.9 μM and 8.7 ± 0.3 μg/mL (57.6 ± 2.0 μM, respectively. Plasma free hemoglobin increased more than 15-fold during CPB, and haptoglobin decreased 73%, indicating hemolysis. Plasma and urinary markers of lipid peroxidation also increased during CPB but returned to baseline by the first postoperative day. Acetaminophen reduced plasma isofuran concentrations over the duration of the study (P = 0.05, and the intraoperative plasma isofuran concentrations that corresponded to peak hemolysis were attenuated in those subjects randomized to acetaminophen (P = 0.03. Perioperative acetaminophen did not affect plasma concentrations of F2-isoprostanes or urinary markers of lipid peroxidation.Intravenous acetaminophen attenuates the increase in intraoperative plasma isofuran concentrations that occurs during CPB, while urinary markers were unaffected.ClinicalTrials.gov NCT

  9. Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Loozen, Charlotte S; van Santvoort, Hjalmar C; van Geloven, Antoinette A W; Nieuwenhuijzen, Grard A P; de Reuver, Philip R; Besselink, Mark H G; Vlaminckx, Bart; Kelder, Johannes C; Knibbe, Catherijne A J; Boerma, Djamila

    2017-08-23

    The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic prophylaxis varies greatly among surgeons and hospitals. Recently, high-level evidence became available demonstrating that postoperative antibiotic prophylaxis in patients with acute cholecystitis does not reduce the risk of infectious complications. Preoperative antibiotic prophylaxis in relation to the risk of infectious complications, however, has never been studied. The PEANUTS II trial is a randomized, controlled, multicenter, open-label noninferiority trial whose aim is to determine the utility of preoperative antibiotic prophylaxis in patients undergoing emergency cholecystectomy for acute calculous cholecystitis. Patients with mild or moderate acute cholecystitis, as defined according the Tokyo Guidelines, will be randomly assigned to a single preoperative dose of antibiotic prophylaxis (2000 mg of first-generation cephalosporin delivered intravenously) or no antibiotic prophylaxis before emergency cholecystectomy. The primary endpoint is a composite endpoint consisting of all postoperative infectious complications occurring during the first 30 days after surgery. Secondary endpoints include all the individual components of the primary endpoint, all other complications, duration of hospital stay, and total costs. The hypothesis is that the absence of antibiotic prophylaxis is noninferior to the presence of antibiotic prophylaxis. A noninferiority margin of 10% is assumed. With a 1-sided risk of 2.5% and a power of 80%, a total of 454 subjects will have to be included. Analysis will be performed according to the intention-to-treat principle. The PEANUTS II trial will provide evidence-based advice concerning the utility of antibiotic prophylaxis in patients undergoing

  10. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, M H; Adamsen, S; Thomsen, R W

    2011-01-01

    Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.......Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU....

  11. Perioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II trial): study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Loozen, Charlotte S.; van Santvoort, Hjalmar C.; van Geloven, Antoinette A. W.; Nieuwenhuijzen, Grard A. P.; de Reuver, Philip R.; Besselink, Mark H. G.; Vlaminckx, Bart; Kelder, Johannes C.; Knibbe, Catherijne A. J.; Boerma, Djamila

    2017-01-01

    Background: The additional value of perioperative antibiotic prophylaxis in preventing infectious complications after emergency cholecystectomy for acute cholecystitis is a much-debated subject in the surgical community. Evidence-based guidelines are lacking, and consequently the use of antibiotic

  12. Mock Trial: A Window to Free Speech Rights and Abilities

    Science.gov (United States)

    Schwartz, Sherry

    2010-01-01

    This article provides some strategies to alleviate the current tensions between personal responsibility and freedom of speech rights in the public school classroom. The article advocates the necessity of making sure students understand the points and implications of the first amendment by providing a mock trial unit concerning free speech rights.…

  13. Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury A Randomized Clinical Trial

    NARCIS (Netherlands)

    Garg, Amit X.; Kurz, Andrea; Sessler, Daniel I.; Cuerden, Meaghan; Robinson, Andrea; Mrkobrada, Marko; Parikh, Chirag R.; Mizera, Richard; Jones, Philip M.; Tiboni, Maria; Font, Adrià; Cegarra, Virginia; Gomez, Maria Fernanda Rojas; Meyhoff, Christian S.; VanHelder, Tomas; Chan, Matthew T. V.; Torres, David; Parlow, Joel; de Nadal Clanchet, Miriam; Amir, Mohammed; Bidgoli, Seyed Javad; Pasin, Laura; Martinsen, Kristian; Malaga, German; Myles, Paul; Acedillo, Rey; Roshanov, Pavel S.; Walsh, Michael; Dresser, George; Kumar, Priya; Fleischmann, Edith; Villar, Juan Carlos; Painter, Thomas; Biccard, Bruce; Bergese, Sergio; Srinathan, Sadeesh; Cata, Juan P.; Chan, Vincent; Mehra, Bhupendra; Wijeysundera, Duminda N.; Leslie, Kate; Forget, Patrice; Whitlock, Richard; Yusuf, Salim; Devereaux, P. J.; Alvarez, A.; Bulach, R.; Hannon, S.; Ives, K.; de Hert, S.

    2014-01-01

    IMPORTANCE Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each

  14. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Directory of Open Access Journals (Sweden)

    Swart Annemiek

    2006-11-01

    Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in

  15. Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial.

    Science.gov (United States)

    Eftekharian, Hamidreza; Vahedi, Ruhollah; Karagah, Tuba; Tabrizi, Reza

    2015-01-01

    Perioperative hemorrhage is an important concern during orthognathic surgery. The purpose of this study was to assess the effect of tranexamic acid (TXA) irrigation on perioperative hemorrhage during orthognathic surgery. In this double-blind, randomized controlled clinical trial, 56 participants who underwent orthognathic surgery were divided into 2 groups. The patients in the first group received TXA irrigation with normal saline (1 mg/mL), and the patients in the second group had normal saline for irrigation during orthognathic surgery. Age, gender, operation duration, the amount of irrigation solution used, and preoperative hemoglobin, hematocrit, and weight were the variables that were studied. The use of TXA solution for irrigation was the predictive factor of the study. Each group consisted of 28 patients. Group 1 consisted of 15 male patients (53.6%) and 13 female patients (46.4%) and group 2 consisted of 14 male patients (50%) and 14 female patients (50%). There was no difference in the distributions of the variables between the 2 groups, except for the duration of the operation. The mean duration of the operation was 3.94 ± 0.61 hours in group 1 and 4.17 ± 0.98 hours in group 2, and the difference in this respect between the 2 groups was statistically significant (P .05). TXA is effective in reducing intraoperative blood loss in patients for whom substantial blood loss is anticipated. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Perioperative synbiotics administration decreases postoperative infections in patients with colorectal cancer: a randomized, double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    ALINE TABORDA FLESCH

    Full Text Available ABSTRACT Objective: to evaluate the effect of perioperative administration of symbiotics on the incidence of surgical wound infection in patients undergoing surgery for colorectal cancer. Methods: We conducted a randomized clinical trial with colorectal cancer patients undergoing elective surgery, randomly assigned to receive symbiotics or placebo for five days prior to the surgical procedure and for 14 days after surgery. We studied 91 patients, 49 in the symbiotics group (Lactobacillus acidophilus 108 to 109 CFU, Lactobacillus rhamnosus 108 to 109 CFU, Lactobacillus casei 108 to 109 CFU, Bifi dobacterium 108 to 109 CFU and fructo-oligosaccharide (FOS 6g and 42 in the placebo group. Results: surgical site infection occurred in one (2% patient in the symbiotics group and in nine (21.4% patients in the control group (p=0.002. There were three cases of intraabdominal abscess and four cases of pneumonia in the control group, whereas we observed no infections in patients receiving symbiotics (p=0.001. Conclusion: the perioperative administration of symbiotics significantly reduced postoperative infection rates in patients with colorectal cancer. Additional studies are needed to confirm the role of symbiotics in the surgical treatment of colorectal cancer.

  17. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Gluud, Christian

    2006-01-01

    Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University...

  18. Perioperative Testosterone Supplementation Increases Lean Mass in Healthy Men Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial.

    Science.gov (United States)

    Wu, Brian; Lorezanza, Dan; Badash, Ido; Berger, Max; Lane, Christianne; Sum, Jonathan C; Hatch, George F; Schroeder, E Todd

    2017-08-01

    Rehabilitation after repair of the anterior cruciate ligament (ACL) is complicated by the loss of leg muscle mass and strength. Prior studies have shown that preoperative rehabilitation may improve muscle strength and postoperative outcomes. Testosterone supplementation may likewise counteract this muscle loss and potentially improve clinical outcomes. The purpose was to investigate the effect of perioperative testosterone administration on lean mass after ACL reconstruction in men and to examine the effects of testosterone on leg strength and clinical outcome scores. It was hypothesized that testosterone would increase lean mass and leg strength and improve clinical outcome scores relative to placebo. Randomized controlled trial; Level of evidence, 1. Male patients (N = 13) scheduled for ACL reconstruction were randomized into 2 groups: testosterone and placebo. Participants in the testosterone group received 200 mg of intramuscular testosterone weekly for 8 weeks beginning 2 weeks before surgery. Participants in the placebo group received saline following the same schedule. Both groups participated in a standard rehabilitation protocol. The primary outcome was the change in total lean body mass at 6 and 12 weeks. Secondary outcomes were extensor muscle strength, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score. There was an increase in lean mass of a mean 2.7 ± 1.7 kg at 6 weeks postoperatively in the testosterone group compared with a decrease of a mean 0.1 ± 1.5 kg in the placebo group ( P = .01). Extensor muscle strength of the uninjured leg also increased more from baseline in the testosterone group (+20.8 ± 25.6 Nm) compared with the placebo group (-21.4 ± 36.7 Nm) at 12 weeks ( P = .04). There were no significant between-group differences in injured leg strength or clinical outcome scores. There were no negative side effects of testosterone noted. Perioperative testosterone supplementation increased lean mass 6 weeks after ACL

  19. Perioperative anaphylaxis

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    Marta Inés Berrío Valencia

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  20. Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial.

    Science.gov (United States)

    Mishra, Ankita; Pandey, Ravinder Kumar; Sharma, Ankur; Darlong, Vanlalnghaka; Punj, Jyotsna; Goswami, Devalina; Sinha, Renu; Rewari, Vimi; Chandralekha, Chandralekha; Bansal, Virinder Kumar

    2017-08-01

    To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. Prospective, randomized, double-blind trial. Operating rooms in a tertiary care hospital of Northern India. One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Randomized trial of aromatherapy versus conventional care for breast cancer patients during perioperative periods.

    Science.gov (United States)

    Tamaki, Kentaro; Fukuyama, Akiko Komatsu; Terukina, Shigeharu; Kamada, Yoshihiko; Uehara, Kano; Arakaki, Miwa; Yamashiro, Kazuko; Miyashita, Minoru; Ishida, Takanori; McNamara, Keely May; Ohuchi, Noriaki; Tamaki, Nobumitsu; Sasano, Hironobu

    2017-04-01

    Several studies focused on the effect of aromatherapy on mood, quality of life (QOL), and physical symptoms in patients with cancer. We compared the effects on QOL, vital signs, and sleep quality between aromatherapy and conventional therapy during perioperative periods of the breast cancer patients in this study. Patients were randomly assigned in a 2:1 ratio to receive aromatherapy or usual care. The primary endpoint was QOL, which was assessed using the quality of life questionnaire QLQ-C30, Version 3.0 of the European Organization for Research and Treatment of Cancer (EORTC) Study Group on quality of life. Secondary endpoints included the necessity of hypnotics, vital signs including blood pressure and heart rate and adverse events. In addition, we also summarized the patients' perception of the experience from a free description-type questionnaire. A total of 249 patients had breast cancer surgery and 162 patients gave physician consent and were recruited; 110 were randomly assigned to aromatherapy group (eight patients showed incomplete EORTC QLQ-C30) and 52 to control group (one patient showed incomplete EORTC QLQ-C30). There were no statistically significant differences between the aromatherapy group and control group in the EORTC QLQ-C30 at the surgery day. As for the results of the post-operation day 1, trends for differentiations of physical functioning and role functioning were detected between aromatherapy group and control group, but the differences did not reach statistical significance (p = 0.08 and 0.09). There were no significant differences of systolic and diastolic blood pressures between aromatherapy group and control group (p = 0.82 and 0.68). There was no statistically significant difference in heart rates between aromatherapy group (70.6 ± 11.0 bpm) and control group (71.2 ± 9.8 bpm) (p = 0.73). Likewise, the rate of hypnotic use was not statistically significant (p = 0.10). No adverse events were reported after aromatherapy

  2. Impact of perioperative blood pressure variability on health resource utilization after cardiac surgery: an analysis of the ECLIPSE trials.

    Science.gov (United States)

    Aronson, Solomon; Levy, Jerrold H; Lumb, Philip D; Fontes, Manuel; Wang, Yamei; Crothers, Tracy A; Sulham, Katherine A; Navetta, Marco S

    2014-06-01

    To examine the impact of blood pressure control on hospital health resource utilization using data from the ECLIPSE trials. Post-hoc analysis of data from 3 prospective, open-label, randomized clinical trials (ECLIPSE trials). Sixty-one medical centers in the United States. Patients 18 years or older undergoing cardiac surgery. Clevidipine was compared with nitroglycerin, sodium nitroprusside, and nicardipine. The ECLIPSE trials included 3 individual randomized open-label studies comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood pressure control was assessed as the integral of the cumulative area under the curve (AUC) outside specified systolic blood pressure ranges, such that lower AUC represents less variability. This analysis examined surgery duration, time to extubation, as well as intensive care unit (ICU) and hospital length of stay (LOS) in patients with AUC≤10 mmHg×min/h compared to patients with AUC>10 mmHg×min/h. One thousand four hundred ten patients were included for analysis; 736 patients (52%) had an AUC≤10 mmHg×min/h, and 674 (48%) had an AUC>10 mmHg×min/h. The duration of surgery and ICU LOS were similar between groups. Time to extubation and postoperative LOS were both significantly shorter (p = 0.05 and pAUC≤10. Multivariate analysis demonstrates AUC≤10 was significantly and independently associated with decreased time to extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard ratio 1.221, p = 0.0006). Based on data derived from the ECLIPSE studies, increased perioperative BP variability is associated with delayed time to extubation and increased postoperative LOS. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Individualised perioperative open-lung approach versus standard protective ventilation in abdominal surgery (iPROVE): a randomised controlled trial.

    Science.gov (United States)

    Ferrando, Carlos; Soro, Marina; Unzueta, Carmen; Suarez-Sipmann, Fernando; Canet, Jaume; Librero, Julián; Pozo, Natividad; Peiró, Salvador; Llombart, Alicia; León, Irene; India, Inmaculada; Aldecoa, Cesar; Díaz-Cambronero, Oscar; Pestaña, David; Redondo, Francisco J; Garutti, Ignacio; Balust, Jaume; García, Jose I; Ibáñez, Maite; Granell, Manuel; Rodríguez, Aurelio; Gallego, Lucía; de la Matta, Manuel; Gonzalez, Rafael; Brunelli, Andrea; García, Javier; Rovira, Lucas; Barrios, Francisco; Torres, Vicente; Hernández, Samuel; Gracia, Estefanía; Giné, Marta; García, María; García, Nuria; Miguel, Lisset; Sánchez, Sergio; Piñeiro, Patricia; Pujol, Roger; García-Del-Valle, Santiago; Valdivia, José; Hernández, María J; Padrón, Oto; Colás, Ana; Puig, Jaume; Azparren, Gonzalo; Tusman, Gerardo; Villar, Jesús; Belda, Javier

    2018-03-01

    The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m 2 . Patients were randomly assigned (1:1:1:1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O 2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic

  4. Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction.

    Science.gov (United States)

    Okamura, Kunishige; Tanaka, Kimitaka; Miura, Takumi; Nakanishi, Yoshitsugu; Noji, Takehiro; Nakamura, Toru; Tsuchikawa, Takahiro; Okamura, Keisuke; Shichinohe, Toshiaki; Hirano, Satoshi

    2017-07-01

    The high frequency of surgical site infections (SSIs) after hepato-pancreato-biliary (HPB) surgery is a problem that needs to be addressed. This prospective, randomized, controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI. Participants comprised 126 patients who underwent HPB (bile duct, gallbladder, ampullary, or pancreatic) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 (UMIN Clinical Trial Registry #00001278). Before surgery, subjects were randomly allocated to a targeted group administered antibiotics based on bile culture results or a standard group administered cefmetazole. The primary endpoint was SSI rates within 30 days after surgery. Secondary endpoint was SSI rates for each operative procedure. Of the 126 patients, 124 were randomly allocated (targeted group, n = 62; standard group, n = 62). Frequency of SSI after surgery was significantly lower in the targeted group (27 patients, 43.5%) than in the standard group (44 patients, 71.0%; P = 0.002). Among patients who underwent pancreaticoduodenectomy and hepatectomy, SSI occurred significantly less frequently in the targeted group (P = 0.001 and P = 0.025, respectively). This study demonstrated that preoperative bile culture-targeted administration of prophylactic antibiotics decreased SSIs following HBP surgery with biliary reconstruction. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  5. Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

    LENUS (Irish Health Repository)

    Ali, M

    2010-03-01

    Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery.

  6. Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial.

    Science.gov (United States)

    Emond, Yvette E J J M; Calsbeek, Hiske; Teerenstra, Steven; Bloo, Gerrit J A; Westert, Gert P; Damen, Johan; Wolff, André P; Wollersheim, Hub C

    2015-01-08

    This study is initiated to evaluate the effects, costs, and feasibility at the hospital and patient level of an evidence-based strategy to improve the use of Dutch perioperative safety guidelines. Based on current knowledge, expert opinions and expertise of the project team, a multifaceted implementation strategy has been developed. This is a stepped wedge cluster randomized trial including nine representative hospitals across The Netherlands. Hospitals are stratified into three groups according to hospital type and geographical location and randomized in terms of the period for receipt of the intervention. All adult surgical patients meeting the inclusion criteria are assessed for patient outcomes. The implementation strategy includes education, audit and feedback, organizational interventions (e.g., local embedding of the guidelines), team-directed interventions (e.g., multi-professional team training), reminders, as well as patient-mediated interventions (e.g., patient safety cards). To tailor the implementation activities, we developed a questionnaire to identify barriers for effective guideline adherence, based on (a) a theoretical framework for classifying barriers and facilitators, (b) an instrument for measuring determinants of innovations, and (c) 19 semi-structured interviews with perioperative key professionals. Primary outcome is guideline adherence measured at the hospital (i.e., cluster) and patient levels by a set of perioperative Patient Safety Indicators (PSIs), which was developed parallel to the perioperative guidelines. Secondary outcomes at the patient level are in-hospital complications, postoperative wound infections and mortality, length of hospital stay, and unscheduled transfer to the intensive care unit, non-elective readmission to the hospital and unplanned reoperation, all within 30 days after the initial surgery. Also, patient safety culture and team climate will be studied as potential determinants. Finally, a process evaluation is

  7. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis: a randomized, prospective, controlled trial.

    Science.gov (United States)

    Bickel, Amitai; Gurevits, Michael; Vamos, Ronny; Ivry, Simon; Eitan, Arieh

    2011-04-01

    To assess the influence of hyperoxygenation on surgical site infection by using the most homogeneous study population. A randomized, prospective, controlled trial. Department of surgery in a government hospital. A total of 210 patients who underwent open surgery for acute appendicitis. In the study group, patients received 80% oxygen during anesthesia, followed by high-flow oxygen for 2 hours in the recovery room. The control group received 30% oxygen, as usual. Open appendectomy via incision in the right lower quadrant of the abdomen. Surgical site infection, mainly assessed by the ASEPSIS (additional treatment, serous discharge, erythema, purulent discharge, separation of deep tissues, isolation of bacteria, and stay in hospital prolonged >14 days) system score. Surgical site infections were recorded in 6 of 107 patients (5.6%) in the study group vs 14 of 103 patients (13.6%) in the control group (P = .04). Significant differences in the ASEPSIS score were also found. The mean hospital stay was longer in the control group (2.92 days) compared with the study group (2.51 days) (P = .01). The use of supplemental oxygen is advantageous in operations for acute appendicitis by reducing surgical site infection rate and hospital stay. clinicaltrials.gov Identifier: NCT01002365.

  8. Antiproliferative and metabolic effects of metformin in a preoperative window clinical trial for endometrial cancer

    International Nuclear Information System (INIS)

    Schuler, Kevin M; Rambally, Brooke S; DiFurio, Megan J; Sampey, Brante P; Gehrig, Paola A; Makowski, Liza; Bae-Jump, Victoria L

    2015-01-01

    We conducted a preoperative window study of metformin in endometrial cancer (EC) patients and evaluated its antiproliferative, molecular and metabolic effects. Twenty obese women with endometrioid EC were treated with metformin (850 mg) daily for up to 4 weeks prior to surgical staging. Expression of the proliferation marker Ki-67, estrogen receptor (ER), progesterone receptor (PR), adenosine monophosphate-activated protein kinase (AMPK), and downstream targets of the mammalian target of rapamycin (mTOR) pathway were measured by immunohistochemistry. Global, untargeted metabolomics analysis of serum pre- and postmetformin treatment, and matched tumor, was performed. Metformin reduced proliferation by 11.75% (P = 0.008) based on the comparison of pre- and posttreatment endometrial tumors. A total of 65% of patients responded to metformin as defined by a decrease in Ki-67 staining in their endometrial tumors post-treatment. Metformin decreased expression of phosphorylated (p)-AMPK (P = 0.00001), p-Akt (P = 0.0002), p-S6 (51.2%, P = 0.0002), p-4E-BP-1 (P = 0.001), and ER (P = 0.0002) but not PR expression. Metabolomic profiling of serum indicated that responders versus nonresponders to treatment were more sensitive to metformin's effects on induction of lipolysis, which correlated with increased fatty acid oxidation and glycogen metabolism in matched tumors. In conclusion, metformin reduced tumor proliferation in a pre-operative window study in obese EC patients, with dramatic effects on inhibition of the mTOR pathway. Metformin induced a shift in lipid and glycogen metabolism that was more pronounced in the serum and tumors of responders versus nonresponders to treatment.This study provides support for therapeutic clinical trials of metformin in obese patients with EC

  9. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  10. Influence of Nitrous Oxide Anesthesia, B-Vitamins, and MTHFR gene polymorphisms on Perioperative Cardiac Events: The Vitamins in Nitrous Oxide (VINO) Randomized Trial

    Science.gov (United States)

    Nagele, Peter; Brown, Frank; Francis, Amber; Scott, Mitchell G.; Gage, Brian F.; Miller, J. Philip

    2013-01-01

    Background Nitrous oxide causes an acute increase in plasma homocysteine that is more pronounced in patients with the MTHFR C677T or A1298C gene variant. In this randomized controlled trial we sought to determine if patients carrying the MTHFR C677T or A1298C variant had a higher risk for perioperative cardiac events after nitrous oxide anesthesia and if this risk could be mitigated by B-vitamins. Methods We randomized adult patients with cardiac risk factors undergoing noncardiac surgery to receive nitrous oxide plus intravenous B-vitamins before and after surgery or to nitrous oxide and placebo. Serial cardiac biomarkers and 12-lead electrocardiograms were obtained. The primary study endpoint was the incidence of myocardial injury, as defined by cardiac troponin I elevation within the first 72 hours after surgery. Results A total of 500 patients completed the trial. Patients who were homozygous for either MTHFR C677T or A1298C gene variant (n= 98; 19.6%) had no increased rate of postoperative cardiac troponin I elevation compared to wild-type and heterozygous patients (11.2% vs. 14.0%; relative risk 0.96, 95% CI 0.85 to 1.07, p=0.48). B-vitamins blunted the rise in homocysteine, but had no effect on cardiac troponin I elevation compared to patients receiving placebo (13.2% vs. 13.6%; relative risk 1.02, 95% CI 0.78 to 1.32, p=0.91). Conclusions Neither MTHFR C677T and A1298C gene variant nor acute homocysteine increase are associated with perioperative cardiac troponin elevation after nitrousoxide anesthesia. B-vitamins blunt nitrous oxide-induced homocysteine increase but have no effect on cardiac troponin elevation. PMID:23856660

  11. Influence of nitrous oxide anesthesia, B-vitamins, and MTHFR gene polymorphisms on perioperative cardiac events: the vitamins in nitrous oxide (VINO) randomized trial.

    Science.gov (United States)

    Nagele, Peter; Brown, Frank; Francis, Amber; Scott, Mitchell G; Gage, Brian F; Miller, J Philip

    2013-07-01

    Nitrous oxide causes an acute increase in plasma homocysteine that is more pronounced in patients with the methylenetetrahydrofolate reductase (MTHFR) C677T or A1298C gene variant. In this randomized controlled trial, the authors sought to determine whether patients carrying the MTHFR C677T or A1298C variant had a higher risk for perioperative cardiac events after nitrous oxide anesthesia and whether this risk could be mitigated by B-vitamins. The authors randomized adult patients with cardiac risk factors undergoing noncardiac surgery, to receive nitrous oxide plus intravenous B-vitamins before and after surgery, or to nitrous oxide and placebo. Serial cardiac biomarkers and 12-lead electrocardiograms were obtained. The primary study endpoint was the incidence of myocardial injury, as defined by cardiac troponin I increase within the first 72 h after surgery. A total of 500 patients completed the trial. Patients who were homozygous for either MTHFR C677T, or A1298C gene variant (n=98; 19.6%) had no increased rate of postoperative cardiac troponin I increase compared with wild-type and heterozygous patients (11.2 vs. 14.0%; relative risk 0.96; 95% CI, 0.85-1.07; P=0.48). B-vitamins blunted the rise in homocysteine, but had no effect on cardiac troponin I increase compared with patients receiving placebo (13.2 vs. 13.6%; relative risk 1.02; 95% CI 0.78 to 1.32; P=0.91). Neither MTHFR C677T and A1298C gene variant, nor acute homocysteine increase are associated with perioperative cardiac troponin increase after nitrous oxide anesthesia. B-vitamins blunt nitrous oxide-induced homocysteine increase but have no effect on cardiac troponin I increase.

  12. The effect of perioperative probiotics treatment for colorectal cancer: short-term outcomes of a randomized controlled trial.

    Science.gov (United States)

    Yang, Yongzhi; Xia, Yang; Chen, Hongqi; Hong, Leiming; Feng, Junlan; Yang, Jun; Yang, Zhe; Shi, Chenzhang; Wu, Wen; Gao, Renyuan; Wei, Qing; Qin, Huanlong; Ma, Yanlei

    2016-02-16

    This study was designed to mainly evaluate the anti-infective effects of perioperative probiotic treatment in patients receiving confined colorectal cancer (CRC) respective surgery. From November 2011 to September 2012, a total of 60 patients diagnosed with CRC were randomly assigned to receive probiotic (n = 30) or placebo (n = 30) treatment. The operative and post-operative clinical results including intestinal cleanliness, days to first - flatus, defecation, fluid diet, solid diet, duration of pyrexia, average heart rate, length of intraperitoneal drainage, length of antibiotic therapy, blood index changes, rate of infectious and non-infectious complications, postoperative hospital stay, and mortality were investigated. The patient demographics were not significantly different (p > 0.05) between the probiotic treated and the placebo groups. The days to first flatus (3.63 versus 3.27, p = 0.0274) and the days to first defecation (4.53 versus 3.87, p = 0.0268) were significantly improved in the probiotic treated patients. The incidence of diarrhea was significantly lower (p = 0.0352) in probiotics group (26.67%, 8/30) compared to the placebo group (53.33%, 16/30). There were no statistical differences (p > 0.05) in other infectious and non-infectious complication rates including wound infection, pneumonia, urinary tract infection, anastomotic leakage, and abdominal distension. In conclusion, for those patients undergoing confined CRC resection, perioperative probiotic administration significantly influenced the recovery of bowel function, and such improvement may be of important clinical significance in reducing the short-term infectious complications such as bacteremia.

  13. Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial).

    Science.gov (United States)

    Benedetto, Umberto; Altman, Douglas G; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Angelini, Gianni D; Flather, Marcus; Taggart, David P

    2018-03-03

    There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the ART patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short-term (in-hospital) and long-term outcomes by performing a post hoc analysis of the ART. Among patients enrolled in the ART (n=3102) from 2004 to 2007, we excluded those who did not undergo surgery (n=18) and those with no information about use of perioperative aprotinin (n=9). Finally, 836 of 3076 patients (27%) received aprotinin. Propensity matching was used to select 536 pairs for final comparison. Aprotinin was also associated with an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds ratio, 9.12; 95% confidence interval [CI], 1.15-72.2; P =0.03), intra-aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds ratio, 2.26; 95% CI, 1.26-4.07; P =0.006), and acute kidney injury (102 [19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95% CI, 1.03-1.97; P =0.03). Aprotinin was not associated with a lower incidence of transfusion (37 [6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95% CI, 0.81-2.23; P =0.25) and reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95% CI, 0.76-2.53; P =0.28). At 5 years, all-cause mortality was significantly increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard ratio, 1.51; 95% CI, 1.0-2.28; P =0.045). In the present post hoc ART analysis, aprotinin was associated with a significantly increased risk of early and late mortality. URL: http://www.isrctn.com. Unique identifier: ISRCTN46552265. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  14. Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.

    Science.gov (United States)

    Clark, Nathan P; Douketis, James D; Hasselblad, Vic; Schulman, Sam; Kindzelski, Andrei L; Ortel, Thomas L

    2018-01-01

    The use of low-molecular weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days postprocedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. We analyzed 1,813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6 years, and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0 days (interquartile range, 4.0-18.0 days) postprocedure. Bridge therapy was a baseline predictor of major bleeding (odds ratio [OR]=2.4, 95% CI: 1.2-4.8), as were a history of renal disease (OR=2.9, 95% CI: 1.4-6.0), and high-bleeding risk procedures (vs low-bleeding risk procedures) (OR=2.9, 95% CI: 1.4-5.9). Perioperative aspirin use (OR=3.6, 95% CI: 1.1-11.9) and postprocedure international normalized ratio >3.0 (OR=2.1, 95% CI: 1.5-3.1) were time-dependent predictors of major bleeding. Major bleeding was most common in the first 10 days compared with 11-37 days postprocedure (OR=3.5, 95% CI: 1.8-6.9). In addition to bridge therapy, perioperative aspirin use, postprocedure international normalized ratio >3.0, a history of renal failure, and having a high-bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Understanding Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  16. Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up

    Directory of Open Access Journals (Sweden)

    Hansen Torben B

    2008-04-01

    Full Text Available Abstract Background In Denmark, approximately 12,000 hip and knee arthroplasties were performed in 2006, and the hospital costs were close to US$ 110,000,000. In a randomized clinical trial, we have recently demonstrated the efficacy of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty compared to current intervention under ideal circumstances. We do not, however, know whether these results could be reached under usual circumstances of healthcare practice. We therefore investigated whether length of stay after implementation of accelerated perioperative care and rehabilitation after hip and knee arthroplasty could be reduced in a normal healthcare setting, and how the achieved results matched those observed during the randomized clinical trial. Methods An effectiveness study as a before-after trial was undertaken in which all elective primary total hip and total knee arthroplasty patients were divided into a before-implementation group receiving the current perioperative procedure, and an after-implementation group receiving the new accelerated perioperative care and rehabilitation procedures as provided by a new multi-disciplinary organization. We used the Breakthrough Series Collaborative Model for implementation. The primary outcome measure was in hospital length of stay (LOS, and the secondary outcome measure was adverse effects within 3 months postoperatively. Results We included a total of 247 patients. Mean LOS was significantly (P Conclusion Accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty was successfully and effectively implemented. Results obtained during usual hospital circumstances matched the results achieved under ideal circumstances in this group of patients.

  17. Effect of perioperative sodium bicarbonate administration on renal function following cardiac surgery for infective endocarditis: a randomized, placebo-controlled trial.

    Science.gov (United States)

    Cho, Jin Sun; Soh, Sarah; Shim, Jae-Kwang; Kang, Sanghwa; Choi, Haegi; Kwak, Young-Lan

    2017-01-05

    Patients with infective endocarditis (IE) have an elevated risk of renal dysfunction because of extensive systemic inflammation and use of nephrotoxic antibiotics. In this randomized, placebo-controlled trial, we investigated whether perioperative sodium bicarbonate administration could attenuate postoperative renal dysfunction in patients with IE undergoing cardiac surgery. Seventy patients randomly received sodium chloride (n = 35) or sodium bicarbonate (n = 35). Sodium bicarbonate was administered as a 0.5 mmol/kg loading dose for 1 h commencing with anesthetic induction, followed by a 0.15 mmol/kg/h infusion for 23 h. The primary outcome was peak serum creatinine (SCr) level during the first 48 h postoperatively. The incidence of acute kidney injury, SCr level, estimated glomerular filtration rate, and major morbidity endpoints were assessed postoperatively. The peak SCr during the first 48 h postoperatively (bicarbonate vs. 1.01 (0.74, 1.37) mg/dl vs. 0.88 (0.76, 1.27) mg/dl, P = 0.474) and the incidence of acute kidney injury (bicarbonate vs. 29% vs. 23%, P = 0.584) were similar in both groups. The postoperative increase in SCr above baseline was greater in the bicarbonate group than in the control group on postoperative day 2 (0.21 (0.07, 0.33) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.028) and postoperative day 5 (0.23 (0.08, 0.36) mg/dl vs. 0.06 (0.00, 0.23) mg/dl, P = 0.017). Perioperative sodium bicarbonate administration had no favorable impact on postoperative renal function and outcomes in patients with IE undergoing cardiac surgery. Instead, it was associated with possibly harmful renal effects, illustrated by a greater increase in SCr postoperatively, compared to control. ClinicalTrials.gov, NCT01920126 . Registered on 31 July 2013.

  18. Effect of perioperative insulin infusion on surgical morbidity and mortality

    DEFF Research Database (Denmark)

    Gandhi, Gunjan Y; Murad, M Hassan; Flynn, Errol David

    2008-01-01

    To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients.......To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients....

  19. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  20. Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial.

    Science.gov (United States)

    Lagier, David; Nee, Laetitia; Guieu, Régis; Kerbaul, François; Fenouillet, Emmanuel; Roux, Nicolas; Giorgi, Roch; Theron, Alexis; Grisoli, Dominique; Gariboldi, Vlad; Collart, Frederic; Bruder, Nicolas; Velly, Lionel; Guidon, Catherine

    2018-04-26

    Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. A randomised controlled study. Single University Hospital. One hundred and ten patients scheduled for heart valve surgery with CPB. We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. ClinicalTrials.gov, no.: NCT01999829.

  1. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial).

    NARCIS (Netherlands)

    Wind, J.; Hofland, J.; Preckel, B.; Hollman, M.W.; Bossuyt, P.M.M.; Gouma, D.J.; Berge Henegouwen, M.I.; Fuhring, J.W.; Dejong, C.H.C.; Dam, R.M. van; Cuesta, M.A.; Noordhuis, A.; Jong, D. de; Zalingen, E. van; Engel, A.F.; Goei, T.H.; Stoppelaar, I.E. de; Tets, W.F. van; Wagensveld, B.A. van; Swart, A.; Elsen, M.J.L.J. van den; Gerhards, M.F.; Wit, L.Th. De; Siepel, M.A.M.; Geloven, A.A.W. van; Juttmann, J.-W.; Clevers, J.C.; Bemelman, W.A.

    2006-01-01

    BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst

  2. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial)

    NARCIS (Netherlands)

    Wind, Jan; Hofland, Jan; Preckel, Benedikt; Hollmann, Markus W.; Bossuyt, Patrick M. M.; Gouma, Dirk J.; van Berge Henegouwen, Mark I.; Fuhring, Jan Willem; Dejong, Cornelis H. C.; van Dam, Ronald M.; Cuesta, Miguel A.; Noordhuis, Astrid; de Jong, Dick; van Zalingen, Edith; Engel, Alexander F.; Goei, T. Hauwy; de Stoppelaar, I. Erica; van Tets, Willem F.; van Wagensveld, Bart A.; Swart, Annemiek; van den Elsen, Maarten J. L. J.; Gerhards, Michael F.; de Wit, Laurens Th; Siepel, Muriel A. M.; van Geloven, Anna A. W.; Juttmann, Jan-Willem; Clevers, Wilfred; Bemelman, Willem A.

    2006-01-01

    BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst

  3. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)

    NARCIS (Netherlands)

    Vlug, Malaika S.; Wind, Jan; Hollmann, Markus W.; Ubbink, Dirk T.; Cense, Huib A.; Engel, Alexander F.; Gerhards, Michael F.; van Wagensveld, Bart A.; van der Zaag, Edwin S.; van Geloven, Anna A. W.; Sprangers, Mirjam A. G.; Cuesta, Miguel A.; Bemelman, Willem A.; Preckel, Benedikt; Bossuyt, Patrick; Gouma, Dirk; van Berge Henegouwen, Mark; Fuhring, Jan; van Lenthe, Ineke Picard; Bakker, Chris; King-Kalimanis, Bellinda; Hofland, Jan; Dejong, Cornelis; van Dam, Ronald; van der Peet, Donald; van Zalingen, Edith; Noordhuis, Astrid; de Jong, Dick; Goei, T. Hauwy; de Stoppelaar, Erica; van den Dongen, Marjon; van Tets, Willem; van den Elsen, Maarten; Swart, Annemiek; deWit, Laurens; Siepel, Muriel; Molly, Glaresa; Juttmann, Jan; Clevers, Wilfred; Bieleman, Andrea; Coenen, Ludo; Bonekamp, Elly; van Abeelen, Jacobus; van Iterson-de Jong, Diana; Krombeen, Margriet

    2011-01-01

    To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of

  4. Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial

    NARCIS (Netherlands)

    Peters, Emmeline G.; Smeets, Boudewijn J. J.; Nors, Jesper; Back, Christian M.; Funder, Jonas A.; Sommer, Thorbjørn; Laurberg, Søren; Løve, Uffe S.; Leclercq, Wouter K. G.; Slooter, Gerrit D.; de Vries Reilingh, Tammo S.; Wegdam, Johannes A.; Nieuwenhuijzen, Grard A. P.; Hiligsmann, Mickaël; Buise, Marc P.; Buurman, Willem A.; de Jonge, Wouter J.; Rutten, Harm J. T.; Luyer, Misha D. P.

    2018-01-01

    Postoperative ileus and anastomotic leakage severely impair recovery after colorectal resection. We investigated the effect of perioperative lipid-enriched enteral nutrition versus standard care on the risk of postoperative ileus, anastomotic leakage, and other clinical outcomes. We did an

  5. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Marianne J E van der Heijden

    Full Text Available Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery.We searched 25 electronic databases from their first available date until October 2014.Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music.4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators.Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated, the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale.Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07 and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16.This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.

  6. Peri-operative morbidity and early results of a randomised trial comparing TVT and TVT-O.

    Science.gov (United States)

    Meschia, Michele; Bertozzi, Rosanna; Pifarotti, Paola; Baccichet, Roberto; Bernasconi, Francesco; Guercio, Elso; Magatti, Fabio; Minini, Gianfranco

    2007-11-01

    The aim of this study was to compare the morbidity and short-term efficacy of retro-pubic (TVT) and inside-out trans-obturator (TVT-O) sub-urethral sling in the treatment of stress urinary incontinence. This was a prospective multi-centre randomised trial; 231 women with primary stress urinary incontinence were randomised to TVT (114) or TVT-O (117). The International Consultation on Incontinence-Short Form (ICIQ-SF), Women Irritative Prostate Symptoms Score (W-IPSS) and Patient Global Impression of Severity (PGI-S) questionnaires were used to evaluate the impact of incontinence and voiding dysfunction on QoL and to measure the patient's perception of incontinence severity. The primary and secondary outcome measures were rates of success and complications. The SPSS software was used for data analysis. The TVT-O procedure was associated with significantly shorter operation time and with a more extensive use of general anaesthesia when compared with TVT. There were 5 (4%) bladder perforations in the TVT group compared with none in the TVT-O group. Rates of early post-operative urinary retention and voiding difficulty were similar for both groups and no difference was found in the average hospital stay. Six patients (5%) in the TVT-O group complained of thigh pain in the post-operative course. The median follow-up time was 6 months. Two hundred eighteen patients were available for the analysis of outcomes. Subjective and objective cure rates were 92% and 92% in the TVT group and 87% and 89% in the TVT-O group. The ICIQ-SF questionnaire symptoms score showed a highly statistical decrease in both groups, the W-IPSS on the contrary was unchanged. Our data show that both procedures were equally effective in the short-term for the treatment of stress urinary incontinence with a highly significant improvement in incontinence-related QoL.

  7. The Effects of Perioperative Music Interventions in Pediatric Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

    Science.gov (United States)

    van der Heijden, Marianne J E; Oliai Araghi, Sadaf; van Dijk, Monique; Jeekel, Johannes; Hunink, M G Myriam

    2015-01-01

    Music interventions are widely used, but have not yet gained a place in guidelines for pediatric surgery or pediatric anesthesia. In this systematic review and meta-analysis we examined the effects of music interventions on pain, anxiety and distress in children undergoing invasive surgery. We searched 25 electronic databases from their first available date until October 2014. Included were all randomized controlled trials with a parallel group, crossover or cluster design that included pediatric patients from 1 month to 18 years old undergoing minimally invasive or invasive surgical procedures, and receiving either live music therapy or recorded music. 4846 records were retrieved from the searches, 26 full text reports were evaluated and data was extracted by two independent investigators. Pain was measured with the Visual Analogue Scale, the Coloured Analogue Scale and the Facial Pain Scale. Anxiety and distress were measured with an emotional index scale (not validated), the Spielberger short State Trait Anxiety Inventory and a Facial Affective Scale. Three RCTs were eligible for inclusion encompassing 196 orthopedic, cardiac and day surgery patients (age of 1 day to 18 years) receiving either live music therapy or recorded music. Overall a statistically significant positive effect was demonstrated on postoperative pain (SMD -1.07; 95%CI-2.08; -0.07) and on anxiety and distress (SMD -0.34 95% CI -0.66; -0.01 and SMD -0.50; 95% CI -0.84; - 0.16. This systematic review and meta-analysis indicates that music interventions may have a statistically significant effect in reducing post-operative pain, anxiety and distress in children undergoing a surgical procedure. Evidence from this review and other reviews suggests music therapy may be considered for clinical use.

  8. A systematic review of peri-operative melatonin

    DEFF Research Database (Denmark)

    Andersen, L P H; Werner, M U; Rosenberg, J

    2014-01-01

    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  9. Utilising advance care planning videos to empower perioperative cancer patients and families: a study protocol of a randomised controlled trial.

    Science.gov (United States)

    Aslakson, Rebecca A; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Yang, Ting; Weiss, Matthew; Volandes, Angelo E; Bridges, John F P; Roter, Debra L

    2017-06-06

    Despite positive health outcomes associated with advance care planning (ACP), little research has investigated the impact of ACP in surgical populations. Our goal is to evaluate how an ACP intervention video impacts the patient centredness and ACP of the patient-surgeon conversation during the presurgical consent visit. We hypothesise that patients who view the intervention will engage in a more patient-centred communication with their surgeons compared with patients who view a control video. Randomised controlled superiority trial of an ACP video with two study arms (intervention ACP video and control video) and four visits (baseline, presurgical consent, postoperative 1 week and postoperative 1 month). Surgeons, patients, principal investigator and analysts are blinded to the randomisation assignment. Single, academic, inner city and tertiary care hospital. Data collection began July 16, 2015 and continues to March 2017. Patients recruited from nine surgical oncology clinics who are undergoing major cancer surgery. In the intervention arm, patients view a patient preparedness video developed through extensive engagement with patients, surgeons and other stakeholders. Patients randomised to the control arm viewed an informational video about the hospital surgical programme. Primary Outcome: Patient centredness and ACP of patient-surgeon conversations during the presurgical consent visit as measured through the Roter Interaction Analysis System. patient Hospital Anxiety and Depression Scale score; patient goals of care; patient, companion and surgeon satisfaction; video helpfulness; medical decision maker designation; and the frequency patients watch the video. Intent-to-treat analysis will be used to assess the impact of video assignment on outcomes. Sensitivity analyses will assess whether there are differential effects contingent on patient or surgeon characteristics. This study has been approved by the Johns Hopkins School of Medicine institutional review

  10. A comparative study between a simplified Kalman filter and Sliding Window Averaging for single trial dynamical estimation of event-related potentials

    DEFF Research Database (Denmark)

    Vedel-Larsen, Esben; Fuglø, Jacob; Channir, Fouad

    2010-01-01

    , are variable and depend on cognitive function. This study compares the performance of a simplified Kalman filter with Sliding Window Averaging in tracking dynamical changes in single trial P300. The comparison is performed on simulated P300 data with added background noise consisting of both simulated and real...... background EEG in various input signal to noise ratios. While both methods can be applied to track dynamical changes, the simplified Kalman filter has an advantage over the Sliding Window Averaging, most notable in a better noise suppression when both are optimized for faster changing latency and amplitude...

  11. A prospective randomized controlled trial of the two-window technique without membrane versus the solo-window technique with membrane over the osteotomy window for maxillary sinus augmentation.

    Science.gov (United States)

    Yu, Huajie; He, Danqing; Qiu, Lixin

    2017-12-01

    Maturation of the grafted volume after lateral sinus elevation is crucial for the long-term survival of dental implants. To compare endo-sinus histomorphometric bone formation between the solo- and two-window maxillary sinus augmentation techniques with or without membrane coverage for the rehabilitation of multiple missing posterior teeth. Patients with severely atrophic posterior maxillae were randomized to receive lateral sinus floor elevation via the solo-window technique with membrane coverage (Control Group) or the two-window technique without coverage (Test Group). Six months after surgery, bone core specimens harvested from the lateral aspect were histomorphometrically analyzed. Ten patients in each group underwent 21 maxillary sinus augmentations. Histomorphometric analysis revealed mean newly formed bone values of 26.08 ± 16.23% and 27.14 ± 18.11%, mean connective tissue values of 59.34 ± 12.42% and 50.03 ± 17.13%, and mean residual graft material values of 14.6 ± 14.56% and 22.78 ± 10.83% in the Test and Control Groups, respectively, with no significant differences. The two-window technique obtained comparative maturation of the grafted volume even without membrane coverage, and is a viable alternative for the rehabilitation of severely atrophic posterior maxillae with multiple missing posterior teeth. © 2017 Wiley Periodicals, Inc.

  12. Prevention of heterotopic ossification about the hip using perioperative radiotherapy: Results of two randomized trials in 410 patients

    International Nuclear Information System (INIS)

    Seegenschmiedt, M. Heinrich; Keiholz, Ludwig; Martus, Peter; Woelfel, Rainer; Henning, Friedrich; Sauer, Rolf

    1996-01-01

    BACKGROUND: In-vivo data (Kantorowitz et al., 1991) indicate the efficacy of pre- and postoperative radiotherapy (RT) in suppressing development of heterotopic ossification (HO) after hip surgery. Since 1987 two prospective randomized trials were initiated at our institution to assess the comparative efficacy of 'high-dose RT' versus 'low-dose RT' (HOP study 1) and 'preoperative RT' versus 'postoperative RT' (HOP study 2). A control arm without radiotherapy (RT) was avoided, as only those patients (pts) were entered, who had a very high risk to develop HO after hip arthroplasty. PATIENTS and METHODS: In HOP study 1 (accrual: June 1987 - June 1992), 249 pts were randomized between the following postoperative RT schedules: 'low-dose RT' with 5 x 2 Gy, 10 Gy total RT dose (N = 129) versus 'high dose RT' with 5 x 3.5 Gy, 17.5 Gy total RT dose (N = 121); RT was applied with daily fractionation starting at postoperative day 1 - 4. In HOP study 2 (accrual : July 1992 - July 1995), 161 pts were randomized between 'preoperative RT' using a single dose of 7 Gy (N = 80 pts) and postoperative RT with 5 x 3.5 Gy (N = 51 pts). In both studies only patients were includes with one or multiple of the following risk factors for HO: ipsi- (55%) or contralateral HO (33%), hypertrophic osteoarthritis (48%), repeated hip surgery, acetabular fracture or severe hip trauma (43%); 62% of all pts had at least two risk factors. The structure of the relevant and possibly confounding patient and disease parameters and risk factors was similar in each of the treatment arms within the two randomized studies. - The assessment of 'treatment failures' was based upon the comparison of the amount of HO seen on the immediately postoperative radiograph as compared to radiographs obtained at least 6 months after surgery (Brooker Score). Any progression of HO by Brooker score was regarded as treatment failure. RESULTS: At last FU, in January 1996 both studies 369 of 410 pts (90%) had received an effective

  13. Danish Perioperative Nurses' Documentation

    DEFF Research Database (Denmark)

    Søndergaard, Susanne Friis; Lorentzen, Vibeke; Sørensen, Erik E

    2017-01-01

    of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative...

  14. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  15. The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery.

    Science.gov (United States)

    Gyulaházi, Judit; Varga, Katalin; Iglói, Endre; Redl, Pál; Kormos, János; Fülesdi, Béla

    2015-01-01

    Images evoked immediately before the induction of anesthesia with the help of suggestions may influence dreaming during anesthesia.The aim of the study was to assess the incidence of evoked dreams and dream recalls by employing suggestions before induction of anesthesia while administering different general anesthetic combinations. This is a single center, prospective randomized including 270 adult patients scheduled for maxillofacial surgical interventions. Patients were assigned to control, suggestion and dreamfilm groups according to the psychological method used. According to the anesthetic protocol there were also three subgroups: etomidate & sevoflurane, propofol & sevoflurane, propofol & propofol groups. Primary outcome measure was the incidence of postoperative dreams in the non-intervention group and in the three groups receiving different psychological interventions. Secondary endpoint was to test the effect of perioperative suggestions and dreamfilm-formation training on the occurrance of dreams and recallable dreams in different general anesthesiological techniques. Dream incidence rates measured in the control group did not differ significantly (etomidate & sevoflurane: 40%, propofol & sevoflurane: 26%, propofol & propofol: 39%). A significant increase could be observed in the incidence rate of dreams between the control and suggestion groups in the propofol & sevoflurane (26%-52%) group (p = 0.023). There was a significant difference in the incidence of dreams between the control and dreamfilm subgroup in the propofol & sevoflurane (26% vs. 57%), and in the propofol & propofol group (39% vs.70%) (p = 0.010, and p = 0.009, respectively). Similar to this, there was a significant difference in dream incidence between the dreamfilm and the suggestion subgroups (44% vs. 70%) in the propofol & propofol group (p = 0.019). Propofol as an induction agent contributed most to dream formation and recalls (χ2-test p value: 0.005). The content of images and dreams

  16. Surgical Stress Response and Postoperative Immune Function After Laparoscopy or Open Surgery With Fast Track or Standard Perioperative Care A Randomized Trial

    NARCIS (Netherlands)

    Veenhof, A. A. F. A.; Vlug, M. S.; van der Pas, M. H. G. M.; Sietses, C.; van der Peet, D. L.; de Lange-de Klerk, E. S. M.; Bonjer, H. J.; Bemelman, W. A.; Cuesta, M. A.

    2012-01-01

    Objective: To evaluate the effect of laparoscopic or open colectomy with fast track or standard perioperative care on patient's immune status and stress response after surgery. Methods: Patients with nonmetastasized colon cancer were randomized to laparoscopic or open colectomy with fast track or

  17. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment. A double-blinded randomized placebo-controlled trial

    NARCIS (Netherlands)

    Shoroghi, Mehrdad; Arbabi, Shahriyar; Farahbakhsh, Farshid; Sheikhvatan, Mehrdad; Abbasi, Ali

    2011-01-01

    Purpose: To investigate and compare the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in children who underwent skin laser treatment in an academic educational Hospital. Methods: Ninety children, candidates for skin laser

  18. Windows Azure

    CERN Document Server

    Johnson, Bruce; Chambers, James; Garber, Danny; Malik, Jamal; Fazio, Adam

    2013-01-01

    A collection of five must-have Azure titles, from some of the biggest names in the field Available individually, but at a discounted rate for the collection, this bundle of five e-books covers key developer and IT topics of Windows Azure, including ASP.NET, mobile services, web sites, data storage, and the hybrid cloud. A host of Microsoft employees and MPVs come together to cover the biggest challenges that professionals face when working with Windows Azure. The e-books included are as follows: Windows Azure and ASP.NET MVC MigrationWindows Azure Mobile ServicesWindows Azure Web SitesWindows

  19. Phase II/III multicentre randomised controlled trial evaluating a strategy of primary surgery and adjuvant chemotherapy versus peri-operative chemotherapy for resectable gastric signet ring cell adenocarcinomas – PRODIGE 19 – FFCD1103 – ADCI002

    International Nuclear Information System (INIS)

    Piessen, Guillaume; Mariette, Christophe; Messager, Mathieu; Le Malicot, Karine; Robb, William B; Di Fiore, Frédéric; Guilbert, Marie; Moreau, Marie; Christophe, Véronique; Adenis, Antoine

    2013-01-01

    A dramatic increase in the incidence of the diffuse form of gastric adenocarcinomas and particularly signet ring cell carcinomas has been observed in Western countries. Evidence is accruing that signet ring cell carcinomas may have inherent chemo resistance leaving many clinicians unsure of the benefits of delaying surgery to pursue a neoadjuvant approach. PRODIGE-19-FFCD1103-ADCI002 is a prospective multicentre controlled randomised phase II/III trial comparing current standard of care of perioperative chemotherapy (2x3 cycles of Epirubicin, cisplatin, 5-fluorouracil) with a strategy of primary surgery followed by adjuvant chemotherapy (6 cycles of Epirubicin, cisplatin, 5-fluorouracil) in patients with a stage IB-III gastric signet ring cell tumour. The principal objective of the phase II study (84 patients) is to determine if the experimental arm (primary surgery followed by adjuvant chemotherapy) has sufficient interest in terms of percentage of living patients at 24 months to be evaluated in a phase III trial. If 7 or less patients in the experimental arm are alive at 24 months, phase III will not be initiated. The primary objective of phase III (230 additional patients) is to demonstrate superiority of the experimental arm in terms of overall survival. Secondary endpoints include overall survival at 36 months, disease free survival at 24 and 36 months, R0 resection rates, treatment tolerance, postoperative mortality and morbidity evaluated by Clavien-Dindo severity index, the prognostic impact of positive peritoneal cytology and the assessment of quality of life. An ancillary study will assess the emotional and cognitive impact of surgery and perioperative chemotherapy for both the patient and their partner. As inherent chemo resistance of signet ring cell tumours and delay in definitive surgery may favour tumour progression we hypothesise that a policy of primary surgery followed by adjuvant chemotherapy will improve overall survival compared to a standard

  20. Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial.

    Science.gov (United States)

    McIlroy, David; Murphy, Deirdre; Kasza, Jessica; Bhatia, Dhiraj; Wutzlhofer, Lisa; Marasco, Silvana

    2017-06-01

    The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. The perioperative protocol governed all fluid administration from commencement of anesthesia through to discharge from the intensive care unit and varied over four sequential periods, each lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a chloride-limited strategy, consisting of a buffered salt solution and 20% albumin, was used. Co-primary outcomes were peak delta serum creatinine (∆S Cr ) within 5 days after the operation and KDIGO-defined stage 2 or stage 3 acute kidney injury (AKI) within 5 days after the operation. We enrolled and analysed data from 1136 patients, with 569 patients assigned to a chloride-rich fluid strategy and 567 to a chloride-limited one. Compared with a chloride-limited strategy and adjusted for prespecified covariates, there was no association between a chloride-rich perioperative fluid strategy and either peak ∆S Cr , transformed to satisfy the assumptions of multivariable linear regression [regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08); p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI 0.65-1.47; p = 0.90]. A perioperative fluid strategy to restrict IV chloride administration was not associated with an altered incidence of AKI or other metrics of renal injury in adult patients undergoing cardiac surgery. Clinicaltrials.gov Identifier: NCT02020538.

  1. Window Stories

    DEFF Research Database (Denmark)

    Hauge, Bettina

    This research project has investigated 17 households in Germany (cities and rural areas). The main aim was to learn about the significance of the window to these people: What they think of their windows, how, when and why they use them in their everyday life, if they have a favorite window and wh...

  2. The effect of screening doors and windows on indoor density of Anopheles arabiensis in south-west Ethiopia: a randomized trial.

    Science.gov (United States)

    Massebo, Fekadu; Lindtjørn, Bernt

    2013-09-12

    Screening of houses might have impact on density of indoor host-seeking Anopheles mosquitoes. A randomized trial of screening windows and doors with metal mesh, and closing openings on eves and walls by mud was conducted to assess if reduce indoor densities of biting mosquitoes. Mosquitoes were collected in forty houses using Centers for Diseases Control and Prevention (CDC) light traps biweekly in March and April 2011. A randomization of houses into control and intervention groups was done based on the baseline data. Windows and doors of 20 houses were screened by metal mesh, and openings on the walls and eves closed by mud and the rest 20 houses were used as control group. Mosquitoes were collected biweekly in October and November 2011 from both control and intervention houses. A Generalized Estimating Equations (GEE) with a negative binomial error distribution was used to account for over dispersion of Anopheles arabiensis and culicine counts and repeated catches made in the same house. Screening doors and windows, and closing openings on eves and wall by mud reduced the overall indoor densities of An. arabiensis by 40%. The effect of screenings pronounced on unfed An. arabiensis by resulting 42% reduction in houses with interventions. The total costs for screening windows and doors, and to close openings on the eves and walls by mud was 7.34 USD per house. Screening houses reduced indoor density of An. arabiensis, and it was cheap and can easily incorporated into malaria vector strategies by local communities, but improving doors and windows fitness for screening should be considered during house construction to increase the efficacy of screenings.

  3. Nitrous oxide and perioperative outcomes.

    Science.gov (United States)

    Ko, Hanjo; Kaye, Alan David; Urman, Richard D

    2014-06-01

    There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

  4. Proper Installation of Replacement Windows | Efficient Windows

    Science.gov (United States)

    Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

  5. Window Glazing Types | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  6. Window Frame Types | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  7. Performance Standards for Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  8. Benefits of Efficient Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  9. Assessing Window Replacement Options | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  10. Windows for New Construction | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  11. Window Operator Types | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  12. A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial.

    Science.gov (United States)

    Weltert, Luca; Rondinelli, Beatrice; Bello, Ricardo; Falco, Mauro; Bellisario, Alessandro; Maselli, Daniele; Turani, Franco; De Paulis, Ruggero; Pierelli, Luca

    2015-07-01

    We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin (HRE), given just 2 days before cardiac surgery, could be effective in reducing perioperative allogeneic red blood cell transfusion (aRBCt). Six-hundred patients presenting with preoperative hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to either HRE or control. The primary endpoint was the incidence of perioperative aRBCt. The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery, Hb level on Postoperative Day 4, and number of units of RBC transfusions in the first 4 days after surgery. A total of 17% (HRE) versus 39% (control) required transfusion (relative risk, 0.436; pHRE (0%) and control (3.5%) among the patients with baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of the study population. The mean (range) Hb level on Postoperative Day 4 was 10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; pHRE (pHRE) versus 3.33% (control). The 45-day adverse event rate was 4.33% (HRE) versus 5.67% (control; both p=NS). In anemic patients (HbHRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events. © 2015 AABB.

  13. Metastasis: recent discoveries and novel perioperative treatment strategies with particular interest in the hemostatic compound desmopressin.

    Science.gov (United States)

    Alonso, D F; Ripoll, G V; Garona, J; Iannucci, N B; Gomez, D E

    2011-11-01

    Metastatic disease is responsible for most of cancer lethality. A main obstacle for therapy of advanced cancers is that the outcome of metastasis depends on a complex interplay between malignant and host cells. The perioperative period represents an underutilized window of opportunity for cancer treatment where tumor-host interactions can be modulated, reducing the risk of local recurrences and distant metastases. Blood-saving agents are attractive compounds to be administered during tumor surgery. Desmopressin (DDAVP) is a safe and convenient hemostatic peptide with proved antimetastastic properties in experimental models and veterinary clinical trials. The compound seems to induce a dual angiostatic and antimetastatic effect, breaking the cooperative function of cancer cells and endothelial cells during residual tumor progression. DDAVP is therefore an interesting lead compound to develop novel synthetic peptide analogs with enhanced antitumor properties.

  14. Perioperative nutritional support.

    Science.gov (United States)

    Morán López, Jesús Manuel; Piedra León, María; García Unzueta, María Teresa; Ortiz Espejo, María; Hernández González, Miriam; Morán López, Ruth; Amado Señaris, José Antonio

    2014-01-01

    The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  15. Burnout in perioperative context

    OpenAIRE

    Galvão, Ana Maria; Gonçalves, Ana Rita Veloso; Certo, Ana

    2014-01-01

    Companies in a global context are going through moments of great development of information and technologies. In these environments Burnout is highly prevalent, this syndrome is considered as one of physical and emotional stress that leads to a lack of motivation to work, leading to a progressive sense of inadequacy and failure. Objectives: What level of stress Perioperative nurses for nurses in the Region of Tras-os-Montes and Alto Douro. Methods: Non-experimental study,...

  16. Peri-operative care.

    Science.gov (United States)

    Baston, Helen

    2004-05-01

    This is the third 'midwifery basics' series aimed at student midwives, and focuses on midwifery care during labour. This article provides a summary of peri-operative care for women who experience caesarean birth. Students are encouraged to seek further information through a series of activities, and to link theory with practice by considering the issues relating to the care of the woman described in the short vignette.

  17. The role of perioperative warming in surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Muhammad Shafique Sajid

    Full Text Available OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD. RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

  18. Levosimendan for Perioperative Cardioprotection: Myth or Reality?

    Science.gov (United States)

    Santillo, Elpidio; Migale, Monica; Massini, Carlo; Incalzi, Raffaele Antonelli

    2018-03-21

    Levosimendan is a calcium sensitizer drug causing increased contractility in the myocardium and vasodilation in the vascular system. It is mainly used for the therapy of acute decompensated heart failure. Several studies on animals and humans provided evidence of the cardioprotective properties of levosimendan including preconditioning and anti-apoptotic. In view of these favorable effects, levosimendan has been tested in patients undergoing cardiac surgery for the prevention or treatment of low cardiac output syndrome. However, initial positive results from small studies have not been confirmed in three recent large trials. To summarize levosimendan mechanisms of action and clinical use and to review available evidence on its perioperative use in cardiac surgery setting. We searched two electronic medical databases for randomized controlled trials studying levosimendan in cardiac surgery patients, ranging from January 2000 to August 2017. Meta-analyses, consensus documents and retrospective studies were also reviewed. In the selected interval of time, 54 studies on the use of levosimendan in heart surgery have been performed. Early small size studies and meta-analyses have suggested that perioperative levosimendan infusion could diminish mortality and other adverse outcomes (i.e. intensive care unit stay and need for inotropic support). Instead, three recent large randomized controlled trials (LEVO-CTS, CHEETAH and LICORN) showed no significant survival benefits from levosimendan. However, in LEVO-CTS trial, prophylactic levosimendan administration significantly reduced the incidence of low cardiac output syndrome. Based on most recent randomized controlled trials, levosimendan, although effective for the treatment of acute heart failure, can't be recommended as standard therapy for the management of heart surgery patients. Further studies are needed to clarify whether selected subgroups of heart surgery patients may benefit from perioperative levosimendan

  19. Preemptive carprofen for peri-operative analgesia in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO): a prospective, randomized, blinded, placebo controlled clinical trial.

    Science.gov (United States)

    Bufalari, A; Maggio, C; Cerasoli, I; Morath, U; Adami, C

    2012-03-01

    Eighteen client-owned dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO) were included in this blinded clinical study and randomly assigned to one of two treatment groups. Group C (carprofen) received intravenous (IV) carprofen, 4 mg/kg, prior to anesthesia, whereas group P (placebo) received IV saline. General anesthesia was maintained with isoflurane in oxygen and a constant rate infusion (CRI) of sufentanyl IV. Intra-operatively, assessment of nociception was based on changes in physiological parameters and on the analgesics requirement, whereas in the post-operative period evaluation of pain was performed by using a Hellyer and Gaynor pain score and by comparing the doses of rescue buprenorphine required by the two treatment groups. Although no statistically significant differences in intra-operative sufentanyl doses were found between treatment groups, group C had superior cardiovascular stability, and lower post-operative pain scores and rescue buprenorphine doses than group P. Our results indicate that administration of carprofen prior to surgery was effective in improving peri-operative analgesia in dogs undergoing TPLO.

  20. Perioperative Management of Neurological Conditions

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Dhallu

    2017-06-01

    Full Text Available Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

  1. Positive regulatory effects of perioperative probiotic treatment on postoperative liver complications after colorectal liver metastases surgery: a double-center and double-blind randomized clinical trial.

    Science.gov (United States)

    Liu, Zhihua; Li, Chao; Huang, Meijin; Tong, Chao; Zhang, Xingwei; Wang, Lei; Peng, Hui; Lan, Ping; Zhang, Peng; Huang, Nanqi; Peng, Junsheng; Wu, Xiaojian; Luo, Yanxing; Qin, Huanlong; Kang, Liang; Wang, Jianping

    2015-03-20

    Colorectal liver metastases (CLM) occur frequently and postoperative intestinal infection is a common complication. Our previous study showed that probiotics could decrease the rate of infectious complications after colectomy for colorectal cancer. To determine the effects of the perioperative administration of probiotics on serum zonulin levels which is a marker of intestinal permeability and the subsequent impact on postoperative infectious complications in patients with CLM. 150 patients with CLM were randomly divided into control group (n = 68) and probiotics group (n = 66). Probiotics and placebo were given orally for 6 days preoperatively and 10 days postoperatively to control group and probiotics group respectively. We used the local resection for metastatic tumor ,while for large tumor, the segmental hepatectomy. Postoperative outcome were recorded. Furthermore, complications in patients with normal intestinal barrier function and the relation with serum zonulin were analyzed to evaluate the impact on the liver barrier dysfunction. The incidence of infectious complications in the probiotics group was lower than control group. Analysis of CLM patients with normal postoperative intestinal barrier function paralleled with the serum zonulin level. And probiotics could also reduce the concentration of serum zonulin (P = 0.004) and plasma endotoxin (P zonulin level, the rate of postoperative septicemia and maintain the liver barrier in patients undergoing CLM surgery. we propose a new model about the regulation of probiotics to liver barrier via clinical regulatory pathway. We recommend the preoperative oral intake of probiotics combined with postoperative continued probiotics treatment in patients who undergo CLM surgery. ChiCTR-TRC- 12002841 . 2012/12/21.

  2. Resources | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  3. Links | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  4. Efficient Windows Collaborative | Home

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  5. FAQ | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  6. Glossary | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  7. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative

    DEFF Research Database (Denmark)

    Myles, P S; Boney, O; Botti, M

    2018-01-01

    Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus...

  8. Window shopping

    International Nuclear Information System (INIS)

    Anon.

    1987-01-01

    'A large window for surprises' was how Gordon Kane of Michigan summarized the potential of the proposed 84-kilometre US Superconducting Supercollider (SSC). With George Trilling of Berkeley unable to attend this year's High Energy Physics Conference at Vanderbilt University, Nashville, Tennessee, from 8-10 October, Kane played a dual role - looking ahead to SSC physics, and summarizing the meeting

  9. The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial.

    Science.gov (United States)

    Liu, Zhi-Hua; Huang, Mei-Jin; Zhang, Xing-Wei; Wang, Lei; Huang, Nan-Qi; Peng, Hui; Lan, Pin; Peng, Jun-Sheng; Yang, Zhen; Xia, Yang; Liu, Wei-Jie; Yang, Jun; Qin, Huan-Long; Wang, Jian-Ping

    2013-01-01

    Zonulin is a newly discovered protein that has an important role in the regulation of intestinal permeability. Our previous study showed that probiotics can decrease the rate of infectious complications in patients undergoing colectomy for colorectal cancer. The objective was to determine the effects of the perioperative administration of probiotics on serum zonulin concentrations and the subsequent effect on postoperative infectious complications in patients undergoing colorectal surgery. A total of 150 patients with colorectal carcinoma were randomly assigned to the control group (n = 75), which received placebo, or the probiotics group (n = 75). Both the probiotics and placebo were given orally for 6 d preoperatively and 10 d postoperatively. Outcomes were measured by assessing bacterial translocation, postoperative intestinal permeability, serum zonulin concentrations, duration of postoperative pyrexia, and cumulative duration of antibiotic therapy. The postoperative infection rate, the positive rate of blood microbial DNA, and the incidence of postoperative infectious complications-including septicemia, central line infection, pneumonia, urinary tract infection, and diarrhea-were also assessed. The infection rate was lower in the probiotics group than in the control group (P zonulin concentration (P zonulin concentrations in patients undergoing colectomy. We propose a clinical regulatory model that might explain this association. This trial was registered at http://www.chictr.org/en/ as ChiCTR-TRC-00000423.

  10. Supplemental Peri-Operative Oxygen and Incision Site Infection after Surgery for Perforated Peptic Ulcer: A Randomized, Double-Blind Monocentric Trial.

    Science.gov (United States)

    Schietroma, Mario; Cecilia, Emanuela Marina; De Santis, Giuseppe; Carlei, Francesco; Pessia, Beatrice; Amicucci, Gianfranco

    2016-02-01

    The clinical role of hyperoxia for preventing surgical site infection (SSI) remains uncertain because randomized controlled trials on this topic have reported disparate results. One of the principal reasons for this outcome may be that prior trials have entered heterogeneous populations of patients and a variety of procedures. The aim of our study was to assess the influence of hyperoxygenation on SSI using a homogeneous study population. From January 2004 to April 2013, we studied, in a randomized trial, 239 patients, who underwent open surgery for perforated peptic ulcer (PPU). The surgical procedure was performed through an upper abdominal midline incision, and closure of PPU was achieved by suture alone or in combination with an omental patch. Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 120) or 80% (n = 119). Administration was commenced after induction of anesthesia and maintained for 6 hours after surgery. The overall incision infection rate was 38.4% (92 of 239): 61 patients (50.8%) had an infection in the 30% FiO2 group and 31 (26%) in the 80% FiO2 group (p operative SSI, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.

  11. Benefits and harms of perioperative beta-blockade

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Juul, Anne Benedicte

    2006-01-01

    randomized trials. However, confidence intervals of the intervention effects in the meta-analyses are wide, leaving room for both benefits and harms. The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk...

  12. Strategic Windows

    DEFF Research Database (Denmark)

    Risberg, Annette; King, David R.; Meglio, Olimpia

    We examine the importance of speed and timing in acquisitions with a framework that identifies management considerations for three interrelated acquisition phases (selection, deal closure and integration) from an acquiring firm’s perspective. Using a process perspective, we pinpoint items within ...... acquisition phases that relate to speed. In particular, we present the idea of time-bounded strategic windows in acquisitions consistent with the notion of kairòs, where opportunities appear and must be pursued at the right time for success to occur....

  13. Window shopping

    OpenAIRE

    Oz Shy

    2013-01-01

    The terms "window shopping" and "showrooming" refer to the activity in which potential buyers visit a brick-and-mortar store to examine a product but end up either not buying it or buying the product from an online retailer. This paper analyzes potential buyers who differ in their preference for after-sale service that is not offered by online retailers. For some buyers, making a trip to the brick-and-mortar store is costly; however, going to the store to examine the product has the advantage...

  14. A randomized clinical trial of a peri-operative behavioral intervention to improve physical activity adherence and functional outcomes following total knee replacement

    Directory of Open Access Journals (Sweden)

    Zheng Hua

    2011-10-01

    Full Text Available Abstract Background Total knee replacement (TKR is a common and effective surgical procedure to relieve advanced knee arthritis that persists despite comprehensive medical treatment. Although TKR has excellent technical outcomes, significant variation in patient-reported functional improvement post-TKR exists. Evidence suggests that consistent post-TKR exercise and physical activity is associated with functional gain, and that this relationship is influenced by emotional health. The increasing use of TKR in the aging US population makes it critical to find strategies that maximize functional outcomes. Methods/Design This randomized clinical trial (RCT will test the efficacy of a theory-based telephone-delivered Patient Self-Management Support intervention that seeks to enhance adherence to independent exercise and activity among post- TKR patients. The intervention consists of 12 sessions, which begin prior to surgery and continue for approximately 9 weeks post-TKR. The intervention condition will be compared to a usual care control condition using a randomized design and a probabilistic sample of men and women. Assessments are conducted at baseline, eight weeks, and six- and twelve- months. The project is being conducted at a large healthcare system in Massachusetts. The study was designed to provide greater than 80% power for detecting a difference of 4 points in physical function (SF36/Physical Component Score between conditions (standard deviation of 10 at six months with secondary outcomes collected at one year, assuming a loss to follow up rate of no more than 15%. Discussion As TKR use expands, it is important to develop methods to identify patients at risk for sub-optimal functional outcome and to effectively intervene with the goal of optimizing functional outcomes. If shown efficacious, this peri-TKR intervention has the potential to change the paradigm for successful post-TKR care. We hypothesize that Patient Self-Management Support

  15. Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial.

    Science.gov (United States)

    Gillis, Chelsia; Loiselle, Sarah-Eve; Fiore, Julio F; Awasthi, Rashami; Wykes, Linda; Liberman, A Sender; Stein, Barry; Charlebois, Patrick; Carli, Francesco

    2016-05-01

    A previous comprehensive prehabilitation program, providing nutrition counseling with whey protein supplementation, exercise, and psychological care, initiated 4 weeks before colorectal surgery for cancer, improved functional capacity before surgery and accelerated functional recovery. Those receiving standard of care deteriorated. The specific role of nutritional prehabilitation alone on functional recovery is unknown. This study was undertaken to estimate the impact of nutrition counseling with whey protein on preoperative functional walking capacity and recovery in patients undergoing colorectal resection for cancer. We conducted a double-blinded randomized controlled trial at a single university-affiliated tertiary center located in Montreal, Quebec, Canada. Colon cancer patients (n=48) awaiting elective surgery for nonmetastatic disease were randomized to receive either individualized nutrition counseling with whey protein supplementation to meet protein needs or individualized nutrition counseling with a nonnutritive placebo. Counseling and supplementation began 4 weeks before surgery and continued for 4 weeks after surgery. The primary outcome was change in functional walking capacity as measured with the 6-minute walk test. The distance was recorded at baseline, the day of surgery, and 4 weeks after surgery. A change of 20 m was considered clinically meaningful. The whey group experienced a mean improvement in functional walking capacity before surgery of +20.8 m, with a standard deviation of 42.6 m, and the placebo group improved by +1.2 (65.5) m (P=0.27). Four weeks after surgery, recovery rates were similar between groups (P=0.81). Clinically meaningful improvements in functional walking capacity were achieved before surgery with whey protein supplementation. These pilot results are encouraging and justify larger-scale trials to define the specific role of nutrition prehabilitation on functional recovery after surgery. Copyright © 2016 Academy of

  16. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  17. Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: a prospective, randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Georgopoulou Stavroula

    2010-02-01

    Full Text Available Abstract Background Cardiac surgery is a major consumer of blood products, and hemodilution increases transfusion requirements during cardiac surgery under CPB. As intraoperative parenteral fluids contribute to hemodilution, we evaluated the hypothesis that intraoperative fluid restriction reduces packed red-cell (PRC use, especially in transfusion-prone adults undergoing elective cardiac surgery. Methods 192 patients were randomly assigned to restrictive (group A, 100 pts, or liberal (group B, 92 pts intraoperative intravenous fluid administration. All operations were conducted by the same team (same surgeon and perfusionist. After anesthesia induction, intravenous fluids were turned off in Group A (fluid restriction patients, who only received fluids if directed by protocol. In contrast, intravenous fluid administration was unrestricted in group B. Transfusion decisions were made by the attending anesthesiologist, based on identical transfusion guidelines for both groups. Results 137 of 192 patients received 289 PRC units in total. Age, sex, weight, height, BMI, BSA, LVEF, CPB duration and surgery duration did not differ between groups. Fluid balance was less positive in Group A. Fewer group A patients (62/100 required transfusion compared to group B (75/92, p Conclusions Our data suggest that fluid restriction reduces intraoperative PRC transfusions without significantly increasing postoperative transfusions in cardiac surgery; this effect is more pronounced in transfusion-prone patients. Trial registration NCT00600704, at the United States National Institutes of Health.

  18. A prospective randomized controlled trial of two-window versus solo-window technique by lateral sinus floor elevation in atrophic posterior maxilla: Results from a 1-year observational phase.

    Science.gov (United States)

    Yu, Huajie; Qiu, Lixin

    2017-10-01

    Implant failures are more common when multiple missing posterior teeth need lateral sinus floor elevation owing to inadequate tissue maturation after grafting. Effects of lateral window dimensions on vital bone formation have rarely been compared. To compare endo-sinus bone formation between two- and solo-window techniques to rehabilitate multiple missing posterior teeth that need substantial augmentation. Patients with severely atrophic posterior maxilla were randomized to receive lateral sinus floor elevation via solo or two bony windows. Bone core specimens harvested from lateral aspect of the augmentation sites were histomorphometrically analyzed. Proportions of mineralized bone (MB), bone substitute materials (BS), and nonmineralized tissue (NMT) were quantified. Twenty-one patients underwent 23 maxillary sinus augmentations. One patient in each group dropped out during the follow-up period. Lateral window dimensions were 81.65 ± 4.59 and 118.04 ± 19.53 mm 2 in the test and control groups, respectively. Histomorphometric analysis revealed mean MB of 42.32% ± 13.07% and 26.00% ± 15.23%, BS of 40.34% ± 9.52% and 60.03% ± 10.13%, and NMT of 18.14% ± 14.24% and 14.75% ± 10.38% in test and control groups, respectively, with significant differences. The two-window technique could facilitate faster maturation and consolidation of the grafted volume and is an effective alternative for rehabilitation of severely atrophic posterior maxilla with multiple missing posterior teeth. © 2017 Wiley Periodicals, Inc.

  19. Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery: a multicenter double-blinded randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Michael Haase

    Full Text Available Preliminary evidence suggests a nephroprotective effect of urinary alkalinization in patients at risk of acute kidney injury. In this study, we tested whether prophylactic bicarbonate-based infusion reduces the incidence of acute kidney injury and tubular damage in patients undergoing open heart surgery.In a multicenter, double-blinded (patients, clinical and research personnel, randomized controlled trial we enrolled 350 adult patients undergoing open heart surgery with the use of cardiopulmonary bypass. At induction of anesthesia, patients received either 24 hours of intravenous infusion of sodium bicarbonate (5.1 mmol/kg or sodium chloride (5.1 mmol/kg. The primary endpoint was the proportion of patients developing acute kidney injury. Secondary endpoints included the magnitude of acute tubular damage as measured by urinary neutrophil gelatinase-associated lipocalin (NGAL, initiation of acute renal replacement therapy, and mortality. The study was stopped early under recommendation of the Data Safety and Monitoring Committee because interim analysis suggested likely lack of efficacy and possible harm. Groups were non-significantly different at baseline except that a greater proportion of patients in the sodium bicarbonate group (66/174 [38%] presented with preoperative chronic kidney disease compared to control (44/176 [25%]; p = 0.009. Sodium bicarbonate increased urinary pH (from 6.0 to 7.5, p<0.001. More patients receiving bicarbonate (83/174 [47.7%] developed acute kidney injury compared with control patients (64/176 [36.4%], odds ratio [OR] 1.60 [95% CI 1.04-2.45]; unadjusted p = 0.032. After multivariable adjustment, a non-significant unfavorable group difference affecting patients receiving sodium bicarbonate was found for the primary endpoint (OR 1.45 [0.90-2.33], p = 0.120]. A greater postoperative increase in urinary NGAL in patients receiving bicarbonate infusion was observed compared to control patients (p = 0

  20. Comparing Formation or Non-Formation of Bladder Flap at Cesarean Section on Perioperative and Postoperative Complications: Double-Blind Clinical Trial

    Directory of Open Access Journals (Sweden)

    Farideh Akhlaghi

    2018-03-01

    Full Text Available Objective: To investigating formation or non-formation of bladder flap at Cesarean section on the complications during and after surgery.Materials and methods: This is a double-blind clinical trial study conducted during February 2014 to May 2015 on 64 pregnant women with gestational age of 36 weeks or more who were delivered by Cesarean section for the first time. They were randomly divided into two groups (intervention group: non-formation of bladder flap; control group: formation of bladder flap. The time to cut out the baby by Cesarean section, total duration of operation, bladder injury, intraoperative bleeding, hematocrit changes expected prior to during and following operation, postoperative pain, macroscopic and microscopic hematuria, postoperative complications and duration of  hospitalization were compared between two groups. The data were analyzed with SPSS version 16 using and statistics tests. p < 0.05 was considered significant.Results: Time to cut out the baby for the intervention group (124.9 ± 40.5 seconds and for control group 155.1 ± 42.9 seconds and total duration of the operation (intervention group: 27.7 ± 5.2 min and control group: 34 ± 4.73 min were significantly different (p = 0.000. Number of gauze consumption during operation and postoperative hematocrit drop in the intervention group was significantly lower in the intervention group compared the control group (p = 0.000. The postoperative pain score in the intervention group (4.8 ± 1.1 and in control group (6.3 ± 0.9 were significantly different (p = 0.000.Conclusion: Omission of the bladder flap at Cesarean section leads to short-term benefits such as reducing the time to cut out the fetus, duration of surgery, decreasing postoperative bleeding and lowering pain.

  1. Habits in perioperative nursing culture.

    Science.gov (United States)

    Lindwall, Lillemor; von Post, Iréne

    2008-09-01

    This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).

  2. A protocol for a systematic review for perioperative pregabalin use

    Directory of Open Access Journals (Sweden)

    Eipe Naveen

    2012-09-01

    Full Text Available Abstract Background Perioperative pain management has recently been revolutionized with the recognition of novel mechanisms and introduction of newer drugs. Many randomized trials have studied the use of the gabapentinoid anti-epileptic, pregabalin, in acute pain. Published systematic reviews suggest that using pregabalin for perioperative pain management may decrease analgesic requirements and pain scores, at the expense of troublesome side effects. A major limitation of the extant reviews is the lack of rigorous investigation of clinical characteristics that would maximize the benefit harms ratio in favor of surgical patients. We posit that effects of pregabalin for perioperative pain management vary by the type of surgical pain model and propose this systematic review protocol to update previous systematic reviews and investigate the heterogeneity in findings across subgroups of surgical pain models. Methods/Design Using a peer-reviewed search strategy, we will search key databases for clinical trials on perioperative pregabalin use in adults. The electronic searches will be supplemented by scanning the reference lists of included studies. No limits of language, country or year will be imposed. Outcomes will include pain; use of co-analgesia, particularly opioids; enhanced recovery; and drug-related harms. We will focus on the identification of surgical models and patient characteristics that have shown benefit and adverse effects from pregabalin. Two clinical experts will independently screen the studies for inclusion using eligibility criteria established a priori. Data extracted by the reviewers will then be verified. Publication bias will be assessed, as will risk of bias using the Cochrane Risk of Bias tool. Meta-analysis and meta-regression are planned if the studies are deemed statistically, methodologically and clinically homogenous. Evidence will be graded for its strength for a select number of outcomes. Discussion We will explore

  3. Vibrant SoundBridge application to middle ear windows versus conventional hearing aids: a comparative study based on international outcome inventory for hearing aids.

    Science.gov (United States)

    Atas, Ahmet; Tutar, Hakan; Gunduz, Bulent; Bayazıt, Yıldırım A

    2014-01-01

    In this study, we aimed to compare the outcomes of satisfaction of the patients who used hearing aids preceding the vibrant sound bridge (VSB) application on middle ear windows (14 oval window and 5 round window). Nineteen adult patients with conductive or mixed hearing loss were included in the study. All patients used behind the ear hearing aids on the site which was selected for VSB application. The patients used hearing aids for at least 3 months before the VSB operation. The floating mass transducer (FMT) was placed on one of the middle ear windows (oval or round) in VSB operation. The patients were evaluated with International Outcome Inventory for Hearing Aids (IOI-HA) preoperatively after at least 3 months trial of conventional hearing aid and postoperatively after 3 months use of VSB. No perioperative problem was encountered. The total score of IOI-HA was significantly higher with VSB compared with conventional hearing aids (p 0.05). The IOI-HA scores were significantly higher with the middle ear implant than the conventional hearing aid regarding benefit and residual participation restrictions (p < 0.05). Although the scores for quality of life assessment was similar between VSB and hearing aid use, there was a superiority of VSB in terms of benefit and residual participation restrictions as well as overall IOI-HA scores as the FMT was placed on one of the middle ear windows.

  4. Windows server cookbook for Windows server 2003 and Windows 2000

    CERN Document Server

    Allen, Robbie

    2005-01-01

    This practical reference guide offers hundreds of useful tasks for managing Windows 2000 and Windows Server 2003, Microsoft's latest server. These concise, on-the-job solutions to common problems are certain to save you many hours of time searching through Microsoft documentation. Topics include files, event logs, security, DHCP, DNS, backup/restore, and more

  5. Implementing a Perioperative Nursing Student Summer Internship.

    Science.gov (United States)

    Nash, Janice; Kamel, Teya C; Sherer, Joanne; Nauer, Kathleen

    2018-01-01

    Using qualitative research and a collaborative academic service partnership, we created an innovative 120-hour perioperative nursing summer internship for eight undergraduate nursing students in 2016. Recognizing that perioperative exposure is limited in the traditional baccalaureate program, this unpaid internship served to clarify student perceptions of perioperative nursing care and encourage graduates to meet perioperative workforce demands. We based the theoretical and practical student learning experiences on the AORN Periop 101 learning modules and included faculty-led discussions, student journaling, and onsite precepted clinical activities. Evaluation data revealed that students achieved an enhanced awareness of perioperative nursing, and a majority of the participants expressed a desire to enter the perioperative field after graduation. We suggest that stakeholders continue to strategize ways to maximize educational preparation to address the evolving health care market supply and demand. © AORN, Inc, 2018.

  6. Transitioning From Perioperative Staff Nurse to Perioperative Educator.

    Science.gov (United States)

    Mower, Juliana

    2017-08-01

    Perioperative nurses who enjoy teaching may wish to become staff development educators. The shift to this new role requires a transition period during which the new educator acquires the knowledge, skills, and attitudes integral to mastering the job. A systematic approach to achieving baseline competencies in the educator role helps to ensure a successful conversion from providing direct patient care to supporting the educational needs of staff members. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian Sylvest; Jorgensen, Lars N; Wetterslev, Jørn

    2012-01-01

    A high perioperative inspiratory oxygen fraction (80%) has been recommended to prevent postoperative wound infections. However, the most recent and one of the largest trials, the PROXI trial, found no reduction in surgical site infection, and 30-day mortality was higher in patients given 80% oxygen...

  8. Design Guidance for New Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  9. Selection Process for New Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  10. Selection Process for Replacement Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  11. Design Guidance for Replacement Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  12. Replacement Windows for Existing Homes Homes | Efficient Windows

    Science.gov (United States)

    Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

  13. Proper Installation of New Windows | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  14. Tramadol hydrochloride/acetaminophen combination versus non-steroidal anti-inflammatory drug for the treatment of perioperative pain after total knee arthroplasty: A prospective, randomized, open-label clinical trial.

    Science.gov (United States)

    Mochizuki, Takeshi; Yano, Koichiro; Ikari, Katsunori; Hiroshima, Ryo; Takaoka, Hiromitsu; Kawakami, Kosei; Koenuma, Naoko; Ishibashi, Mina; Shirahata, Toshikatsu; Momohara, Shigeki

    2016-09-01

    While many of the commonly used treatments for perioperative pain after total knee arthroplasty (TKA) have been recognized as effective, there is still insufficient evidence for oral medication. In orthopedics, non-steroidal anti-inflammatory drugs (NSAIDs) have been commonly used for perioperative pain; however, serious adverse events have been reported. Conversely, tramadol hydrochloride/acetaminophen combination (TRAM/APAP) therapy has been shown to reduce pain, particularly for chronic pain in Japan. This study aimed to determine TRAM/APAP efficacy in comparison with NSAIDs for perioperative pain after TKA. Two hundred eighty patients were enrolled in this study; 137 patients were treated with TRAM/APAP, and 143 patients were treated with NSAID from postoperative (PO) day 2. The primary endpoint was a comparison between the pain visual analog scale (VAS) change from baseline (PO day 2) and PO day 4, day 7, day 10, and day 14. The second endpoint was the number of days until the patient achieved independence from cane walking. Analysis of endpoints included 130 and 139 patients in the TRAM/APAP and NSAID groups, respectively. The pain VAS change in the TRAM/APAP group on any of the measurement days was significantly improved compared with the NSAID group (P pain management after TKA of TRAM/APAP was shown to be superior to that of NSAID; TRAM/APAP was also effective in improving the progress of rehabilitation. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  15. Desmopressin use for minimising perioperative blood transfusion

    Science.gov (United States)

    Desborough, Michael J; Oakland, Kathryn; Brierley, Charlotte; Bennett, Sean; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Stanworth, Simon J; Estcourt, Lise J

    2017-01-01

    Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low

  16. Provide Views | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  17. Reduced Fading | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  18. EWC Members | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  19. Visible Transmittance | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  20. Gas Fills | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  1. EWC Membership | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  2. Reducing Condensation | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  3. Improved Comfort | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  4. Financing & Incentives | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  5. Tools & Resources | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  6. Books & Publications | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  7. Design Considerations | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  8. Windows and doors

    Energy Technology Data Exchange (ETDEWEB)

    1988-01-01

    A complete manual is presented on windows and doors for the housing contractor. In order to understand the role of windows and doors in a house's energy performance, an introduction explains the house as a system of components that can have effects on each other. Further chapters explain in detail the parts of a window, window types and RSI values; window servicing and repair; window replacement; parts of a door, door types and RSI values; door service and repair, including weatherstripping; door replacement; and how to ensure quality, service, and customer satisfaction. A glossary of terms is included. 61 figs., 3 tabs.

  9. Windows 10 simplified

    CERN Document Server

    McFedries, Paul

    2015-01-01

    Learn Windows 10 quickly and painlessly with this beginner's guide Windows 10 Simplified is your absolute beginner's guide to the ins and outs of Windows. Fully updated to cover Windows 10, this highly visual guide covers all the new features in addition to the basics, giving you a one-stop resource for complete Windows 10 mastery. Every page features step-by-step screen shots and plain-English instructions that walk you through everything you need to know, no matter how new you are to Windows. You'll master the basics as you learn how to navigate the user interface, work with files, create

  10. Windows 10 for dummies

    CERN Document Server

    Rathbone, Andy

    2015-01-01

    The fast and easy way to get up and running with Windows 10 Windows 10 For Dummies covers the latest version of Windows and gets you up and running with the changes and new features you'll find in this updated operating system. Packed with time-saving tips to help you get the most out of the software, this helpful Windows 10 guide shows you how to manage Windows tasks like navigating the interface with a mouse or touchscreen, connecting to the web, and troubleshooting problems and making quick fixes. Assuming no prior knowledge of the software, Windows 10 For Dummies addresses the updates to

  11. Perioperative aspirin and clonidine and risk of acute kidney injury

    DEFF Research Database (Denmark)

    Garg, Amit X; Kurz, Andrea; Sessler, Daniel I

    2014-01-01

    IMPORTANCE: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain...... and each intervention has the potential for harm. OBJECTIVE: To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. DESIGN, SETTING, AND PARTICIPANTS: A 2 × 2 factorial randomized, blinded, clinical trial of 6905...... patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. INTERVENTIONS: Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days...

  12. Schematic Window Methodology Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The aim of this IRAD is to produce a generic launch window analyzer (SWM) that allows for large-scale rapid analysis of a launch window and orbit design trade space....

  13. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery ... Oxygenation failure, pulmonary hypertension and refractory systemic hypotension in infants with ... managing pulmonary and systemic perioperative haemodynamic instability in infants with diaphragmatic hernia.

  14. Window Selection Tool | Efficient Windows Collaborative

    Science.gov (United States)

    Louisville LA Lake Charles LA New Orleans LA Shreveport MA Boston MD Baltimore ME Portland MI Detroit MI Window Selection Tool will take you through a series of design conditions pertaining to your design and

  15. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  16. Windows for Intel Macs

    CERN Document Server

    Ogasawara, Todd

    2008-01-01

    Even the most devoted Mac OS X user may need to use Windows XP, or may just be curious about XP and its applications. This Short Cut is a concise guide for OS X users who need to quickly get comfortable and become productive with Windows XP basics on their Macs. It covers: Security Networking ApplicationsMac users can easily install and use Windows thanks to Boot Camp and Parallels Desktop for Mac. Boot Camp lets an Intel-based Mac install and boot Windows XP on its own hard drive partition. Parallels Desktop for Mac uses virtualization technology to run Windows XP (or other operating systems

  17. Windows® Internals

    CERN Document Server

    Russinovich, Mark E; Ionescu, Alex

    2009-01-01

    See how the core components of the Windows operating system work behind the scenes-guided by a team of internationally renowned internals experts. Fully updated for Windows Server 2008 and Windows Vista, this classic guide delivers key architectural insights on system design, debugging, performance, and support-along with hands-on experiments to experience Windows internal behavior firsthand.Delve inside Windows architecture and internals:Understand how the core system and management mechanisms work-from the object manager to services to the registryExplore internal system data structures usin

  18. Advanced energy efficient windows

    DEFF Research Database (Denmark)

    Thomsen, Kirsten Engelund

    2007-01-01

    Windows should be paid special attention as they contribute a significant part of the total heat-loss coefficient of the building. Contrary to other parts of the thermal envelope the windows are not only heat loosers, but may gain heat in the day-time. Therefore there are possibilities for large...... energy savings. In terms of energy, windows occupy a special position compared with other thermal envelope structures due to their many functions: 1) windows let daylight into the building and provide occupants with visual contact with their surroundings 2) windows protect against the outdoor climate 3......) windows transmit solar energy that may contribute to a reduction of energy consumption, but which may also lead to unpleasant overheating. In the following paragraphs the current use of windows is reviewed with an emphasis on energy, while special products like solar protection glazing and security...

  19. Perioperative corticosteroids for intermittent and mild persistent asthma

    Directory of Open Access Journals (Sweden)

    Hiroto Matsuse

    2002-01-01

    Conclusions: Our results suggest that perioperative corticosteroids are effective in preventing perioperative bronchospasm in stable asthmatics during surgery under general anesthesia by suppressing airway hyperresponsiveness.

  20. Statins and perioperative myocardial infarction. | Levin | Southern ...

    African Journals Online (AJOL)

    The growing prevalence of atherosclerosis means that perioperative myocardial infarction (PMI) is of significant concern to anesthesiologists. Perioperative revascularization (if indicated medically), beta blockade (in high risk patients) and statin therapy are therapeutic modalities that are currently employed to reduce PMI.

  1. Windows 8 secrets

    CERN Document Server

    Thurrott, Paul

    2012-01-01

    Tips, tricks, treats, and secrets revealed on Windows 8 Microsoft is introducing a major new release of its Windows operating system, Windows 8, and what better way to learn all its ins and outs than from two internationally recognized Windows experts and Microsoft insiders, authors Paul Thurrott and Rafael Rivera? They cut through the hype to get at useful information you'll not find anywhere else, including what role this new OS plays in a mobile and tablet world. Regardless of your level of knowledge, you'll discover little-known facts about how things work, what's new and different, and h

  2. Mastering Windows 7 Deployment

    CERN Document Server

    Finn, Aidan; van Surksum, Kenneth

    2011-01-01

    Get professional-level instruction on Windows 7 deployment tools Enterprise-level operating system deployment is challenging and requires knowledge of specific tools. It is expected that Windows 7 will be extensively deployed in businesses worldwide. This comprehensive Sybex guide provides thorough coverage of the Microsoft deployment tools that were specifically created for Windows 7, preparing system administrators, MIS professionals, and corporate programmers to tackle the task effectively.Companies worldwide are expected to deploy Windows 7 as their enterprise operating system; system admi

  3. Programming Windows Azure

    CERN Document Server

    Krishnan, Sriram

    2010-01-01

    Learn the nuts and bolts of cloud computing with Windows Azure, Microsoft's new Internet services platform. Written by a key member of the product development team, this book shows you how to build, deploy, host, and manage applications using Windows Azure's programming model and essential storage services. Chapters in Programming Windows Azure are organized to reflect the platform's buffet of services. The book's first half focuses on how to write and host application code on Windows Azure, while the second half explains all of the options you have for storing and accessing data on the plat

  4. Beginning Windows 8

    CERN Document Server

    Halsey, Mike

    2012-01-01

    Windows 8 has been described by Microsoft as its 'boldest' Windows release ever. Beginning Windows 8 takes you through the new features and helps you get more out of the familiar to reveal the possibilities for this amazing new operating system. You will learn, with non-technical language used throughout, how to get up and running in the new Windows interface, minimize downtime, maximize productivity, and harness the features you never knew existed to take control of your computer and enjoy the peace of mind and excitement that comes with it. From tips and tweaks to easy-to-follow guides and d

  5. Windows 8 tweaks

    CERN Document Server

    Sinchak, Steve

    2013-01-01

    Acres of Windows 8 tweaks from a Microsoft MVP and creator of Tweaks.com! From a Microsoft MVP, who is also the savvy creator of Tweaks.com, comes this ultimate collection of Windows 8 workarounds. Steve Sinchak takes you way beyond default system settings, deep under the hood of Windows 8, down to the hidden gems that let you customize your Windows 8 system like you wouldn't believe. From helping you customize the appearance to setting up home networking, sharing media, and squeezing every ounce of performance out of the OS, this book delivers. Get ready to rock and roll with Wind

  6. Risk reduction: perioperative smoking intervention

    DEFF Research Database (Denmark)

    Møller, Ann; Tønnesen, Hanne

    2006-01-01

    Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk...... of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  7. Digital health and perioperative care.

    Science.gov (United States)

    Fotis, Theofanis

    2017-06-01

    According to the U.S. Food and Drug Administration 'the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin digital health group with more than 40,000 members, defined digital health as 'the convergence of the digital and genomic revolutions with health, healthcare, living, and society' (storyofdigitalhealth.com 2016). Copyright the Association for Perioperative Practice.

  8. Psychotropic drugs and the perioperative period : A proposal for a guideline in elective surgery

    NARCIS (Netherlands)

    Huyse, FJ; Touw, DJ; Van Schijndel, RS; De Lange, JJ; Slaets, JPJ

    Evidence-based guidelines for the perioperative management of psychotropic drugs are lacking. The level of evidence is low and is based on case reports, open trials, and non-systematic reviews. However, the interactions and effects mentioned indicate that patients who use psychotropics and require

  9. Optimal glucose management in the perioperative period.

    Science.gov (United States)

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. Published by Elsevier Inc.

  10. Color Wheel Windows

    Science.gov (United States)

    Leonard, Stephanie

    2012-01-01

    In this article, the author describes a painting and drawing lesson which was inspired by the beautiful circular windows found in cathedrals and churches (also known as "rose windows"). This two-week lesson would reinforce both the concept of symmetry and students' understanding of the color wheel. (Contains 1 online resource.)

  11. Efficient Windows Collaborative

    Energy Technology Data Exchange (ETDEWEB)

    Nils Petermann

    2010-02-28

    The project goals covered both the residential and commercial windows markets and involved a range of audiences such as window manufacturers, builders, homeowners, design professionals, utilities, and public agencies. Essential goals included: (1) Creation of 'Master Toolkits' of information that integrate diverse tools, rating systems, and incentive programs, customized for key audiences such as window manufacturers, design professionals, and utility programs. (2) Delivery of education and outreach programs to multiple audiences through conference presentations, publication of articles for builders and other industry professionals, and targeted dissemination of efficient window curricula to professionals and students. (3) Design and implementation of mechanisms to encourage and track sales of more efficient products through the existing Window Products Database as an incentive for manufacturers to improve products and participate in programs such as NFRC and ENERGY STAR. (4) Development of utility incentive programs to promote more efficient residential and commercial windows. Partnership with regional and local entities on the development of programs and customized information to move the market toward the highest performing products. An overarching project goal was to ensure that different audiences adopt and use the developed information, design and promotion tools and thus increase the market penetration of energy efficient fenestration products. In particular, a crucial success criterion was to move gas and electric utilities to increase the promotion of energy efficient windows through demand side management programs as an important step toward increasing the market share of energy efficient windows.

  12. Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway.

    Science.gov (United States)

    Steppan, Jochen; Diaz-Rodriguez, Natalia; Barodka, Viachaslau M; Nyhan, Daniel; Pullins, Erica; Housten, Traci; Damico, Rachel L; Mathai, Stephen C; Hassoun, Paul M; Berkowitz, Dan E; Maxwell, Bryan G; Kolb, Todd M

    2018-01-15

    Morbidity and mortality risk increase considerably for patients with pulmonary hypertension (PH) undergoing non-cardiac surgery. Unfortunately, there are no comprehensive, evidence-based guidelines for perioperative evaluation and management of these patients. We present a brief review of the literature on perioperative outcomes for patients with PH and describe the implementation of a collaborative perioperative management program for these high-risk patients at a tertiary academic center.

  13. Visual merchandising window display

    Directory of Open Access Journals (Sweden)

    Opris (Cas. Stanila M.

    2013-12-01

    Full Text Available Window display plays a major part in the selling strategies; it does not only include the simple display of goods, nowadays it is a form of art, also having the purpose of sustaining the brand image. This article wants to reveal the tools that are essential in creating a fabulous window display. Being a window designer is not an easy job, you have to always think ahead trends, to have a sense of colour, to know how to use light to attract customers in the store after only one glance at the window. The big store window displays are theatre scenes: with expensive backgrounds, special effects and high fashion mannequins. The final role of the displays is to convince customers to enter the store and trigger the purchasing act which is the final goal of the retail activity.

  14. Adverse effects of perioperative paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations

    DEFF Research Database (Denmark)

    Mathiesen, O; Wetterslev, Jørn; Kontinen, V K

    2014-01-01

    with the most common perioperative non-opioid analgesics: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta-analyses of analgesic efficacy and/or adverse effects...... of perioperative non-opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post-operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality...

  15. Perioperative lung protective ventilation in obese patients

    NARCIS (Netherlands)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent

  16. GA microwave window development

    International Nuclear Information System (INIS)

    Moeller, C.P.; Kasugai, A.; Sakamoto, K.; Takahashi, K.

    1994-10-01

    The GA prototype distributed window was tested in a 32 mm diam. waveguide system at a power density suitable for a MW gyrotron, using the JAERI/Toshiba 110 GHz long pulse internal converter gyrotron in the JAERI test stand. The presence of the untilted distributed window had no adverse effect on the gyrotron operation. A pulse length of 10 times the calculated thermal equilibrium time (1/e time) of 30 msec was reached, and the window passed at least 750 pulses greater than 30 msec and 343 pulses greater than 60 msec. Beyond 100 msec, the window calorimetry reached steady state, allowing the window dissipation to be measured in a single pulse. The measured loss of 4.0% agrees both with the estimated loss, on which the stress calculations are based, and with the attenuation measured at low power in the HE 11 mode. After the end of the tests, the window was examined; no evidence of arcing air coating was found in the part of the window directly illuminated by the microwaves, although there was discoloration in a recess containing an optical diagnostic which outgassed, causing a local discharge to occur in that recess. Finally, there was no failure of the metal-sapphire joints during a total operating time of 50 seconds consisting of pulses longer than 30 msec

  17. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  18. Windows 8 simplified

    CERN Document Server

    McFedries, Paul

    2012-01-01

    The easiest way for visual learners to get started with Windows 8 The popular Simplified series makes visual learning easier than ever, and with more than 360,000 copies sold, previous Windows editions are among the bestselling Visual books. This guide goes straight to the point with easy-to-follow, two-page tutorials for each task. With full-color screen shots and step-by-step directions, it gets beginners up and running on the newest version of Windows right away. Learn to work with the new interface and improved Internet Explorer, manage files, share your computer, and much more. Perfect fo

  19. Windows 95 Beslutningsguide

    DEFF Research Database (Denmark)

    Sørensen, Jens Otto

    1996-01-01

    Mange virksomheder der bruger pc'er står netop nu over for valget: Skal vi fortsætte med DOS/Windows 3.x som operativsystem, eller skal vi skifte til efterfølgeren Windows 95? Skal vi/kan vi skifte successivt, eller skal det være en "alt eller intet beslutning". Hvornår er det rigtige tidspunkt...... at skifte? Denne artikel vil forsøge at give en baggrundsviden om Windows 95, der kan hjælpe virksomhederne igennem denne beslutningsfase....

  20. Rails on Windows

    CERN Document Server

    Hibbs, Curt

    2007-01-01

    It's no secret that the entire Ruby onRails core team uses OS X as their preferreddevelopment environment. Becauseof this, it is very easy to findauthoritative information on the webabout using Rails on OS X. But the truthis that Windows developers using Railsprobably outnumber those using otherplatforms. A Windows development environmentcan be just as productive asany other platform. This is a guide to developing with Rubyon Rails under Windows. It won't teachyou how to write Ruby on Rails web applications,but it will show you what toolsto use and how to set them up to createa complete Rail

  1. The Efficient Windows Collaborative

    Energy Technology Data Exchange (ETDEWEB)

    Petermann, Nils

    2006-03-31

    The Efficient Windows Collaborative (EWC) is a coalition of manufacturers, component suppliers, government agencies, research institutions, and others who partner to expand the market for energy efficient window products. Funded through a cooperative agreement with the U.S. Department of Energy, the EWC provides education, communication and outreach in order to transform the residential window market to 70% energy efficient products by 2005. Implementation of the EWC is managed by the Alliance to Save Energy, with support from the University of Minnesota and Lawrence Berkeley National Laboratory.

  2. Windows 7 resource kit

    CERN Document Server

    Northrup, Tony; Honeycutt, Jerry; Wilson, Ed

    2009-01-01

    In-depth and comprehensive, this RESOURCE KIT delivers the information you need to administer your Windows 7 system. You get authoritative technical guidance from those who know the technology best-Microsoft Most Valuable Professionals (MVPs) and the Windows 7 product team-along with essential scripts and resources. In addition, "Direct from the Source" sidebars offer deep insights and troubleshooting tips from the Windows 7 team. Get expert guidance on how to: Use Microsoft Deployment Toolkit best practices and tools. Plan user-state migration and test application compatibility.

  3. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial.

    Science.gov (United States)

    Saver, Jeffrey L; Gornbein, Jeffrey; Grotta, James; Liebeskind, David; Lutsep, Helmi; Schwamm, Lee; Scott, Phillip; Starkman, Sidney

    2009-07-01

    Measures of a therapy's effect size are important guides to clinicians, patients, and policy-makers on treatment decisions in clinical practice. The ECASS 3 trial demonstrated a statistically significant benefit of intravenous tissue plasminogen activator for acute cerebral ischemia in the 3- to 4.5-hour window, but an effect size estimate incorporating benefit and harm across all levels of poststroke disability has not previously been derived. Joint outcome table specification was used to derive number needed to treat to benefit (NNTB) and number needed to treat to harm (NNTH) values summarizing treatment impact over the entire outcome range on the modified Rankin scale of global disability, including both expert-dependent and expert-independent (algorithmic and repeated random sampling) array generation. For the full 7-category modified Rankin scale, algorithmic analysis demonstrated that the NNTB for 1 additional patient to have a better outcome by >or=1 grades than with placebo must lie between 4.0 and 13.0. In bootstrap simulations, the mean NNTB was 7.1. Expert joint outcome table analyses indicated that the NNTB for improved final outcome was 6.1 (95% CI, 5.6-6.7) and the NNTH 37.5 (95% CI, 34.6-40.5). Benefit per 100 patients treated was 16.3 and harm per 100 was 2.7. The likelihood of help to harm ratio was 6.0. Treatment with tissue plasminogen activator in the 3- to 4.5-hour window confers benefit on approximately half as many patients as treatment <3 hours, with no increase in the conferral of harm. Approximately 1 in 6 patients has a better and 1 in 35 has a worse outcome as a result of therapy.

  4. SAF for Windows

    DEFF Research Database (Denmark)

    Hansen, Timme

    2001-01-01

    SAF for Windows er et computerprogram til parametrisk konstruktion af translationsskaller. Skaloverfladernes tredimensionelle, facetterede form fremkommer ved en kombination af to todimensionelle formbestemmende kurver, som kan vælges og redigeres af brugeren. Programmet kan udfolde de genererede...

  5. Windows Security patch required

    CERN Multimedia

    3004-01-01

    This concerns Windows PCs (XP, 2000, NT) which are NOT centrally managed at CERN for security patches, e.g. home PCs, experiment PCs, portables,... A security hole which can give full privileges on Windows systems needs to be URGENTLY patched. Details of the security hole and hotfix are at: http://cern.ch/it-div/news/hotfix-MS03-026.asp http://www.microsoft.com/technet/security/bulletin/MS03-026.asp

  6. Delineating the conformal window

    DEFF Research Database (Denmark)

    Frandsen, Mads Toudal; Pickup, Thomas; Teper, Michael

    2011-01-01

    We identify and characterise the conformal window in gauge theories relevant for beyond the standard model building, e.g. Technicolour, using the criteria of metric confinement and causal analytic couplings, which are known to be consistent with the phase diagram of supersymmetric QCD from Seiberg...... duality. Using these criteria we find perturbation theory to be consistent throughout the predicted conformal window for several of these gauge theories and we discuss recent lattice results in the light of our findings....

  7. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

    Science.gov (United States)

    Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

    2018-01-01

    The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

  8. Thin Film & Deposition Systems (Windows)

    Data.gov (United States)

    Federal Laboratory Consortium — Coating Lab: Contains chambers for growing thin film window coatings. Plasma Applications Coating Lab: Contains chambers for growing thin film window coatings. Solar...

  9. Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

    Science.gov (United States)

    Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

    2017-06-30

    'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

  10. Perioperative Management of Patients with Rheumatic Diseases

    Science.gov (United States)

    Bissar, Lina; Almoallim, Hani; Albazli, Khaled; Alotaibi, Manal; Alwafi, Samar

    2013-01-01

    This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation PMID:24062860

  11. Perioperative death: Its implications and management

    Directory of Open Access Journals (Sweden)

    J P Attri

    2016-01-01

    Full Text Available Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.

  12. Biomarker and Tumor Responses of Oral Cavity Squamous Cell Carcinoma to Trametinib: A Phase II Neoadjuvant Window-of-Opportunity Clinical Trial.

    Science.gov (United States)

    Uppaluri, Ravindra; Winkler, Ashley E; Lin, Tianxiang; Law, Jonathan H; Haughey, Bruce H; Nussenbaum, Brian; Paniello, Randal C; Rich, Jason T; Diaz, Jason A; Michel, Loren P; Wildes, Tanya; Dunn, Gavin P; Zolkind, Paul; Kallogjeri, Dorina; Piccirillo, Jay F; Dehdashti, Farrokh; Siegel, Barry A; Chernock, Rebecca D; Lewis, James S; Adkins, Douglas R

    2017-05-01

    Purpose: Ras/MEK/ERK pathway activation is common in oral cavity squamous cell carcinoma (OCSCC). We performed a neoadjuvant (preoperative) trial to determine the biomarker and tumor response of OCSCC to MEK inhibition with trametinib. Experimental Design: Patients with stage II-IV OCSCC received trametinib (2 mg/day, minimum 7 days) prior to surgery. Primary tumor specimens were obtained before and after trametinib to evaluate immunohistochemical staining for p-ERK1/2 and CD44, the primary endpoint. Secondary endpoints included changes in clinical tumor measurements and metabolic activity [maximum standardized uptake values (SUV max ) by F-18 fluorodeoxyglucose positron emission tomography/CT), and in tumor downstaging. Drug-related adverse events (AE) and surgical/wound complications were evaluated. Results: Of 20 enrolled patients, 17 (85%) completed the study. Three patients withdrew because of either trametinib-related ( n = 2: nausea, duodenal perforation) or unrelated ( n = 1: constipation) AEs. The most common AE was rash (9/20 patients, 45%). Seventeen patients underwent surgery. No unexpected surgical/wound complications occurred. Evaluable matched pre- and posttrametinib specimens were available in 15 (88%) of these patients. Reduction in p-ERK1/2 and CD44 expression occurred in 5 (33%) and 2 (13%) patients, respectively. Clinical tumor response by modified World Health Organization criteria was observed in 11 of 17 (65%) evaluable patients (median 46% decrease, range 14%-74%). Partial metabolic response (≥25% reduction in SUV max ) was observed in 6 of 13 (46%) evaluable patients (median 25% decrease, range 6%-52%). Clinical-to-pathologic tumor downstaging occurred in 9 of 17 (53%) evaluable patients. Conclusions: Trametinib resulted in significant reduction in Ras/MEK/ERK pathway activation and in clinical and metabolic tumor responses in patients with OCSCC. Clin Cancer Res; 23(9); 2186-94. ©2016 AACR . ©2016 American Association for Cancer

  13. High performance sapphire windows

    Science.gov (United States)

    Bates, Stephen C.; Liou, Larry

    1993-02-01

    High-quality, wide-aperture optical access is usually required for the advanced laser diagnostics that can now make a wide variety of non-intrusive measurements of combustion processes. Specially processed and mounted sapphire windows are proposed to provide this optical access to extreme environment. Through surface treatments and proper thermal stress design, single crystal sapphire can be a mechanically equivalent replacement for high strength steel. A prototype sapphire window and mounting system have been developed in a successful NASA SBIR Phase 1 project. A large and reliable increase in sapphire design strength (as much as 10x) has been achieved, and the initial specifications necessary for these gains have been defined. Failure testing of small windows has conclusively demonstrated the increased sapphire strength, indicating that a nearly flawless surface polish is the primary cause of strengthening, while an unusual mounting arrangement also significantly contributes to a larger effective strength. Phase 2 work will complete specification and demonstration of these windows, and will fabricate a set for use at NASA. The enhanced capabilities of these high performance sapphire windows will lead to many diagnostic capabilities not previously possible, as well as new applications for sapphire.

  14. Perioperative nursing in public university hospitals

    DEFF Research Database (Denmark)

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne

    2014-01-01

    BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light...... of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly...... specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark...

  15. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  16. Adaptive Liquid Crystal Windows

    Energy Technology Data Exchange (ETDEWEB)

    Taheri, Bahman; Bodnar, Volodymyr

    2011-12-31

    Energy consumption by private and commercial sectors in the U.S. has steadily grown over the last decade. The uncertainty in future availability of imported oil, on which the energy consumption relies strongly, resulted in a dramatic increase in the cost of energy. About 20% of this consumption are used to heat and cool houses and commercial buildings. To reduce dependence on the foreign oil and cut down emission of greenhouse gases, it is necessary to eliminate losses and reduce total energy consumption by buildings. To achieve this goal it is necessary to redefine the role of the conventional windows. At a minimum, windows should stop being a source for energy loss. Ideally, windows should become a source of energy, providing net gain to reduce energy used to heat and cool homes. It is possible to have a net energy gain from a window if its light transmission can be dynamically altered, ideally electronically without the need of operator assistance, providing optimal control of the solar gain that varies with season and climate in the U.S. In addition, the window must not require power from the building for operation. Resolution of this problem is a societal challenge and of national interest and will have a broad global impact. For this purpose, the year-round, allclimate window solution to provide an electronically variable solar heat gain coefficient (SHGC) with a wide dynamic range is needed. AlphaMicron, Inc. (AMI) developed and manufactured 1ft × 1ft prototype panels for the world’s first auto-adjusting Adaptive Liquid Crystal Windows (ALCWs) that can operate from sunlight without the need for external power source and demonstrate an electronically adjustable SHGC. This novel windows are based on AlphaMicron’s patented e-Tint® technology, a guesthost liquid crystal system implemented on flexible, optically clear plastic films. This technology is suitable both for OEM and aftermarket (retro-fitting) lamination to new and existing windows. Low level of

  17. Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.

    Science.gov (United States)

    Lakhey, Paleswan Joshi; Bhandari, Ramesh Singh; Ghimire, Bikal; Khakurel, Mahesh

    2010-08-01

    Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital. A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed. Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place. Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.

  18. Windows 8.1 bible

    CERN Document Server

    Boyce, Jim; Tidrow, Rob

    2014-01-01

    Windows 8.1 coverage that goes above and beyond all competitors? Serving as an evolutionary update to Windows 8, Windows 8.1 provides critical changes to parts of Windows 8, such as greater customization of the interface and boot operations, return of a 'start button' that reveals apps, greater integration between the two interfaces, and updates to apps. Weighing in at nearly 1000 pages, Windows 8.1 Bible provides deeper Windows insight than any other book on the market. It's valuable for both professionals needing a guide to the nooks and crannies of Windows and regular users wanting a wide

  19. Service Dogs in the Perioperative Setting.

    Science.gov (United States)

    Levey, Janet A; Chappy, Sharon L

    2017-04-01

    Service dogs are critical for the independence of individuals with disabilities because they assist with daily living activities and help these individuals navigate society. Perioperative nurses need a working knowledge of disability laws pertaining to service dogs to provide patient-centered care for individuals using service dogs. This article provides information on the Americans With Disabilities Act regulations regarding service dogs, makes recommendations for the care of patients with service dogs across the perioperative continuum, and offers policy directives to ensure that safe, high-quality care is delivered to patients using service dogs. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  20. Ethics in perioperative practice--patient advocacy.

    Science.gov (United States)

    Schroeter, Kathryn

    2002-05-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this second of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the third provision statement, which addresses nurses' position as patient advocates.

  1. Windows Azure Platform

    CERN Document Server

    Redkar, Tejaswi

    2010-01-01

    The Azure Services Platform is a brand-new cloud-computing technology from Microsoft. It is composed of four core components-Windows Azure, .NET Services, SQL Services, and Live Services-each with a unique role in the functioning of your cloud service. It is the goal of this book to show you how to use these components, both separately and together, to build flawless cloud services. At its heart Windows Azure Platform is a down-to-earth, code-centric book. This book aims to show you precisely how the components are employed and to demonstrate the techniques and best practices you need to know

  2. Microsoft Windows Security Essentials

    CERN Document Server

    Gibson, Darril

    2011-01-01

    Windows security concepts and technologies for IT beginners IT security can be a complex topic, especially for those new to the field of IT. This full-color book, with a focus on the Microsoft Technology Associate (MTA) program, offers a clear and easy-to-understand approach to Windows security risks and attacks for newcomers to the world of IT. By paring down to just the essentials, beginners gain a solid foundation of security concepts upon which more advanced topics and technologies can be built. This straightforward guide begins each chapter by laying out a list of topics to be discussed,

  3. Microsoft Windows networking essentials

    CERN Document Server

    Gibson, Darril

    2011-01-01

    The core concepts and technologies of Windows networking Networking can be a complex topic, especially for those new to the field of IT. This focused, full-color book takes a unique approach to teaching Windows networking to beginners by stripping down a network to its bare basics, thereby making each topic clear and easy to understand. Focusing on the new Microsoft Technology Associate (MTA) program, this book pares down to just the essentials, showing beginners how to gain a solid foundation for understanding networking concepts upon which more advanced topics and technologies can be built.

  4. Exploring Shop Window Displays

    Science.gov (United States)

    Christopoulou, Martha

    2011-01-01

    Using visual resources from everyday life in art lessons can enrich students' knowledge about the creation of visual images, artifacts, and sites, and develop their critical understanding about the cultural impact of these images and their effects on people's lives. Through examining an exhibition in the windows of Selfridges department store in…

  5. Windows and lighting program

    Energy Technology Data Exchange (ETDEWEB)

    1990-06-01

    More than 30% of all energy use in buildings is attributable to two sources: windows and lighting. Together they account for annual consumer energy expenditures of more than $50 billion. Each affects not only energy use by other major building systems, but also comfort and productivity -- factors that influence building economics far more than does direct energy consumption alone. Windows play a unique role in the building envelope, physically separating the conditioned space from the world outside without sacrificing vital visual contact. Throughout the indoor environment, lighting systems facilitate a variety of tasks associated with a wide range of visual requirements while defining the luminous qualities of the indoor environment. Windows and lighting are thus essential components of any comprehensive building science program. Despite important achievements in reducing building energy consumption over the past decade, significant additional savings are still possible. These will come from two complementary strategies: (1) improve building designs so that they effectively apply existing technologies and extend the market penetration of these technologies; and (2) develop advanced technologies that increase the savings potential of each application. Both the Windows and Daylighting Group and the Lighting System Research Group have made substantial contributions in each of these areas, and continue to do so through the ongoing research summarized here. 23 refs., 16 figs.

  6. anaesthetic registrars' experiences of perioperative death

    African Journals Online (AJOL)

    Death on the table: anaesthetic registrars' experiences of perioperative ... aDepartment of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa ... Results: Themes expressed by participants fell into three broad categories: ... number (up to 70%) of anaesthetists report experiencing adverse.

  7. Patient Education May Improve Perioperative Safety.

    NARCIS (Netherlands)

    de Haan, L.S.; Calsbeek, H; Wolff, André

    2016-01-01

    Importance: There is a growing interest in enabling ways for patients to participate in their own care to improve perioperative safety, but little is known about the effectiveness of interventions enhancing an active patient role. Objective: To evaluate the effect of patient participation on

  8. Perioperative care of the older patient

    NARCIS (Netherlands)

    E. Blommers; M. Klimek (Markus); K.A. Hartholt (Klaas); T.J.M. van der Cammen (Tischa); J. Klein (Jan); P. Noordzij (Peter)

    2011-01-01

    textabstractNearly 60% of the Dutch population undergoing surgery is aged 65 years and over. Older patients are at increased risk of developing perioperative complications (e.g., myocardial infarction, pneumonia, or delirium), which may lead to a prolonged hospital stay or death. Preoperative risk

  9. The treatment of perioperative myocardial infarctions following ...

    African Journals Online (AJOL)

    Background: Perioperative myocardial infarction (PMI) is a common complication following noncardiac surgery, with a 30-day mortality of 10-20%. Effective therapeutic interventions are of public health importance. Method: This is a systematic review, aimed to determine the evidence for therapies following PMI. Results: A ...

  10. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Perioperative care of infants with diaphragmatic hernias can be a challenge because of pulmonary hypertension and systemic hypotension. The objective of this study was to report the usefulness of vasopressin infusion in improving pulmonary and systemic haemodynamics in an infant with congenital diaphragmatic hernia.

  11. Lower HVAC Costs | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  12. Increased Light & View | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  13. Condensation Resistance (CR) | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  14. Fact Sheets & Publications | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  15. State Fact Sheets | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  16. State Code Guides | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  17. Low Conductance Spacers | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  18. National Fenestration Rating Council (NFRC) | Efficient Windows

    Science.gov (United States)

    Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

  19. Energy & Cost Savings | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  20. Provide Natural Light | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  1. Provide Fresh Air | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  2. Air Leakage (AL) | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  3. STOP smoking and alcohol drinking before OPeration for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Lauridsen, Susanne Vahr; Thomsen, Thordis; Thind, Peter; Tønnesen, Hanne

    2017-07-17

    To evaluate the effect of a smoking-, alcohol- or combined-cessation intervention starting shortly before surgery and lasting 6 weeks on overall complications after radical cystectomy. Secondary objectives are to examine the effect on types and grades of complications, smoking cessation and alcohol cessation, length of hospital stay, health-related quality of life and return to work or habitual level of activity up to 12 months postoperatively. The study is a multi-institutional randomised clinical trial involving 110 patients with a risky alcohol intake and daily smoking who are scheduled for radical cystectomy. Patients will be randomised to the 6-week Gold Standard Programme (GSP) or treatment as usual (control). The GSP combines patient education and pharmacologic strategies. Smoking and alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly meetings and at follow-up. Herein, we report the design of the STOP-OP study, objectives and accrual up-date. This study will provide new knowledge about how to prevent smoking and alcohol-related postoperative complications at the time of bladder cancer surgery. Till now 77 patients have been enrolled. Patient accrual is expected to be finalised before the end of 2017 and data will be published in 2018. ClinicalTrials.gov, ID: NCT02188446 . Registered on 28 May 2014.

  4. Thermal bridges of modern windows

    DEFF Research Database (Denmark)

    Hansen, Ernst Jan de Place; Møller, Eva B.; Nielsen, Anker

    2013-01-01

    if the window has an U-factor of 1 W/(m2·K) or lower. This paper describes the development of modern, energy efficient Danish windows with reduced thermal bridges. It focuses on materials, geometry, and sealing of window panes based on a literature review. Examples of modern windows are presented. Experience...... been an important driver for the development of new window solutions in Denmark, increasing the inner-surface temperature at the sealing of window panes. However, it will not stop complaints fromconsumers, as this temperature is calculated under standardized conditions. Increasing requirements...

  5. Occupants' window opening behaviour

    DEFF Research Database (Denmark)

    Fabi, Valentina; Andersen, Rune Korsholm; Corgnati, Stefano

    2012-01-01

    Energy consumption in buildings is influenced by several factors related to the building properties and the building controls, some of them highly connected to the behaviour of their occupants.In this paper, a definition of items referring to occupant behaviour related to the building control...... systems is proposed, based on studies presented in literature and a general process leading to the effects on energy consumptions is identified.Existing studies on the topic of window opening behaviour are highlighted and a theoretical framework to deal with occupants' interactions with building controls......, aimed at improving or maintaining the preferred indoor environmental conditions, is elaborated. This approach is used to look into the drivers for the actions taken by the occupants (windows opening and closing) and to investigate the existing models in literature of these actions for both residential...

  6. Perioperative Vision Loss in Cervical Spinal Surgery.

    Science.gov (United States)

    Gabel, Brandon C; Lam, Arthur; Chapman, Jens R; Oskouian, Rod J; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Hamilton, Steven R; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective multicenter case series. To assess the rate of perioperative vision loss following cervical spinal surgery. Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery. Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period. Perioperative vision loss following cervical spinal surgery is exceedingly rare.

  7. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  8. Detrimental effects of perioperative blood transfusion

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen

    1995-01-01

    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...... similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage....

  9. Using games to provide interactive perioperative education.

    Science.gov (United States)

    Carifa, Linda; Janiszewski Goodin, Heather

    2011-10-01

    Perioperative nurses must use critical thinking and sound clinical judgment to meet their patients' needs safely and effectively. This requires the integration and continual updating of large amounts of detailed clinical information. Innovative education strategies are designed to make teaching and learning more interesting and interactive, especially for the presentation of complex subject material. One interactive educational strategy is the use of games. Educational games can foster collaboration and critical thinking among peers and associates. An example of this was the Perioperative QuizBowl: Evidence-Based Practice presented at the annual AORN Congress from 2003 to 2010, which was used to teach and reinforce evidence-based practice in a fun, competitive way. Although AORN no longer presents this offering, the QuizBowl format demonstrates how educational games can support clinical practice. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  10. Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

    Science.gov (United States)

    Tallier, Peggy C; Reineke, Patricia R; Asadoorian, Kathy; Choonoo, John G; Campo, Marc; Malmgreen-Wallen, Christine

    2017-08-01

    Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Perioperative lung protective ventilation in obese patients

    OpenAIRE

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

  12. Windows Home Server users guide

    CERN Document Server

    Edney, Andrew

    2008-01-01

    Windows Home Server brings the idea of centralized storage, backup and computer management out of the enterprise and into the home. Windows Home Server is built for people with multiple computers at home and helps to synchronize them, keep them updated, stream media between them, and back them up centrally. Built on a similar foundation as the Microsoft server operating products, it's essentially Small Business Server for the home.This book details how to install, configure, and use Windows Home Server and explains how to connect to and manage different clients such as Windows XP, Windows Vist

  13. Teach yourself visually Windows 10

    CERN Document Server

    McFedries, Paul

    2015-01-01

    Learn Windows 10 visually with step-by-step instructions Teach Yourself VISUALLY Windows 10 is the visual learner's guide to the latest Windows upgrade. Completely updated to cover all the latest features, this book walks you step-by-step through over 150 essential Windows tasks. Using full color screen shots and clear instruction, you'll learn your way around the interface, set up user accounts, play media files, download photos from your camera, go online, set up email, and much more. You'll even learn how to customize Windows 10 to suit the way you work best, troubleshoot and repair common

  14. Optimizing Perioperative Nutrition in Pediatric Populations.

    Science.gov (United States)

    Canada, Nicki L; Mullins, Lucille; Pearo, Brittany; Spoede, Elizabeth

    2016-02-01

    Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period. © 2015 American Society for Parenteral and Enteral Nutrition.

  15. Perioperative Management of Diabetes: A Review

    Directory of Open Access Journals (Sweden)

    Md Nazmul Kayes

    2014-07-01

    Full Text Available Diabetes increases the requirements of surgery as well as perioperative morbidity and mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases, intensive intraoperative and postoperative management are essential to optimize the best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and hypoinsulinemia can lead to life threatening complications like ketoacidosis or hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and chance of postoperative wound infection is more in diabetics. Therefore aseptic precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be provided for good metabolic control. Though some current study reveals that oral hypoglycemic agents can be used for the effective management of perioperative diabetes; the adverse effects of newly introduced agents need more clinical observations. Subcutaneous administration of insulin as in Sliding Scale may be a less preferable method, because of unreliable absorption and unpredictable blood glucose. Intravenous administration of rapid onset soluble (short acting insulin as in Alberti (GIK regimen, is safe and effective method controlling perioperative hyperglycemia. Patient with type 1 diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery assessment for diabetic ketoacidosis (DKA and meticulous management is essential. Postoperative pain and hyperglycemia should be treated carefully to avoid complications.

  16. [Perioperative management of long-term medication].

    Science.gov (United States)

    Vogel Kahmann, I; Ruppen, W; Lurati Buse, G; Tsakiris, D A; Bruggisser, M

    2011-01-01

    Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

  17. [Perioperative managment of laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  18. In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration.

    Science.gov (United States)

    Blom, M T; Jansen, S; de Jonghe, A; van Munster, B C; de Boer, A; de Rooij, S E; Tan, H L; van der Velde, N

    2015-05-01

    Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated with potentially dangerous perioperative QTc-prolongation (PD-QTc; increase >50 ms or to >500 ms). Prospective cohort study. Tertiary university teaching-hospital. Patients enrolled in a randomized controlled clinical trial of melatonin versus placebo on occurrence of delirium in hip-fracture patients. Data from ECGs made before and after hip surgery (1-3 days and/or 4-6 days post-surgery) were analyzed. QTc-duration was measured by hand, blinded for haloperidol and pre/post-surgery status. Clinical variables were measured at baseline. Mixed model analysis was used to estimate changes in QTc-duration. Risk-factors for PD-QTc were estimated by logistic regression analysis. We included 89 patients (mean age 84 years, 24% male); 39 were treated with haloperidol. Patients with normal pre-surgery QTc-duration (male ≤430 ms, female ≤450 ms) had a significant increase (mean 12 ms, SD 28) in QTc-duration. A significant decrease (mean 19 ms, SD 34) occurred in patients with prolonged pre-surgery QTc-duration (male >450ms, female >470 ms). Haloperidol-use did not influence the perioperative course of the QTc-interval (p=0.351). PD-QTc (n=8) was not associated with any of the measured risk-factors. QTc-duration changed differentially, increasing in patients with normal, but decreasing in patients with abnormal baseline QTc-duration. PD-QTc was not associated with haloperidol-use or other risk-factors. Low-dose oral haloperidol did not affect perioperative QTc-interval.

  19. Windows Terminal Servers Orchestration

    Science.gov (United States)

    Bukowiec, Sebastian; Gaspar, Ricardo; Smith, Tim

    2017-10-01

    Windows Terminal Servers provide application gateways for various parts of the CERN accelerator complex, used by hundreds of CERN users every day. The combination of new tools such as Puppet, HAProxy and Microsoft System Center suite enable automation of provisioning workflows to provide a terminal server infrastructure that can scale up and down in an automated manner. The orchestration does not only reduce the time and effort necessary to deploy new instances, but also facilitates operations such as patching, analysis and recreation of compromised nodes as well as catering for workload peaks.

  20. Invariant sets for Windows

    CERN Document Server

    Morozov, Albert D; Dragunov, Timothy N; Malysheva, Olga V

    1999-01-01

    This book deals with the visualization and exploration of invariant sets (fractals, strange attractors, resonance structures, patterns etc.) for various kinds of nonlinear dynamical systems. The authors have created a special Windows 95 application called WInSet, which allows one to visualize the invariant sets. A WInSet installation disk is enclosed with the book.The book consists of two parts. Part I contains a description of WInSet and a list of the built-in invariant sets which can be plotted using the program. This part is intended for a wide audience with interests ranging from dynamical

  1. Windows Azure Platform

    CERN Document Server

    Redkar, Tejaswi

    2011-01-01

    The Windows Azure Platform has rapidly established itself as one of the most sophisticated cloud computing platforms available. With Microsoft working to continually update their product and keep it at the cutting edge, the future looks bright - if you have the skills to harness it. In particular, new features such as remote desktop access, dynamic content caching and secure content delivery using SSL make the latest version of Azure a more powerful solution than ever before. It's widely agreed that cloud computing has produced a paradigm shift in traditional architectural concepts by providin

  2. Windows Azure web sites

    CERN Document Server

    Chambers, James

    2013-01-01

    A no-nonsense guide to maintaining websites in Windows Azure If you're looking for a straightforward, practical guide to get Azure websites up and running, then this is the book for you. This to-the-point guide provides you with the tools you need to move and maintain a website in the cloud. You'll discover the features that most affect developers and learn how they can be leveraged to work to your advantage. Accompanying projects enhance your learning experience and help you to walk away with a thorough understanding of Azure's supported technologies, site deployment, and manageme

  3. Handbook on Windows and Energy

    DEFF Research Database (Denmark)

    Thomsen, Kirsten Engelund; Schultz, Jørgen Munthe; Svendsen, Sv Aa Højgaard

    The handbook on windows and energy is a general description of windows with the main focus put on the energy performance. Common window products are described by commonly used nomenclature, description of frame and sash conctructions and description of commonly used glazing types.The energy...... transmission through windows is described in detail including radiation, convection and conduction as well as solar transmittance of window glazing. The most used terms related to characterization of window energy performance are defined and calculation methods according to international standards...... flow and detailed calculation of light and solar transmittance is given.Different measurement techniques for characterization of window heat loss coefficient and total solar energy transmittance is described and references to interantional standards are given.Finally, the handbook includes...

  4. Windows with improved energy performances

    DEFF Research Database (Denmark)

    Laustsen, Jacob Birck; Svendsen, Svend

    2003-01-01

    Heat loss through windows represents a considerable part of the total heat loss from houses. However, apart from providing daylight access and view, windows offer a unique potential for solar gain to be exploited during the heating season. Until now valuation of the energy performance of windows...... has primary focused on the heat loss coefficient, U-value. However, as the U-value, especially for the glazing part, has improved considerably during the last years, the total solar energy transmittance, g-value, has become equally important to the total energy performance of windows. Improved energy...... resulted in a window with a positive net energy gain (in short the Net Gain Window), which means that it contributes to the space heating of the building. All improvements are based on existing technology and manufacturing methods. The results from this work show that the energy performances of windows can...

  5. Wash-resistance of pirimiphos-methyl insecticide treatments of window screens and eave baffles for killing indoor-feeding malaria vector mosquitoes: an experimental hut trial, South East of Zambia.

    Science.gov (United States)

    Chinula, Dingani; Sikaala, Chadwick H; Chanda-Kapata, Pascalina; Hamainza, Busiku; Zulu, Reuben; Reimer, Lisa; Chizema, Elizabeth; Kiware, Samson; Okumu, Fredros O; Killeen, Gerry

    2018-04-13

    The effectiveness of long-lasting insecticidal-treated nets (LLINs) and indoor residual spraying (IRS) for malaria control is threatened by resistance to commonly used pyrethroid insecticides. Rotations, mosaics, combinations, or mixtures of insecticides from different complementary classes are recommended by the World Health Organization (WHO) for mitigating against resistance, but many of the alternatives to pyrethroids are prohibitively expensive to apply in large national IRS campaigns. Recent evaluations of window screens and eave baffles (WSEBs) treated with pirimiphos-methyl (PM), to selectively target insecticides inside houses, demonstrated malaria vector mortality rates equivalent or superior to IRS. However, the durability of efficacy when co-applied with polyacrylate-binding agents (BA) remains to be established. This study evaluated whether WSEBs, co-treated with PM and BA have comparable wash resistance to LLINs and might therefore remain insecticidal for years rather than months. WHO-recommended wire ball assays of insecticidal efficacy were applied to polyester netting treated with or without BA plus 1 or 2 g/sq m PM. They were then tested for insecticidal efficacy using fully susceptible insectary-reared Anopheles gambiae mosquitoes, following 0, 5, 10, 15, then 20 washes as per WHO-recommended protocols for accelerated ageing of LLINs. This was followed by a small-scale field trial in experimental huts to measure malaria vector mortality achieved by polyester netting WSEBs treated with BA and 2 g/sq m PM after 0, 10 and then 20 standardized washes, alongside recently applied IRS using PM. Co-treatment with BA and either dosage of PM remained insecticidal over 20 washes in the laboratory. In experimental huts, WSEBs treated with PM plus BA consistently killed similar proportions of Anopheles arabiensis mosquitoes to PM-IRS (both consistently ≥ 94%), even after 20 washes. Co-treating WSEBs with both PM and BA results in wash

  6. The role of perioperative sodium bicarbonate infusion affecting renal function after Cardiothoracic Surgery

    Directory of Open Access Journals (Sweden)

    Katja Regina Turner

    2014-06-01

    Full Text Available Cardiac surgery associated acute kidney injury (CSA-AKI is associated with poor outcomes including increased mortality, length of hospital stay and cost. The incidence of acute kidney injury (AKI is reported to be between 3-30% depending on the definition of AKI. We designed a multicenter randomized controlled trial to test our hypothesis that a perioperative infusion of sodium bicarbonate during cardiac surgery will attenuate the postoperative rise in creatinine indicating renal injury when compared to a perioperative infusion with normal saline. An interim analysis was performed after data was available on the first 120 participants. A similar number of patients in the two treatment groups developed acute kidney injury (AKI, defined as an increase in serum creatinine the first 48 hours after surgery of 0.3 mg/dl or more. Specifically 14 patients (24% who received sodium chloride (SC and 17 patients (27% who received sodium bicarbonate (SB were observed to develop AKI post surgery, resulting in a relative risk of AKI of 1.1 (95% CI: 0.6-2.1, chi-square p-value=0.68 for patients receiving SB compared to those who received SC . The data safety monitoring board for the trial recommended closing the study early as there was only a 12% probability that the null hypothesis would be rejected. We therefore concluded that a perioperative infusion of sodium bicarbonate failed to attenuate the risk of CSA-AKI.

  7. Windows on the axion

    International Nuclear Information System (INIS)

    Turner, M.S.

    1989-04-01

    Peccei-Quinn symmetry with attendant axion is a most compelling, and perhaps the most minimal, extension of the standard model, as it provides a very elegant solution to the nagging strong CP-problem associated with the Θ vacuum structure of QCD. However, particle physics gives little guidance as to the axion mass; a priori, the plausible values span the range: 10/sup /minus/12/ eV /approx lt/ m/sub a/ /approx lt/ 10 6 eV, some 18 orders-of-magnitude. Axions have a host of interesting astrophysical and cosmological effects, including, modifying the evolution of stars of all types (our sun, red giants, white dwarfs, and neutron stars), contributing significantly to the mass density of the Universe today, and producing detectable line radiation through the decays of relic axions. Consideration of these effects has probed 14 orders-of-magnitude in axion mass, and has left open only two windows for further exploration: 10/sup /minus/6/ eV /approx lt/ m/sub a/ /approx lt/ 10/sup /minus/3/ eV and 1 eV /approx lt/ m/sub a/ /approx lt/ 5 eV (hadronic axions only). Both these windows are accessible to experiment, and a variety of very interesting experiments, all of which involve ''heavenly axions,'' are being planned or are underway. 58 refs., 6 figs., 1 tab

  8. WINDOW-CLEANING

    CERN Multimedia

    Environmental Section / ST-TFM

    2001-01-01

    The two-month window-cleaning session on the Meyrin, Prévessin and LEP sites will soon begin. The cleaning contractors will work from Monday to Saturday, every week from 4.00 a.m. to 8.00 p.m. The work will be organised so as to disturb users as little as possible. In any event, a work notice will be left in each office 24 hours beforehand. To prevent any damage to documents or items which could occur despite the precautions taken, please clear completely the window-sills and the area immediately around them. If, however, for valid reasons, the work cannot be done on the scheduled day, please inform the Environmental Section by telephoning: 73753 / 74233 / 72242 If you are going to be absent during this two-month period, we should be grateful if you would clear the above mentioned areas before your departure. REMINDER To allow more thorough cleaning of the entrance doors to buildings and also facilitate the weekly work of the cleaning contractors, we ask you to make use of the notice boards at the...

  9. Evidence for the perioperative care of mastectomized women

    Directory of Open Access Journals (Sweden)

    Carla Monique Lopes Mourão

    2014-01-01

    Full Text Available This study aimed to evaluate the evidence available in the literature about the perioperative care provided to women submitted to mastectomy. An integrative review of scientific literature conducted in MEDLINE, CINAHL, LILACS, and SciELO databases, published from 2000 to 2011, using the controlled descriptors: preoperative care; preoperative period; intraoperative care; intraoperative period; postoperative care; postoperative period; perioperative care; perioperative period; and mastectomy. The sample of this review consisted of seven articles. The evidence pointed as perioperative care of mastectomy the pharmacological management of pain in different surgical periods. Despite the difficulty in presenting a consensus of evidence for perioperative care of mastectomy, there was concern on the part of professionals to minimize/prevent pre-, intra- and post-operative pain. Nursing should be aware, both of the update of pharmacological treatments in pain management and the development of future research related to nursing care in the perioperative period of mastectomy.

  10. Beta-blocker subtype and risks of perioperative adverse events following non-cardiac surgery

    DEFF Research Database (Denmark)

    Jørgensen, Mads E.; Sanders, Robert D.; Køber, Lars

    2017-01-01

    Aims Beta-blockers vary in pharmacodynamics and pharmacokinetic properties. It is unknown whether specific types are associated with increased perioperative risks. We evaluated perioperative risks associated with beta-blocker subtypes, overall and in patient subgroups. Methods and results We...... performed a Danish Nationwide cohort study, 2005-2011, of patients treated chronically with beta blocker (atenolol, bisoprolol, carvedilol, metoprolol, propranolol, or other) prior to non-cardiac surgery. Risks of 30-day all-cause mortality (ACM) and 30-day major adverse cardiovascular events (MACE) were...... in analyses stratified by age, surgery priority, duration of anaesthesia or surgery risk (all P for interaction >0.05). Conclusion Risks of ACM and MACE did not systematically differ by beta-blocker subtype. Findings may guide clinical practice and future trials....

  11. Working with Windows 7 at CERN (EN)

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    Overview of new concepts and user interface changes in Windows 7 as compared with older versions of Windows: XP or Vista. Availability of Windows 7 at CERN and its integration with CERN Windows infrastructure will be discussed.

  12. Window observers for linear systems

    Directory of Open Access Journals (Sweden)

    Utkin Vadim

    2000-01-01

    Full Text Available Given a linear system x ˙ = A x + B u with output y = C x and a window function ω ( t , i.e., ∀ t , ω ( t ∈ {0,1 }, and assuming that the window function is Lebesgue measurable, we refer to the following observer, x ˆ = A x + B u + ω ( t L C ( x − x ˆ as a window observer. The stability issue is treated in this paper. It is proven that for linear time-invariant systems, the window observer can be stabilized by an appropriate design under a very mild condition on the window functions, albeit for linear time-varying system, some regularity of the window functions is required to achieve observer designs with the asymptotic stability. The corresponding design methods are developed. An example is included to illustrate the possible applications

  13. Windows 7 the definitive guide

    CERN Document Server

    Stanek, William R

    2010-01-01

    This book provides everything you need to manage and maintain Windows 7. You'll learn all of the features and enhancements in complete detail, along with specifics for configuring the operating system to put you in full control. Bestselling author and Windows expert William Stanek doesn't just show you the steps you need to follow, he also tells you how features work, why they work, and how you can customize them to meet your needs. Learn how to squeeze every bit of power out of Windows 7 to take full advantage of its features and programs. Set up, customize, and tune Windows 7-Optimize its

  14. Windows 7 The Missing Manual

    CERN Document Server

    Pogue, David

    2010-01-01

    In early reviews, geeks raved about Windows 7. But if you're an ordinary mortal, learning what this new system is all about will be challenging. Fear not: David Pogue's Windows 7: The Missing Manual comes to the rescue. Like its predecessors, this book illuminates its subject with reader-friendly insight, plenty of wit, and hardnosed objectivity for beginners as well as veteran PC users. Windows 7 fixes many of Vista's most painful shortcomings. It's speedier, has fewer intrusive and nagging screens, and is more compatible with peripherals. Plus, Windows 7 introduces a slew of new features,

  15. Microsoft Windows Operating System Essentials

    CERN Document Server

    Carpenter, Tom

    2012-01-01

    A full-color guide to key Windows 7 administration concepts and topics Windows 7 is the leading desktop software, yet it can be a difficult concept to grasp, especially for those new to the field of IT. Microsoft Windows Operating System Essentials is an ideal resource for anyone new to computer administration and looking for a career in computers. Delving into areas such as fundamental Windows 7 administration concepts and various desktop OS topics, this full-color book addresses the skills necessary for individuals looking to break into a career in IT. Each chapter begins with a list of topi

  16. Beginning Windows 8.1

    CERN Document Server

    Halsey, Mike

    2013-01-01

    Windows 8 has been described by Microsoft as its 'boldest' Windows release ever and the 8.1 update enhances the paradigm further. Beginning Windows 8.1 takes you through the new features and helps you get more out of the familiar to reveal the fullest possibilities for this amazing new operating system. You will learn, with non-technical language used throughout, how to get up and running in the new Windows interface, minimize downtime, maximize productivity, and harness the features you never knew existed to take control of your computer and enjoy the peace of mind and excitement that comes w

  17. Live histograms in moving windows

    International Nuclear Information System (INIS)

    Zhil'tsov, V.E.

    1989-01-01

    Application of computer graphics for specific hardware testing is discussed. The hardware is position sensitive detector (multiwire proportional chamber) which is used in high energy physics experiments, and real-out electronics for it. Testing program is described (XPERT), which utilises multi-window user interface. Data are represented as histograms in windows. The windows on the screen may be moved, reordered, their sizes may be changed. Histograms may be put to any window, and hardcopy may be made. Some program internals are discussed. The computer environment is quite simple: MS-DOS IBM PC/XT, 256 KB RAM, CGA, 5.25'' FD, Epson MX. 4 refs.; 7 figs

  18. Perioperative interstitial brachytherapy for recurrent keloid scars

    International Nuclear Information System (INIS)

    Rio, E.; Bardet, E.; Peuvrel, P.; Martinet, L.; Perrot, P.; Baraer, F.; Loirat, Y.; Sartre, J.Y.; Malard, O.; Ferron, C.; Dreno, B.

    2010-01-01

    Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

  19. Perioperative lung protective ventilation in obese patients.

    Science.gov (United States)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-05-06

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity.

  20. Perioperative pharmacokinetics of methadone in adolescents.

    Science.gov (United States)

    Sharma, Anshuman; Tallchief, Danielle; Blood, Jane; Kim, Thomas; London, Amy; Kharasch, Evan D

    2011-12-01

    Methadone is frequently administered to adults experiencing anesthesia and receiving pain treatment. Methadone pharmacokinetics in adults are well characterized, including the perioperative period. Methadone is also used in children. There is, however, no information on methadone pharmacokinetics in children of any age. The purpose of this investigation was to determine the pharmacokinetics of intravenous methadone in children undergoing surgery. Perioperative opioid-sparing effects were also assessed. Eligible subjects were children 5-18 yr undergoing general anesthesia and surgery, with an anticipated postoperative inpatient stay exceeding 3 days. Three groups of 10 to 11 patients each received intravenous methadone hydrochloride after anesthetic induction in ascending dose groups of 0.1, 0.2, and 0.3 mg/kg (up to 20 mg). Anesthetic care was not otherwise changed. Venous blood was obtained for 4 days, for stereoselective determination of methadone and metabolites. Pain assessments were made each morning. Daily and total opioid consumption was determined. Perioperative opioid consumption and pain was determined in a second cohort, which was matched to age, sex, race, ethnicity, surgical procedure, and length of stay, but not receiving methadone. The final methadone study cohort was 31 adolescents (14 ± 2 yr, range 10-18) undergoing major spine surgery for a diagnosis of scoliosis. Methadone pharmacokinetics were linear over the dose range 0.1-0.3 mg/kg. Disposition was stereoselective. Methadone administration did not dose-dependently affect postoperative pain scores, and did not dose-dependently decrease daily or total postoperative opioid consumption in spinal fusion patients. Methadone enantiomer disposition in adolescents undergoing surgery was similar to that in healthy adults.

  1. Perioperative Prophylaxis for Total Artificial Heart Transplantation.

    Science.gov (United States)

    Chambers, H E; Pelish, P; Qiu, F; Florescu, D F

    2017-11-01

    Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non-penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post-TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). Preventing infections post-TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol. Copyright © 2017. Published by Elsevier Inc.

  2. Melatonin in perioperative medicine: Current perspective

    Directory of Open Access Journals (Sweden)

    Souvik Maitra

    2013-01-01

    Full Text Available Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also.

  3. Peri-operative cognitive dysfunction and protection

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2016-01-01

    Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...... factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can...... reduce the rate of delirium in the elderly, but in spite of promising findings in animal experiments, no intervention reduces postoperative cognitive dysfunction in humans....

  4. Transcultural nursing in perioperative patient care.

    Directory of Open Access Journals (Sweden)

    Anna Kostka

    2017-06-01

    Full Text Available Jehovah's Witnesses is a religious association, who refuses blood transfusions even in life-threatening conditions. There are several alternative methods, implemented for use with patients that religion, whose task is to reduce the risk of bleeding and hemorrhage in the perioperative period. Good cooperation of the therapeutic team, the selection of appropriate treatment, the use of recommended methods of anesthesia, surgical techniques and proper nursing care with careful monitoring of post-operative complications and quick response if they leave, they contribute to the improvement of health.

  5. Windows forensic analysis toolkit advanced analysis techniques for Windows 7

    CERN Document Server

    Carvey, Harlan

    2012-01-01

    Now in its third edition, Harlan Carvey has updated "Windows Forensic Analysis Toolkit" to cover Windows 7 systems. The primary focus of this edition is on analyzing Windows 7 systems and on processes using free and open-source tools. The book covers live response, file analysis, malware detection, timeline, and much more. The author presents real-life experiences from the trenches, making the material realistic and showing the why behind the how. New to this edition, the companion and toolkit materials are now hosted online. This material consists of electronic printable checklists, cheat sheets, free custom tools, and walk-through demos. This edition complements "Windows Forensic Analysis Toolkit, 2nd Edition", (ISBN: 9781597494229), which focuses primarily on XP. It includes complete coverage and examples on Windows 7 systems. It contains Lessons from the Field, Case Studies, and War Stories. It features companion online material, including electronic printable checklists, cheat sheets, free custom tools, ...

  6. Learning Windows Azure Mobile Services for Windows 8 and Windows Phone 8

    CERN Document Server

    Webber-Cross, Geoff

    2014-01-01

    This book is based around a case study game which was written for the book. This means that the chapters progress in a logical way and build upon lessons learned as we go. Real-world examples are provided for each topic that are practical and not given out-of-context so they can be applied directly to other applications.If you are a developer who wishes to build Windows 8 and Phone 8 applications and integrate them with Windows Azure Mobile Services, this book is for you. Basic C# and JavaScript skills are advantageous, as well as some knowledge of building Windows 8 or Windows Phone 8 applica

  7. Critical Elements for the Pediatric Perioperative Anesthesia Environment.

    Science.gov (United States)

    Polaner, David M; Houck, Constance S

    2015-12-01

    The American Academy of Pediatrics proposes guidance for the pediatric perioperative anesthesia environment. Essential components are identified to optimize the perioperative environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events. Copyright © 2015 by the American Academy of Pediatrics.

  8. Perioperative nutrition: what do we know? | Kotze | South African ...

    African Journals Online (AJOL)

    Surgery patients are at risk for iatrogenic malnutrition and subsequent deleterious effects. The benefits of nutrition support on patient outcomes have been demonstrated and the possible benefit of perioperative nutrition support thus implied. Enhanced recovery after surgery (ERAS) protocols, including perioperative nutrition ...

  9. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    Science.gov (United States)

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  10. The impact of acute preoperative beta-blockade on perioperative ...

    African Journals Online (AJOL)

    To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and all- ... Our findings suggest that acute preoperative β-blockade is associated with an increased risk of perioperative cardiac ..... Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE.

  11. Rootkit pro MS Windows

    OpenAIRE

    Trutman, Michal

    2012-01-01

    Tato bakalářská práce se zabývá metodami útoků na operační systém MS Windows a přibližuje techniky skrývání výpočetních prostředků používané existujícími rootkity. Práce je rozdělena na teoretickou a praktickou část. První část pojednává o klasifikaci rootkitů, představuje strukturu jádra systému a následně popisuje jednotlivé techniky napadení operačního systému. V praktické části je prezentována implementace a testování vlastního rootkitu. This bachelor's thesis deals with methods of att...

  12. Destiny's Earth Observation Window

    Science.gov (United States)

    2002-01-01

    Astronaut Michael J. Bloomfield, STS-110 mission commander, looks through the Earth observation window in the Destiny laboratory aboard the International Space Station (ISS). The STS-110 mission prepared the ISS for future spacewalks by installing and outfitting the S0 (S-zero) truss and the Mobile Transporter. The 43-foot-long S0 Truss, weighing in at 27,000 pounds, was the first of 9 segments that will make up the Station's external framework that will eventually stretch 356 feet (109 meters), or approximately the length of a football field. This central truss segment also includes a flatcar called the Mobile Transporter and rails that will become the first 'space railroad,' which will allow the Station's robotic arm to travel up and down the finished truss for future assembly and maintenance. The completed truss structure will hold solar arrays and radiators to provide power and cooling for additional international research laboratories from Japan and Europe that will be attached to the Station. Milestones of the STS-110 mission included the first time the ISS robotic arm was used to maneuver spacewalkers around the Station and marked the first time all spacewalks were based out of the Station's Quest Airlock. It was also the first Shuttle to use three Block II Main Engines. The Space Shuttle Orbiter Atlantis, STS-110 mission, was launched April 8, 2002 and returned to Earth April 19, 2002.

  13. Window prototypes during the project

    DEFF Research Database (Denmark)

    Schultz, Jørgen Munthe

    1996-01-01

    The conditions for the PASSYS test and the results of the measurements on one of the aerogel window prototypes are described.......The conditions for the PASSYS test and the results of the measurements on one of the aerogel window prototypes are described....

  14. Peri-operative glycaemic control regimens for preventing surgical site infections in adults.

    Science.gov (United States)

    Kao, Lillian S; Meeks, Derek; Moyer, Virginia A; Lally, Kevin P

    2009-07-08

    Surgical site infections (SSIs) are associated with significant morbidity, mortality, and resource utilization and are potentially preventable. Peri-operative hyperglycaemia has been associated with increased SSIs and previous recommendations have been to treat glucose levels above 200 mg/dL. However, recent studies have questioned the optimal glycaemic control regimen to prevent SSIs. Whether the benefits of strict or intensive glycaemic control with insulin infusion as compared to conventional management outweigh the risks remains controversial. To summarise the evidence for the impact of glycaemic control in the peri-operative period on the incidence of surgical site infections, hypoglycaemia, level of glycaemic control, all-cause and infection-related mortality, and hospital length of stay and to investigate for differences of effect between different levels of glycaemic control. A search strategy was developed to search the following databases: Cochrane Wounds Group Specialised Register (searched 25 March 2009), The Cochrane Central Register of Controlled Trials, The Cochrane Library 2009, Issue 1; Ovid MEDLINE (1950 to March Week 2 2009); Ovid EMBASE (1980 to 2009 Week 12) and EBSCO CINAHL (1982 to March Week 3 2009). The search was not limited by language or publication status. Randomised controlled trials (RCTs) were eligible for inclusion if they evaluated two (or more) glycaemic control regimens in the peri-operative period (within one week pre-, intra-, and/or post-operative) and reported surgical site infections as an outcome. The standard method for conducting a systematic review in accordance with the Cochrane Wounds Group was used. Two review authors independently reviewed the results from the database searches and identified relevant studies. Two review authors extracted study data and outcomes from each study and reviewed each study for methodological quality. Any disagreement was resolved by discussion or by referral to a third review author. Five

  15. Improved Windows for Cold Climates

    DEFF Research Database (Denmark)

    Laustsen, Jacob Birck; Svendsen, Svend

    2005-01-01

    considerably by reducing the frame width, which results in a larger transparent area causing a larger solar gain but still main-taining a low thermal transmittance. Using three layers of glass with large gaps, using very slim frame profiles, and omitting the edge constructions that normally causes thermal...... windows with improved energy performance. Traditionally evaluation of the energy performance of windows has focused on the thermal transmittance, but as windows differ from the rest of the building envelope by allowing solar energy to enter the building, the total solar energy transmittance is equally...... important. In the heating season in cold climates the solar gain through windows can be utilized for space heating which results in a corresponding reduction in the energy production that is often based on fossil fuels. A suitable quantity for evaluating the energy performance of windows in a simple...

  16. Evolution and revision of the Perioperative Nursing Data Set.

    Science.gov (United States)

    Petersen, Carol; Kleiner, Cathy

    2011-01-01

    The Perioperative Nursing Data Set (PNDS) is a nursing language that provides standardized terminology to support perioperative nursing practice. The PNDS represents perioperative nursing knowledge and comprises data elements and definitions that demonstrate the nurse's influence on patient outcomes. Emerging issues and changes in practice associated with the PNDS standardized terminology require ongoing maintenance and periodic in-depth review of its content. Like each new edition of the Perioperative Nursing Data Set, the third edition, published in 2010, underwent content validation by numerous experts in clinical practice, vocabulary development, and informatics. The goal of this most recent edition is to enable the perioperative nurse to use the PNDS in a meaningful manner, as well as to promote standardization of PNDS implementation in practice, both in written documentation and the electronic health record. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  17. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  18. Lunar phase does not influence perioperative complications in total hip arthroplasty.

    Science.gov (United States)

    Ficklscherer, Andreas; Angermann, Alexander; Weber, Patrick; Wegener, Bernd; Pietschmann, Matthias; Müller, Peter

    2012-02-29

    Lunar calendars, publishing recommendations for daily life, are gaining more and more attention in Germany, where 10.5% of the population believe in lunar effects on disease. A widespread and often heard belief is that a full moon has the most negative effects on surgical outcome. The present study evaluates the effects of lunar phase on perioperative complications in total hip arthroplasty. We performed a retrospective study with 305 patients being provided with a primary hip arthroplasty. To identify possible influences of the lunar phase on perioperative complications we investigated data such as operation length, blood loss and course of C-reactive protein that were collected during the patients' stay in the hospital and allocated them to moon illumination. There were no significant differences in all collected data concerning the lunar phase (p > 0.05). Although not statistically significant, there were fewer operations during the full moon phase. Therefore there is no evidence that lunar phase has an effect on perioperative complications in total hip arthroplasty. Fewer, though not significantly fewer, operations were performed during the full moon phase. Although this was not a prospective randomized trial, the statistical magnitude of the results does not support any recommendations for scheduling patients for total hip arthroplasty at any particular day of the lunar phase.

  19. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  20. Perioperative events influence cancer recurrence risk after surgery.

    Science.gov (United States)

    Hiller, Jonathan G; Perry, Nicholas J; Poulogiannis, George; Riedel, Bernhard; Sloan, Erica K

    2018-04-01

    Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.

  1. Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

    Directory of Open Access Journals (Sweden)

    Aliasgar V Moiyadi

    2012-01-01

    Full Text Available Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

  2. Tokamak physics experiment: Diagnostic windows study

    International Nuclear Information System (INIS)

    Merrigan, M.; Wurden, G.A.

    1995-11-01

    We detail the study of diagnostic windows and window thermal stress remediation in the long-pulse, high-power Tokamak Physics Experiment (TPX) operation. The operating environment of the TPX diagnostic windows is reviewed, thermal loads on the windows estimated, and cooling requirements for the windows considered. Applicable window-cooling technology from other fields is reviewed and its application to the TPX windows considered. Methods for TPX window thermal conditioning are recommended, with some discussion of potential implementation problems provided. Recommendations for further research and development work to ensure performance of windows in the TPX system are presented

  3. The effects of a randomised multi-centre trial and international accreditation on availability and quality of clinical guidelines

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Gluud, Christian; Wetterslev, Jørn

    2005-01-01

    To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation.......To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation....

  4. Transparent solar cell window module

    Energy Technology Data Exchange (ETDEWEB)

    Chau, Joseph Lik Hang; Chen, Ruei-Tang; Hwang, Gan-Lin; Tsai, Ping-Yuan [Nanopowder and Thin Film Technology Center, ITRI South, Industrial Technology Research Institute, Tainan County 709 (China); Lin, Chien-Chu [I-Lai Acrylic Corporation, Tainan City (China)

    2010-03-15

    A transparent solar cell window module based on the integration of traditional silicon solar cells and organic-inorganic nanocomposite material was designed and fabricated. The transparent solar cell window module was composed of a nanocomposite light-guide plate and traditional silicon solar cells. The preparation of the nanocomposite light-guide plate is easy without modification of the traditional casting process, the nanoparticles sol can be added directly to the polymethyl methacrylate (PMMA) monomer syrup during the process. The solar energy collected by this window can be used to power up small household electrical appliances. (author)

  5. Big Book of Windows Hacks

    CERN Document Server

    Gralla, Preston

    2008-01-01

    Bigger, better, and broader in scope, the Big Book of Windows Hacks gives you everything you need to get the most out of your Windows Vista or XP system, including its related applications and the hardware it runs on or connects to. Whether you want to tweak Vista's Aero interface, build customized sidebar gadgets and run them from a USB key, or hack the "unhackable" screensavers, you'll find quick and ingenious ways to bend these recalcitrant operating systems to your will. The Big Book of Windows Hacks focuses on Vista, the new bad boy on Microsoft's block, with hacks and workarounds that

  6. Production management of window handles

    Directory of Open Access Journals (Sweden)

    Manuela Ingaldi

    2014-12-01

    Full Text Available In the chapter a company involved in the production of aluminum window and door handles was presented. The main customers of the company are primarily companies which produce PCV joinery and wholesalers supplying these companies. One chosen product from the research company - a single-arm pin-lift window handle - was described and its production process depicted technologically. The chapter also includes SWOT analysis conducted in the research company and the value stream of the single-arm pin-lift window handle.

  7. Windows 8 visual quick tips

    CERN Document Server

    McFedries, Paul

    2012-01-01

    Easy-in, easy-out format covers all the bells and whistles of Windows 8 If you want to learn how to work smarter and faster in Microsoft's Windows 8 operating system, this easy-to-use, compact guide delivers the goods. Designed for visual learners, it features short explanations and full-color screen shots on almost every page, and it's packed with timesaving tips and helpful productivity tricks. From enhancing performance and managing digital content to setting up security and much more, this handy guide will help you get more out of Windows 8. Uses full-color screen shots and short, step-by-

  8. Windows Phone 7 Made Simple

    CERN Document Server

    Trautschold, Martin

    2011-01-01

    With Windows Phone 7, Microsoft has created a completely new smartphone operating system that focuses on allowing users to be productive with their smartphone in new ways, while offering seamless integration and use of Microsoft Office Mobile as well as other productivity apps available in the Microsoft App Store. Windows Phone 7 Made Simple offers a clear, visual, step-by-step approach to using your Windows Phone 7 smartphone, no matter what the manufacturer. Author Jon Westfall is an expert in mobile devices, recognized by Microsoft as a "Most Valuable Professional" with experience

  9. Holography through optically active windows

    Science.gov (United States)

    Decker, A. J.

    1979-01-01

    By using two orthogonally polarized reference beams, holograms can be recorded through stressed windows and the reconstructed virtual image will show no stress pattern. As shown analytically, the stress-pattern-free hologram is recordable for any polarization state of the object illumination. Hence, the more efficient nondepolarizing diffuser can be used in performing holography through stressed windows if two reference beams are used. Results are presented for a pair of machined polysulfone windows intended for use in a holographic flow-visualization setup in a single-stage-compressor test rig.

  10. Grab Windows training opportunities; check CERN Windows roadmap!

    CERN Multimedia

    IT Department

    2011-01-01

    CERN Operating Systems and Information Services group (IT-OIS) actively monitors market trends to check how new software products correspond to CERN needs. In the Windows world, Windows 7 has been a big hit, with over 1500 Windows 7 PCs within less than a year since its support was introduced at CERN. No wonder: Windows XP is nearly 10 years old and is steadily approaching the end of its life-cycle. At CERN, support for Windows XP will stop at the end of December 2012. Compared to Vista, Windows 7 has the same basic hardware requirements, but offers higher performance, so the decision to upgrade is rather straightforward. CERN support for Vista will end in June 2011. In the world of Microsoft Office, version 2007 offers better integration with the central services than the older version 2003. Progressive upgrade from 2003 to 2007 is planned to finish in September 2011, but users are encouraged to pro-actively upgrade at their convenience. Please note that Office 2007 brings an important change in the area of ...

  11. Perioperative management of facial bipartition surgery

    Directory of Open Access Journals (Sweden)

    Caruselli M

    2015-11-01

    Full Text Available Marco Caruselli,1 Michael Tsapis,1,2 Fabrice Ughetto,1 Gregoire Pech-Gourg,3 Dario Galante,4 Olivier Paut1 1Anesthesia and Intensive Care Unit, La Timone Children’s Hospital, 2Pediatric Transport Team, SAMU 13, La Timone Hospital, 3Pediatric Neurosurgery Unit, La Timone Children’s Hospital, Marseille, France; 4Anesthesia and Intensive Care Unit, University Hospital Ospedali Riuniti of Foggia, Foggia, Italy Abstract: Severe craniofacial malformations, such as Crouzon, Apert, Saethre-Chotzen, and Pfeiffer syndromes, are very rare conditions (one in 50,000/100,000 live births that often require corrective surgery. Facial bipartition is the more radical corrective surgery. It is a high-risk intervention and needs complex perioperative management and a multidisciplinary approach. Keywords: craniofacial surgery, facial bipartition surgery, craniofacial malformations, pediatric anesthesia

  12. Perioperative management of patients with pituitary tumours

    Directory of Open Access Journals (Sweden)

    Mary Abraham

    2016-01-01

    Full Text Available Management of pituitary tumours can be very challenging for the anaesthesiologist. These patients require a thorough pre-operative assessment in view of underlying endocrine disturbances, which could cause anatomic and physiological disturbances. This needs to be optimized prior to surgery and the anaesthetic technique planned accordingly. The main intraoperative problems that could be encountered by the anaesthesiologist are airway problems, haemodynamic disturbances and potential for bleeding during surgery. The postoperative concerns are related to the endocrine system and fluid and water balance and this needs to be monitored closely and managed appropriately. The advent of minimally invasive surgery along with neuroimaging has considerably decreased perioperative morbidity and mortality following pituitary surgery. A team approach and close coordination between the endocrinologist, neurosurgeon and anaesthesiologist is imperative for a favourable outcome in patients undergoing pituitary surgery.

  13. Perioperative Management of Sickle Cell Disease.

    Science.gov (United States)

    Adjepong, Kwame Ofori; Otegbeye, Folashade; Adjepong, Yaw Amoateng

    2018-01-01

    Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  14. Supply chain optimization for pediatric perioperative departments.

    Science.gov (United States)

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. Perceptions of perioperative nursing competence: a cross-country comparison.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma B; Falk-Brynhildsen, Karin; Nilsson, Ulrica; Jaensson, Maria

    2018-01-01

    Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence. Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

  16. Peliohjelmointi Windows Phone 8:lle

    OpenAIRE

    Bäckström, Toni

    2014-01-01

    Tässä insinöörityössä tutustutaan Windows Phone 8 -mobiilikäyttöjärjestelmään peliohjelmoijan näkökulmasta. Työn tavoitteena oli erityisesti esitellä Microsoftin itse kehittämiä XNA- ja DirectX-peliohjelmointikirjastoja teoriassa ja käytännössä. Työn aluksi käydään läpi hieman Windows Phonen historiaa ja yleisesti kehittämistä Windows Phone 8:lle. Tämän jälkeen luodaan katsaus Windows Phone 8:aan pelialustana. Työn suurin osuus on XNA:n ja DirectX:n esittely teoriassa; kummastakin men...

  17. Validation of the TRUST tool in a Greek perioperative setting.

    Science.gov (United States)

    Chatzea, Vasiliki-Eirini; Sifaki-Pistolla, Dimitra; Dey, Nilanjan; Melidoniotis, Evangelos

    2017-06-01

    The aim of this study was to translate, culturally adapt and validate the TRUST questionnaire in a Greek perioperative setting. The TRUST questionnaire assesses the relationship between trust and performance. The study assessed the levels of trust and performance in the surgery and anaesthesiology department during a very stressful period for Greece (economic crisis) and offered a user friendly and robust assessment tool. The study concludes that the Greek version of the TRUST questionnaire is a reliable and valid instrument for measuring team performance among Greek perioperative teams. Copyright the Association for Perioperative Practice.

  18. Introducing a music program in the perioperative area.

    Science.gov (United States)

    Cunningham, M F; Monson, B; Bookbinder, M

    1997-10-01

    Music can touch patients deeply and thus transform their anxiety and stress into relaxation and healing. Patients with cancer who undergo surgical procedures are highly stressed. To help alleviate these patients' stress and improve their comfort, perioperative nurses at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, surveyed surgical patients and staff members about introducing a perioperative music program. This article reviews the literature on the use of music in perioperative care settings and describes MSKCC's decision to evaluate and then implement a music program.

  19. A window on urban sustainability

    International Nuclear Information System (INIS)

    Stigt, Rien van; Driessen, Peter P.J.; Spit, Tejo J.M.

    2013-01-01

    Sustainable urban development requires the integration of environmental interests in urban planning. Although various methods of environmental assessment have been developed, plan outcomes are often disappointing due to the complex nature of decision-making in urban planning, which takes place in multiple arenas within multiple policy networks involving diverse stakeholders. We argue that the concept of ‘decision windows’ can structure this seemingly chaotic chain of interrelated decisions. First, explicitly considering the dynamics of the decision-making process, we further conceptualized decision windows as moments in an intricate web of substantively connected deliberative processes where issues are reframed within a decision-making arena, and interests may be linked within and across arenas. Adopting this perspective in two case studies, we then explored how decision windows arise, which factors determine their effectiveness and how their occurrence can be influenced so as to arrive at more sustainable solutions. We conclude that the integration of environmental interests in urban planning is highly dependent on the ability of the professionals involved to recognize and manipulate decision windows. Finally, we explore how decision windows may be opened. -- Highlights: • Decision-making about sustainable urban development occurs in networks. • The concept of ‘decision windows’ was further elaborated. • Decision windows help understand how environmental interests enter decision-making. • Decision windows can, to some extent, be influenced

  20. A window on urban sustainability

    Energy Technology Data Exchange (ETDEWEB)

    Stigt, Rien van, E-mail: rien.vanstigt@hu.nl [Research Center for Technology and Innovation, Utrecht University of Applied Sciences, P.O. Box 182, 3500 AD Utrecht (Netherlands); Driessen, Peter P.J., E-mail: p.driessen@uu.nl [Copernicus Institute of Sustainable Development, Faculty of Geosciences, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht (Netherlands); Spit, Tejo J.M., E-mail: T.J.M.Spit@uu.nl [Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht (Netherlands)

    2013-09-15

    Sustainable urban development requires the integration of environmental interests in urban planning. Although various methods of environmental assessment have been developed, plan outcomes are often disappointing due to the complex nature of decision-making in urban planning, which takes place in multiple arenas within multiple policy networks involving diverse stakeholders. We argue that the concept of ‘decision windows’ can structure this seemingly chaotic chain of interrelated decisions. First, explicitly considering the dynamics of the decision-making process, we further conceptualized decision windows as moments in an intricate web of substantively connected deliberative processes where issues are reframed within a decision-making arena, and interests may be linked within and across arenas. Adopting this perspective in two case studies, we then explored how decision windows arise, which factors determine their effectiveness and how their occurrence can be influenced so as to arrive at more sustainable solutions. We conclude that the integration of environmental interests in urban planning is highly dependent on the ability of the professionals involved to recognize and manipulate decision windows. Finally, we explore how decision windows may be opened. -- Highlights: • Decision-making about sustainable urban development occurs in networks. • The concept of ‘decision windows’ was further elaborated. • Decision windows help understand how environmental interests enter decision-making. • Decision windows can, to some extent, be influenced.

  1. Mastering Microsoft Windows Server 2008 R2

    CERN Document Server

    Minasi, Mark; Finn, Aidan

    2010-01-01

    The one book you absolutely need to get up and running with Windows Server 2008 R2. One of the world's leading Windows authorities and top-selling author Mark Minasi explores every nook and cranny of the latest version of Microsoft's flagship network operating system, Windows Server 2008 R2, giving you the most in-depth coverage in any book on the market.: Focuses on Windows Windows Server 2008 R2, the newest version of Microsoft's Windows' server line of operating system, and the ideal server for new Windows 7 clients; Author Mark Minasi is one of the world's leading Windows authorities and h

  2. Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery.

    Directory of Open Access Journals (Sweden)

    Baohui Yang

    Full Text Available BACKGROUND: Tranexamic acid (TXA is well-established as a versatile oral, intramuscular, and intravenous (IV antifibrinolytic agent. However, the efficacy of IV TXA in reducing perioperative blood transfusion in spinal surgery is poorly documented. METHODOLOGY: We conducted a meta-analysis of randomized controlled trials (RCTs and quasi-randomized (qi-RCTs trials that included patients for various spinal surgeries, such as adolescent scoliosis surgery administered with perioperative IV TXA according to Cochrane Collaboration guidelines using electronic PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. Additional journal articles and conference proceedings were manually located by two independent researchers. RESULTS: Totally, nine studies were included, with a total sample size of 581 patients. Mean blood loss was decreased in patients treated with perioperative IV TXA by 128.28 ml intraoperatively (ranging from 33.84 to 222.73 ml, 98.49 ml postoperatively (ranging from 83.22 to 113.77 ml, and 389.21 ml combined (ranging from 177.83 to 600.60 ml. The mean volume of transfused packed cells were reduced by 134.55 ml (ranging 51.64 to 217.46 (95% CI; P = 0.0001. Overall, the number of patients treated with TXA who required blood transfusions was lower by 35% than that of patients treated with the comparator and who required blood transfusions (RR 0.65; 95% CI; 0.53 to 0.85; P<0.0001, I(2 = 0%. A dose-independent beneficial effect of TXA was observed, and confirmed in subgroup and sensitivity analyses. A total of seven studies reported DVT data. The study containing only a single DVT case was not combined. CONCLUSIONS: The blood loss was reduced in spinal surgery patients with perioperative IV TXA treatment. Also the percentage of spinal surgery patients who required blood transfusion was significantly decreased. Further evaluation is required to confirm our findings before TXA can be safely used in patients

  3. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

    Science.gov (United States)

    Gower, Emily W; Lindsley, Kristina; Tulenko, Samantha E; Nanji, Afshan A; Leyngold, Ilya; McDonnell, Peter J

    2017-01-01

    Background Endophthalmitis is a severe inflammation of the anterior or posterior (or both) chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. Objectives To evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery compared with no prophylaxis or other form of prophylaxis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 12), Ovid MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily (January 1946 to December 2016), Embase (January 1980 to December 2016), Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to December 2016),the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We used no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 6 December 2016. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. We included trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic), or postoperative antibiotic prophylaxis for acute endophthalmitis. We excluded studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine or antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two review authors independently reviewed abstracts and

  4. Perioperative leadership: managing change with insights, priorities, and tools.

    Science.gov (United States)

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  5. Perioperative care of a pregnant trauma victim: a review of ...

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... (until proven otherwise) in any female trauma patient of child- ... The perioperative management of pregnant trauma victims re- ... trauma, abdominal trauma, head injury, cervical spine injury, fetal injury, gun shot wounds, blunt.

  6. [Aspects of perioperative care in patients with diabetes].

    Science.gov (United States)

    Pestel, G; Closhen, D; Zimmermann, A; Werner, C; Weber, M M

    2013-01-01

    Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

  7. Perioperative Evaluation of Pregnant Surgical Patients: A Review

    Directory of Open Access Journals (Sweden)

    Manu Gupta

    2016-06-01

    Full Text Available Pregnant Females require special perioperative consideration as females react differently to treatment from physiologic and behavioural standpoints. Thus a standard perioperative assessment plays a crucial role for successful accomplishment of intraoperative and postoperative phase as well as to resist complications due to pregnancy. Each physiologic system is affected in such a way that may or may not have clinical significance for the surgeons. Thus affect of Pregnancy on cardiovascular, respiratory, gastrointestinal, renal and endocrinal system have been reviewed. Moreover to decrease the hazards to the developing child, impact of surgery/treatment on the fetus has also been discussed. It was concluded that the goal of the perioperative evaluation of pregnant females is to identify its physiological effects on various systems and provide for the best efficacious perioperative treatment algorithm that shall minimize the patient morbidity.

  8. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

    National Research Council Canada - National Science Library

    Cole, Lisa M; Walker, Theodore J; Nader, Kelly C; Glover, Dennis E; Newkirk, Laura E

    2006-01-01

    A clearly defined role of the Perioperative Clinical Nurse Specialist (PONS) is not identified. The purpose of this study was to provide recommendations for a delineated role of the PONS that will provide role clarity and practice guidance...

  9. Trials

    Directory of Open Access Journals (Sweden)

    Michele Fornaro

    2010-01-01

    Full Text Available Mental Retardation (MR is a developmental disability characterized by impairments in adaptive daily life skills and difficulties in social and interpersonal functioning. Since multiple causes may contribute to MR, associated clinical pictures may vary accordingly. Nevertheless, when psychiatric disorders as Treatment Resistant Depression (TRD and/or alcohol abuse co-exist, their proper detection and management is often troublesome, essentially due to a limited vocabulary MR people could use to describe their symptoms, feelings and concerns, and the lack of reliable screening tools. Furthermore, MR people are among the most medicated subjects, with (over prescription of antidepressants and/or typical antipsychotics being the rule rather than exception. Thus, treatment resistance or even worsening of depression, constitute frequent occurrences. This report describes the case of a person with MR who failed to respond to repetitive trials of antidepressant monotherapies, finally recovering using aripiprazole to fluvoxamine augmentation upon consideration of a putative bipolar diathesis for “agitated” TRD. Although further controlled investigations are needed to assess a putative bipolar diathesis in some cases of MR associated to TRD, prudence is advised in the long-term prescription of antidepressant monotherapies in such conditions.

  10. Perioperative corticosteroids for intermittent and mild persistent asthma

    OpenAIRE

    Hiroto Matsuse; Terufumi Shimoda; Ikuko Machida; Yuki Kondo; Tetsuya Kawano; Sachiko Saeki; Shinya Tomari; Kazuko Mitsuta; Chizu Fukushima; Yasushi Obase; Shigeru Kohno

    2002-01-01

    Objectives: Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Methods: Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwe...

  11. I need to know! Timely accessing of perioperative user manuals.

    Science.gov (United States)

    Landreneau, Raphael

    2010-12-01

    Ready access to equipment or product information is essential for the safe operation of the many items that a perioperative nurse is asked to use, troubleshoot, or maintain. One institution's solution for making manufacturer information available in the practice setting was to create a facility intranet site dedicated to OR equipment manuals. This site provides information access to perioperative nurses and support staff members and, ultimately, helps improve patient care. Published by Elsevier Inc. All rights reserved.

  12. Switchable Materials for Smart Windows.

    Science.gov (United States)

    Wang, Yang; Runnerstrom, Evan L; Milliron, Delia J

    2016-06-07

    This article reviews the basic principles of and recent developments in electrochromic, photochromic, and thermochromic materials for applications in smart windows. Compared with current static windows, smart windows can dynamically modulate the transmittance of solar irradiation based on weather conditions and personal preferences, thus simultaneously improving building energy efficiency and indoor human comfort. Although some smart windows are commercially available, their widespread implementation has not yet been realized. Recent advances in nanostructured materials provide new opportunities for next-generation smart window technology owing to their unique structure-property relations. Nanomaterials can provide enhanced coloration efficiency, faster switching kinetics, and longer lifetime. In addition, their compatibility with solution processing enables low-cost and high-throughput fabrication. This review also discusses the importance of dual-band modulation of visible and near-infrared (NIR) light, as nearly 50% of solar energy lies in the NIR region. Some latest results show that solution-processable nanostructured systems can selectively modulate the NIR light without affecting the visible transmittance, thus reducing energy consumption by air conditioning, heating, and artificial lighting.

  13. Novel approaches in management of perioperative coagulopathy.

    Science.gov (United States)

    Tanaka, Kenichi A; Bader, Stephen O; Görlinger, Klaus

    2014-02-01

    The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates. Implementing suitable laboratory tests and transfusion protocols is highly recommended because the laboratory test guided, protocol-driven transfusion approach reduces blood component utilization, and possibly leads to improved outcomes. Timely assessment of coagulation has been difficult using conventional coagulation tests, but thrombocytopenia, fibrin polymerization defects, and fibrinolysis can be quickly assessed on thromboelastometry. The latter testing can be applied to guide the dosing of fibrinogen and prothrombin complex concentrate, which are selectively used to correct fibrinogen deficiency, and improve thrombin generation in acquired coagulopathy. These therapeutic approaches are novel, and potentially effective in reducing the exposure to allogeneic components (e.g., plasma and platelets) and side-effects of transfusion. Although the accessibility of different therapies among different countries, tranexamic acid is widely available, and is an effective blood conservation measure with a good safety profile in various surgical settings. Our understanding of perioperative coagulopathy, diagnostic tools, and therapeutic approaches has evolved in recent years. Additional multidisciplinary efforts are required to understand the optimal combinations, cost-effectiveness, and safety profiles of allogeneic components, and available factor concentrates.

  14. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    V. N. Amirdzhanova

    2014-01-01

    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  15. Travailler avec Windows 7 au CERN (FR)

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    Vue d'ensemble des nouveaux concepts et des changements dans l'interface utilisateur survenus dans Windows 7 depuis les versions antérieures de Windows (XP ou Vista). La mise à disposition de Windows 7 au CERN et son intégration dans l’infrastructure de Windows au CERN seront présentées.

  16. Music@Microsoft.Windows: Composing Ambience

    Science.gov (United States)

    Rickert, Thomas

    2010-01-01

    It is well known, of course, that all Windows versions except for 3.1 have a brief (four to six second) piece of music indicating that Windows is booted and ready for use. While the music may indicate Windows has booted, it bears no immediately discernable relation to the various uses we might actually put Windows to--working, gaming,…

  17. Windows Server 2012 R2 administrator cookbook

    CERN Document Server

    Krause, Jordan

    2015-01-01

    This book is intended for system administrators and IT professionals with experience in Windows Server 2008 or Windows Server 2012 environments who are looking to acquire the skills and knowledge necessary to manage and maintain the core infrastructure required for a Windows Server 2012 and Windows Server 2012 R2 environment.

  18. Windows with improved energy performance

    DEFF Research Database (Denmark)

    Noyé, Peter Anders; Laustsen, Jacob Birck; Svendsen, Svend

    2002-01-01

    According to the Danish energy protocol, Energy 21, one of the goals with highest priority is to reduce the CO2-emission. Energy consumption for domestic heating is a major contributor to the CO2-emission; hence one of the primary efforts to reach the goal is by saving energy in the households...... performances. During the last 20 years the U-value of the glazing part of windows has been improved considerably, but the frame part has not followed the same development with respect to energy performance. Therefore an increasingly large part of the total heat loss through windows is relating to the frame...... part, for which reason, as far as energy efficiency and total economy are concerned, it has become more interesting to further develop frame structures. Traditionally, the energy performance of windows has primarily been characterised by the heat loss coefficient, U-value. However as the heat loss has...

  19. Oscillatory integration windows in neurons

    Science.gov (United States)

    Gupta, Nitin; Singh, Swikriti Saran; Stopfer, Mark

    2016-01-01

    Oscillatory synchrony among neurons occurs in many species and brain areas, and has been proposed to help neural circuits process information. One hypothesis states that oscillatory input creates cyclic integration windows: specific times in each oscillatory cycle when postsynaptic neurons become especially responsive to inputs. With paired local field potential (LFP) and intracellular recordings and controlled stimulus manipulations we directly test this idea in the locust olfactory system. We find that inputs arriving in Kenyon cells (KCs) sum most effectively in a preferred window of the oscillation cycle. With a computational model, we show that the non-uniform structure of noise in the membrane potential helps mediate this process. Further experiments performed in vivo demonstrate that integration windows can form in the absence of inhibition and at a broad range of oscillation frequencies. Our results reveal how a fundamental coincidence-detection mechanism in a neural circuit functions to decode temporally organized spiking. PMID:27976720

  20. Teach yourself visually Windows 8

    CERN Document Server

    McFedries, Paul

    2012-01-01

    A practical guide for visual learners eager to get started with Windows 8 If you learn more quickly when you can see how things are done, this Visual guide is the easiest way to get up and running on Windows 8. It covers more than 150 essential Windows tasks, using full-color screen shots and step-by-step instructions to show you just what to do. Learn your way around the interface and how to install programs, set up user accounts, play music and other media files, download photos from your digital camera, go online, set up and secure an e-mail account, and much more. The tried-and-true format

  1. Windows 7 is supported at CERN

    CERN Multimedia

    IT Department

    2010-01-01

    The new version of the Windows operating system - Windows 7 - is now officially supported at CERN. Windows 7 32-bit is now the default operating system for the new computers at CERN. What’s new in Windows 7 Users of Windows XP will find many new features and options. Users of Windows Vista will feel very familiar with one major difference: higher performance and better responsiveness of the operating system. Other enhancements include: refined Aero desktop that makes it easier to navigate between your different application windows; new snapping windows that allows user to resize a window simply by dragging it to the edge of the screen and “pin” that allows grouping and arranging often accessed applications on the taskbar. Windows 7 introduces the new concept of libraries – containers for user files that have links to different local or network folders. By default, users can see four libraries: Documents, Music, Pictures and Videos. These libraries point to the cor...

  2. *New* CRITICAL Windows Security patch

    CERN Multimedia

    2003-01-01

    On 10 September 2003, Microsoft issued a new CRITICAL security patch, MS03-039. It must be URGENTLY applied on ALL WINDOWS systems, which are not centrally managed for security patches. This includes Experiment computers, Home computers and Windows Portable and Desktop systems not running NICE. Details of the security hole and patch for MS03-039 (which also includes MS03-026) are at: http://cern.ch/it-div/news/hotfix-MS03-039.asp http://www.microsoft.com/technet/security/bulletin/MS03-039.asp

  3. *New*: CRITICAL Windows Security patch

    CERN Multimedia

    2003-01-01

    On 10 September 2003, Microsoft issued a new CRITICAL security patch, MS03-039. It must be URGENTLY applied on ALL WINDOWS systems, which are not centrally managed for security patches. This includes Experiment computers, Home computers and Windows Portable and Desktop systems not running NICE. Details of the security hole and patch for MS03-039 (which also includes MS03-026) are at: http://cern.ch/it-div/news/hotfix-MS03-039.asp http://www.microsoft.com/technet/security/bulletin/MS03-039.asp

  4. Microsoft Windows Server Administration Essentials

    CERN Document Server

    Carpenter, Tom

    2011-01-01

    The core concepts and technologies you need to administer a Windows Server OS Administering a Windows operating system (OS) can be a difficult topic to grasp, particularly if you are new to the field of IT. This full-color resource serves as an approachable introduction to understanding how to install a server, the various roles of a server, and how server performance and maintenance impacts a network. With a special focus placed on the new Microsoft Technology Associate (MTA) certificate, the straightforward, easy-to-understand tone is ideal for anyone new to computer administration looking t

  5. Windows Vista Administrator's Pocket Guide

    CERN Document Server

    Stanek, William R

    2007-01-01

    Portable and precise, this pocket-sized guide delivers immediate answers for the day-to-day administration of Windows Vista. Zero in on core support and maintenance tasks using quick-reference tables, instructions, and lists. You'll get the precise information you need to solve problems and get the job done-whether you're at your desk or in the field! Get fast facts to: Install and configure Windows Vista-and optimize the user workspaceMaintain operating system components, hardware devices, and driversCreate user and group accounts-and control rights and permissionsAdminister group policy se

  6. What's New in Windows Vista?

    CERN Document Server

    Culp, Brian

    2006-01-01

    Get ready for a quick blast through this significant change to Windows! This guide will give you a quick look at many of the most significant new features in Vista, Microsoft's first revision of Windows in nearly six years. Starting with the changes to the interface, introducing Aero, and showing you some visuals, we then move on to the completely revamped search options. The new task scheduler and printing gadgets, are next with some cool new changes. Probably the most significant changes, however, come in the area of security and this guide takes a look at them from user priveleges, to

  7. [Computerized study of perioperative difficulties of stapedectomy].

    Science.gov (United States)

    Cadavid Zink, R; Ballivian, H; Gamboa, F J; Olaizola, F

    1993-01-01

    A retrospective study of 1035 stapedectomies was performed to assess the incidence of intraoperative complications between 1972-1990. We found 45.89% of complications. We divided this alterations in 6 groups: 1) hemorrhage (20.67%), 2) stapes, foot plate, oval window (8.40%), 3) alterations in the middle ear (6.85%), 4) alterations in the incus (3.76%), 5) alterations in the external ear canal (3.57%) and 6) problems with protesis or graf (2.60%). We have analyzed these complications. We propose to carry out the solutions.

  8. Exceptional and Spinorial Conformal Windows

    DEFF Research Database (Denmark)

    Mojaza, Matin; Pica, Claudio; Ryttov, Thomas

    2012-01-01

    We study the conformal window of gauge theories containing fermionic matter fields, where the gauge group is any of the exceptional groups with the fermions transforming according to the fundamental and adjoint representations and the orthogonal groups where the fermions transform according...

  9. Respiratory Management of Perioperative Obese Patients.

    Science.gov (United States)

    Imber, David Ae; Pirrone, Massimiliano; Zhang, Changsheng; Fisher, Daniel F; Kacmarek, Robert M; Berra, Lorenzo

    2016-12-01

    With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. Copyright © 2016 by Daedalus Enterprises.

  10. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  11. Round window stimulation for conductive and mixed hearing loss.

    Science.gov (United States)

    Dillon, Margaret T; Tubbs, Rhonda S; Adunka, Marcia C; King, English R; Hillman, Todd A; Adunka, Oliver F; Chen, Douglas A; Buchman, Craig A

    2014-10-01

    Assess surgical complications, postoperative residual hearing, and speech perception outcomes of placement of a middle ear implant on the round window in conductive and mixed hearing loss cases. Single-subject, repeated-measures design where each subject served as his or her own control. Tertiary referral medical systems. Eighteen subjects with either conductive or mixed hearing loss who could not benefit from conventional amplification were enrolled in a clinical trial investigating vibratory stimulation of the round window. The floating mass transducer (FMT) was positioned in the round window niche. Unaided residual hearing, and aided sound field thresholds and speech perception abilities were evaluated preoperatively, and at 1, 3, 6, and 10 months post-activation of the external speech processor. Six subjects experienced complications that either required further medical management or resolved on their own. There was no difference in residual bone conduction thresholds or unaided word discrimination over time. All subjects experienced a significant improvement in aided speech perception abilities as compared to preoperative performance. Subjects with conductive and mixed hearing loss with placement of the FMT in the round window niche experienced improved sound field thresholds and speech perception, without compromising residual hearing thresholds. Vibratory stimulation of the round window via a middle ear implant may be an appropriate treatment option for patients with conductive and mixed hearing loss. Additional research is needed on the preferred placement of the FMT, improvement of functional gain, and methods to limit postoperative complications and need for revision surgery.

  12. Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

    Science.gov (United States)

    Henry, David A; Carless, Paul A; Moxey, Annette J; O’Connell, Dianne; Stokes, Barrie J; Fergusson, Dean A; Ker, Katharine

    2014-01-01

    the head-to-head trials suggest an advantage of aprotinin over the lysine analogues TXA and EACA in terms of reducing perioperative blood loss, but the differences were small. Compared to control, aprotinin reduced the probability of requiring RBC transfusion by a relative 34% (relative risk [RR] 0.66, 95% confidence interval [CI] 0.60 to 0.72). The RR for RBC transfusion with TXA was 0.61 (95% CI 0.53 to 0.70) and was 0.81 (95% CI 0.67 to 0.99) with EACA. When the pooled estimates from the head-to-head trials of the two lysine analogues were combined and compared to aprotinin alone, aprotinin appeared more effective in reducing the need for RBC transfusion (RR 0.90; 95% CI 0.81 to 0.99). Aprotinin reduced the need for re-operation due to bleeding by a relative 54% (RR 0.46, 95% CI 0.34 to 0.62). This translates into an absolute risk reduction of 2% and a number needed-to-treat (NNT) of 50 (95% CI 33 to 100). A similar trend was seen with EACA (RR 0.32, 95% CI 0.11 to 0.99) but not TXA (RR 0.80, 95% CI 0.55 to 1.17). The blood transfusion data were heterogeneous and funnel plots indicate that trials of aprotinin and the lysine analogues may be subject to publication bias. When compared with no treatment aprotinin did not increase the risk of myocardial infarction (RR 0.87, 95% CI 0.69 to 1.11), stroke (RR 0.82, 95% CI 0.44 to 1.52), renal dysfunction (RR 1.10, 95% CI 0.79 to 1.54) or overall mortality (RR 0.81, 95% CI 0.63 to 1.06). Similar trends were seen with the lysine analogues, but data were sparse. These data conflict with the results of recently published non-randomised studies, which found increased risk of cardiovascular complications and death with aprotinin. There are concerns about the adequacy of reporting of uncommon events in the small clinical trials included in this review. When aprotinin was compared directly with either, or both, of the two lysine analogues it resulted in a significant increase in the risk of death (RR 1.39, 95% CI 1.02, 1.89), and

  13. Examining the Role of Perioperative Nerve Blocks in Hip Arthroscopy: A Systematic Review.

    Science.gov (United States)

    Kay, Jeffrey; de Sa, Darren; Memon, Muzammil; Simunovic, Nicole; Paul, James; Ayeni, Olufemi R

    2016-04-01

    This systematic review examined the efficacy of perioperative nerve blocks for pain control after hip arthroscopy. The databases Embase, PubMed, and Medline were searched on June 2, 2015, for English-language studies that reported on the use of perioperative nerve blocks for hip arthroscopy. The studies were systematically screened and data abstracted in duplicate. Nine eligible studies were included in this review (2 case reports, 2 case series, 3 non-randomized comparative studies, and 2 randomized controlled trials). In total, 534 patients (534 hips), with a mean age of 37.2 years, who underwent hip arthroscopy procedures were administered nerve blocks for pain management. Specifically, femoral (2 studies), fascia iliaca (2 studies), lumbar plexus (3 studies), and L1 and L2 paravertebral (2 studies) nerve blocks were used. All studies reported acceptable pain scores after the use of nerve blocks, and 4 studies showed significantly lower postoperative pain scores acutely with the use of nerve blocks over general anesthesia alone. The use of nerve blocks also resulted in a decrease in opioid consumption in 4 studies and provided a higher level of patient satisfaction in 2 studies. No serious acute complications were reported in any study, and long-term complications from lumbar plexus blocks, such as local anesthetic system toxicity (0.9%) and long-term neuropathy (2.8%), were low in incidence. The use of perioperative nerve blocks provides effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques. Level IV, systematic review of Level I to Level IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Understanding Value as a Key Concept in Sustaining the Perioperative Nursing Workforce.

    Science.gov (United States)

    Kapaale, Chaluza C

    2018-03-01

    Perioperative nursing is faced with a staffing crisis attributed in part to minimal numbers of newly graduated nurses choosing a career in this specialty. This article analyzes and applies the concept of value to explore how to maintain an adequate perioperative nursing workforce; recruit newly graduated nurses; and encourage career professional, nurse educator, and student collaboration to generate meaningful value for perioperative nursing. This analysis revealed that value co-creation for perioperative nursing could lead to newly graduated nurses increasingly choosing perioperative nursing as a career, and enjoying satisfying perioperative nursing careers while providing high-quality patient care. © AORN, Inc, 2018.

  15. Solar Heat Gain Coefficient (SHGC) | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  16. U-Factor (U-value) | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  17. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  18. Perioperative management of children with obstructive sleep apnea.

    Science.gov (United States)

    Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

    2009-07-01

    Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

  19. Tranexamic Acid: From Trauma to Routine Perioperative Use

    Science.gov (United States)

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  20. Old, new and hidden causes of perioperative hypersensitivity

    DEFF Research Database (Denmark)

    Garvey, Lene Heise

    2016-01-01

    intravenously such as neuromuscular blocking agents (NMBA), induction agents and antibiotics have traditionally been reported to be implicated most commonly. It has recently become apparent that there are geographical differences in sensitization patterns related to variation in exposures, referral patterns...... and performance and interpretation of investigations. Differences in sensitization to NMBAs are partly explained by cross sensitization to pholcodine, an ingredient in cough-medicines available in some countries. While NMBAs are the most common causes of perioperative hypersensitivity in some countries, this may...... in causes of perioperative hypersensitivity emerging over time and to increase awareness about the “hidden allergens” in the perioperative setting. Some practical advice on how to approach the patient testing negative on all initial investigations is also included....

  1. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  2. A Novel Process Audit for Standardized Perioperative Handoff Protocols.

    Science.gov (United States)

    Pallekonda, Vinay; Scholl, Adam T; McKelvey, George M; Amhaz, Hassan; Essa, Deanna; Narreddy, Spurthy; Tan, Jens; Templonuevo, Mark; Ramirez, Sasha; Petrovic, Michelle A

    2017-11-01

    A perioperative handoff protocol provides a standardized delivery of communication during a handoff that occurs from the operating room to the postanestheisa care unit or ICU. The protocol's success is dependent, in part, on its continued proper use over time. A novel process audit was developed to help ensure that a perioperative handoff protocol is used accurately and appropriately over time. The Audit Observation Form is used for the Audit Phase of the process audit, while the Audit Averages Form is used for the Data Analysis Phase. Employing minimal resources and using quantitative methods, the process audit provides the necessary means to evaluate the proper execution of any perioperative handoff protocol. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  3. *NEW* CRITICAL Windows Security patches

    CERN Multimedia

    2003-01-01

    On 3 October and 10 September 2003, Microsoft issued new CRITICAL security patches MS03-040 and MS03-039. They must be URGENTLY applied on ALL WINDOWS systems, which are not centrally managed for security patches. This includes Experiment computers, Home computers and Windows Portable and Desktop systems not running NICE. Details of the security holes and patches are at: MS03-039: http://cern.ch/it-div/news/hotfix-MS03-039.asp http://www.microsoft.com/technet/security/bulletin/MS03-039.asp MS03-040: http://cern.ch/it-div/news/hotfix-MS03-040.asp http://www.microsoft.com/technet/security/bulletin/MS03-040.asp

  4. Migration towards Windows 2000/XP

    International Nuclear Information System (INIS)

    Gal, J.

    2004-01-01

    The article deals with interesting technical solutions used in the project 'Migration towards Windows 2000/XP', which was introduced by the company AITEN, Plc for companies SE Plc, SEPS Plc and TEKO, Plc in the period 2002 and 2003. The contents of the project was migration of about 100 servers and more than 4 000 PC to the Windows 2000 and XP environs. The result of the project is a unified and documented system in the field of file, print and small application servers and PC. It has enabled to increase the system reliability and availability, to decrease the total costs for administration and operation and to establish the steady environs for users of the applications. (author)

  5. Perioperative chemotherapy in gastroesophageal cancer. A retrospective monocenter evaluation of 42 cases.

    Directory of Open Access Journals (Sweden)

    Ann-Christin E Brehler

    Full Text Available Perioperative chemotherapy increases the overall and progression-free survival of patients suffering from resectable adenocarcinomas of the lower esophagus, gastroesophageal junction and stomach (GEC. Comparing different chemotherapy regimens platin-based protocols with 5-fluorouracil (5-FU/calcium folinate (CF or oral fluoropyrimidines were favorable in terms of efficacy and side-effects. However, there is no consensus which regimen is the most efficacious.42 consecutive patients with resectable GEC (UICC II and III were treated with 3 pre- and postoperative chemotherapy cycles each consisting of epirubicin, oxaliplatin and capecitabine (EOX. We analyzed the overall survival, progression-free survival and toxicity retrospectively in comparison to published data.The median overall survival in our cohort was 29 months and the progression-free survival was 17 months. The most frequent grade 3 and 4 toxicities during preoperative chemotherapy were diarrhea (16.7%, leukocytopenia (9.5% and nausea (9.5%; overall 38.1% of our patients suffered from grade 3 or 4 toxicity. Surgery was carried out in 83% of our patients, 69% of those achieved R0 resection.Comparing our data with the results of previously published randomized trials EOX is at least non-inferior with regard to overall survival, progression-free survival and toxicity. In conclusion, EOX is an appropriate perioperative therapy for patients with resectable GEC.

  6. Participation in paediatric perioperative care: 'what it means for parents'.

    Science.gov (United States)

    Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

    2017-12-01

    To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

  7. Electrochromic Windows: Advanced Processing Technology

    Energy Technology Data Exchange (ETDEWEB)

    SAGE Electrochromics, Inc

    2006-12-13

    This project addresses the development of advanced fabrication capabilities for energy saving electrochromic (EC) windows. SAGE EC windows consist of an inorganic stack of thin films deposited onto a glass substrate. The window tint can be reversibly changed by the application of a low power dc voltage. This property can be used to modulate the amount of light and heat entering buildings (or vehicles) through the glazings. By judicious management of this so-called solar heat gain, it is possible to derive significant energy savings due to reductions in heating lighting, and air conditioning (HVAC). Several areas of SAGE’s production were targeted during this project to allow significant improvements to processing throughput, yield and overall quality of the processing, in an effort to reduce the cost and thereby improve the market penetration. First, the overall thin film process was optimized to allow a more robust set of operating points to be used, thereby maximizing the yield due to the thin film deposition themselves. Other significant efforts aimed at improving yield were relating to implementing new procedures and processes for the manufacturing process, to improve the quality of the substrate preparation, and the quality of the IGU fabrication. Furthermore, methods for reworking defective devices were developed, to enable devices which would otherwise be scrapped to be made into useful product. This involved the in-house development of some customized equipment. Finally, the improvements made during this project were validated to ensure that they did not impact the exceptional durability of the SageGlass® products. Given conservative estimates for cost and market penetration, energy savings due to EC windows in residences in the US are calculated to be of the order 0.026 quad (0.026×1015BTU/yr) by the year 2017.

  8. Linear gate with prescaled window

    Energy Technology Data Exchange (ETDEWEB)

    Koch, J; Bissem, H H; Krause, H; Scobel, W [Hamburg Univ. (Germany, F.R.). 1. Inst. fuer Experimentalphysik

    1978-07-15

    An electronic circuit is described that combines the features of a linear gate, a single channel analyzer and a prescaler. It allows selection of a pulse height region between two adjustable thresholds and scales the intensity of the spectrum within this window down by a factor 2sup(N) (0<=N<=9), whereas the complementary part of the spectrum is transmitted without being affected.

  9. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ehab A. Wahby

    2016-08-01

    Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.

  10. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  11. Strategier til begraensning af det perioperative forbrug af allogent blod

    DEFF Research Database (Denmark)

    Jørgensen, B G; Qvist, N

    2001-01-01

    Allogenic blood transfusion carries the risk of immunological and non-immunological adverse effects. Consequently, blood transfusion should be limited to situations where alternatives are not available. This article reviews current by available alternative strategies that reduce the need...... for perioperative allogenic blood transfusion. The effectiveness of a number of these alternatives needs to be documented and potential adverse effects clarified. The acceptance of a lower haemoglobin level as the transfusion trigger value is perhaps the most important factor in reducing the need for peri......-operative allogenic blood transfusion...

  12. Perioperative Management of a Patient with Cold Urticaria

    Directory of Open Access Journals (Sweden)

    Priscilla Agbenyefia

    2017-12-01

    Full Text Available Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.

  13. Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care

    DEFF Research Database (Denmark)

    Hertel-Joergensen, Michala; Abrahamsen, Charlotte; Jensen, Carsten

    2018-01-01

    patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score......AIM: To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation. INTRODUCTION: Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently...... was 0.92, with subfactors ranging from 0.72 to 0.87. CONCLUSION: Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical. RELEVANCE TO CLINICAL...

  14. Microsoft Windows Intune 20 Quickstart Administration

    CERN Document Server

    Overton, David

    2012-01-01

    This book is a concise and practical tutorial that shows you how to plan, set up and maintain Windows Intune and manage a group of PCs. If you are an administrator or partner who wants to plan, set up and maintain Windows Intune and manage a group of PCs then this book is for you . You should have a basic understanding of Windows administration, however, knowledge of Windows Intune would not be required.

  15. Effects of using WeChat-assisted perioperative care instructions for parents of pediatric patients undergoing day surgery for herniorrhaphy.

    Science.gov (United States)

    Liu, Jun; Zheng, Xin; Chai, Shouxia; Lei, Meirong; Feng, Zehui; Zhang, Xuelin; Lopez, Violeta

    2018-02-19

    This study examined the effects of WeChat-assisted perioperative instructions for parents whose children were to undergo herniorrhaphy. A randomized controlled trial was conducted in a day surgery center in China. Participants were randomly assigned to the intervention (WeChat) group (n = 209) and the control (Leaflet) group (n = 209). The primary outcomes of this study were parents' knowledge regarding hernia and rate of cancellation of children's surgery. The secondary outcomes were the rate of lost-to-follow-up and the rate of complications and adverse events during the seventh postoperative follow-up day. There was a significant difference in the rate of cancelling the surgery and the mean knowledge score between the WeChat group and leaflet groups. The lost-to-follow-up rate was significantly lower in the WeChat group (0.54%) than in the leaflet group (3.66%). The incidence of postoperative complications were higher in the control group. WeChat-assisted perioperative care instructions enhanced parents' knowledge on perioperative instructions and promoted the preparation of their children for day surgery resulting in lower rate of cancelling the surgery. WeChat has the ability to expand health services outside the hospital confines and could be used as an important low-cost health educational medium in China. Copyright © 2018 Elsevier B.V. All rights reserved.

  16. Travailler avec Windows 7 au CERN

    CERN Multimedia

    CERN. Geneva

    2011-01-01

    Vue d'ensemble des nouveaux concepts et des changements dans l'interface utilisateur survenus dans Windows 7 depuis les versions antérieures de Windows (XP ou Vista). Le plan de migration à Windows 7 sera aussi débattu.

  17. Travailler avec Windows 7 au CERN

    CERN Multimedia

    CERN. Geneva

    2012-01-01

    Vue d'ensemble des nouveaux concepts et des changements dans l'interface utilisateur survenus dans Windows 7 depuis les versions antérieures de Windows (XP ou Vista). Le plan de migration à Windows 7 sera aussi débattu.

  18. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T

    2012-01-01

    Abstract Objective: To evaluate the effects of two different doses of etoricoxib delivered perioperatively compared with placebo and standard pain management on pain at rest, pain with mobilization, and use of additional morphine/opioids postoperatively. Research design and methods: In this double......-blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n...... in the active treatment groups by ~10 hours vs. placebo. A greater proportion of patients on etoricoxib (10-30% greater than placebo) achieved mild levels of pain with movement, defined as pain pain measurements were not designated...

  19. Administration of perioperative penicillin reduces postoperative serum amyloid A response in horses being castrated standing

    DEFF Research Database (Denmark)

    Busk, Peter; Jacobsen, Stine; Martinussen, Torben

    2010-01-01

    Objectives: To compare postoperative inflammatory responses in horses administered perioperative procaine penicillin and those not administered penicillin using acute phase protein serum amyloid A (SAA) as a marker of inflammation. Study Design: Randomized clinical trial. Animals: Stallions (n = 50......) castrated under field conditions. Methods: SAA concentrations were determined on days 0, 3, and 8. Six horses were subsequently excluded because of elevated SAA concentrations on day 0. Of the remaining 50 horses, 26 were administered nonsteroidal anti-inflammatory drug (NSAID) therapy and 24 were...... administered NSAID and 25,000 U/kg procaine penicillin on day 0, 1, and 2. Results: SAA concentrations increased significantly from preoperative levels in both groups, and on day 8 concentrations were significantly (P o .02) higher in horses administered only NSAID than in those administered procaine penicillin...

  20. Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery

    DEFF Research Database (Denmark)

    Madsen, Michael Tvilling; Voigt Hansen, Melissa; Andersen, Lærke Toftegård

    2016-01-01

    STUDY OBJECTIVES: To investigate whether administration of an oral dose of 6 mg melatonin before bedtime perioperatively in breast cancer surgery could change sleep outcomes measured by actigraphy. METHODS: This paper reports secondary outcomes from a double-blind, placebo-controlled, randomized...... clinical trial where patients received 6 mg melatonin (n = 27) or placebo (n = 21) approximately 60 minutes before bedtime 3 nights preoperatively until at least one week postoperatively. Participants were monitored in the entire period with actigraphy, and were instructed to complete visual analogue scale...... significantly changed sleep efficiency and wake after sleep onset after surgery, but had no effects on other objective sleep outcomes or on subjective sleep quality (VAS and KSS)....

  1. Peri-operative Blood Transfusion in open Suprapubic Transvesical ...

    African Journals Online (AJOL)

    INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood ...

  2. Pediatric Perioperative Pulmonary Arterial Hypertension: A Case-Based Primer

    Directory of Open Access Journals (Sweden)

    Shilpa Shah

    2017-10-01

    Full Text Available The perioperative period is an extremely tenuous time for the pediatric patient with pulmonary arterial hypertension. This article will discuss a multidisciplinary approach to preoperative planning, the importance of early identification of pulmonary hypertensive crises, and practical strategies for postoperative management for this unique group of children.

  3. Important issues for perioperative systemic antimicrobial prophylaxis in surgery

    NARCIS (Netherlands)

    Sinha, Bhanu; van Assen, Sander; Friedrich, Alexander W.

    PURPOSE OF REVIEW: Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and

  4. Optimization of peri-operative care in colorectal surgery

    NARCIS (Netherlands)

    Kornmann, V.N.N.

    2016-01-01

    Colorectal cancer is an important health issue, and colorectal surgery is increasingly being performed. During the last years, quality and safety of care, new surgical techniques and attention for peri-operative risks resulted in reduction of postoperative morbidity and mortality. Despite these

  5. Perioperative adverse airway events in cleft lip and palate repair ...

    African Journals Online (AJOL)

    Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate ...

  6. Patient satisfaction with the perioperative surgical services and ...

    African Journals Online (AJOL)

    Introduction: Globally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients' ...

  7. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    Science.gov (United States)

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  8. The need for peri-operative supplemental oxygen | Chikungwa ...

    African Journals Online (AJOL)

    The need for peri-operative supplemental oxygen. M. T. Chikungwa, K. Jonsson. Abstract. (Central African Journal of Medicine: 2002 48 (5-6): 72-73). AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use ...

  9. Neuroanaesthetic and perioperative challenges in the management of giant encephaloceles

    Directory of Open Access Journals (Sweden)

    V Bhatnagar

    2013-01-01

    Full Text Available There are complex issues involved in the surgical management of giant occipital encephaloceles, especially in neonates and young infants. Airway management can cause technical difficulties due to location of lesion, associated abnormalities and the position to be maintained during surgery. We present perioperative challenges we faced in the management of one such case.

  10. Perioperative nurses' attitudes toward the electronic health record.

    Science.gov (United States)

    Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

    2015-02-01

    The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  11. Current attitudes regarding the use of perioperative analgesics and ...

    African Journals Online (AJOL)

    A survey was performed in 2017 to evaluate the use of perioperative analgesia and routine anaesthetic management in dogs and cats by Cameroon veterinarians in 19 veterinary clinics, including 7 and 12 in Douala and Yaounde, respectively. The questionnaire consisted of five sections recording demographic data, ...

  12. Current aspects of perioperative fluid handling in vascular surgery

    NARCIS (Netherlands)

    Jacob, Matthias; Chappell, Daniel; Hollmann, Markus W.

    2009-01-01

    Purpose of review Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate

  13. An Audit Of Perioperative Cardiac Arrest At Lagos University ...

    African Journals Online (AJOL)

    Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests ...

  14. Nursing reflections from journaling during a perioperative internship.

    Science.gov (United States)

    Kuiper, Ruth Ann

    2004-01-01

    AN IMPORTANT CONCERN in nursing practice and education is the difficulties nurses experience as they transition into a new clinical area. THIS STUDY compared the reflective journals of 26 experienced and inexperienced nurses participating in a nine-week perioperative internship. THE STUDY examined self-regulated learning strategies used to enhance metacognitive critical thinking abilities.

  15. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

    DEFF Research Database (Denmark)

    Christiansen, I S; Krøigaard, M; Mosbech, H

    2015-01-01

    of causation in the perioperative setting. Provocations were always positive when carried out in skin test positive patients; however 8 patients had positive provocations only, highlighting the need for provocation in skin test negative patients. This article is protected by copyright. All rights reserved....

  16. Rhinoplasty perioperative database using a personal digital assistant.

    Science.gov (United States)

    Kotler, Howard S

    2004-01-01

    To construct a reliable, accurate, and easy-to-use handheld computer database that facilitates the point-of-care acquisition of perioperative text and image data specific to rhinoplasty. A user-modified database (Pendragon Forms [v.3.2]; Pendragon Software Corporation, Libertyville, Ill) and graphic image program (Tealpaint [v.4.87]; Tealpaint Software, San Rafael, Calif) were used to capture text and image data, respectively, on a Palm OS (v.4.11) handheld operating with 8 megabytes of memory. The handheld and desktop databases were maintained secure using PDASecure (v.2.0) and GoldSecure (v.3.0) (Trust Digital LLC, Fairfax, Va). The handheld data were then uploaded to a desktop database of either FileMaker Pro 5.0 (v.1) (FileMaker Inc, Santa Clara, Calif) or Microsoft Access 2000 (Microsoft Corp, Redmond, Wash). Patient data were collected from 15 patients undergoing rhinoplasty in a private practice outpatient ambulatory setting. Data integrity was assessed after 6 months' disk and hard drive storage. The handheld database was able to facilitate data collection and accurately record, transfer, and reliably maintain perioperative rhinoplasty data. Query capability allowed rapid search using a multitude of keyword search terms specific to the operative maneuvers performed in rhinoplasty. Handheld computer technology provides a method of reliably recording and storing perioperative rhinoplasty information. The handheld computer facilitates the reliable and accurate storage and query of perioperative data, assisting the retrospective review of one's own results and enhancement of surgical skills.

  17. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

    Directory of Open Access Journals (Sweden)

    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  18. Rigid thin windows for vacuum applications

    Science.gov (United States)

    Meyer, Glenn Allyn; Ciarlo, Dino R.; Myers, Booth Richard; Chen, Hao-Lin; Wakalopulos, George

    1999-01-01

    A thin window that stands off atmospheric pressure is fabricated using photolithographic and wet chemical etching techniques and comprises at least two layers: an etch stop layer and a protective barrier layer. The window structure also comprises a series of support ribs running the width of the window. The windows are typically made of boron-doped silicon and silicon nitride and are useful in instruments such as electron beam guns and x-ray detectors. In an electron beam gun, the window does not impede the electrons and has demonstrated outstanding gun performance and survivability during the gun tube manufacturing process.

  19. Purged window apparatus utilizing heated purge gas

    Science.gov (United States)

    Ballard, Evan O.

    1984-01-01

    A purged window apparatus utilizing tangentially injected heated purge gases in the vicinity of electromagnetic radiation transmitting windows, and a tapered external mounting tube to accelerate these gases to provide a vortex flow on the window surface and a turbulent flow throughout the mounting tube. Use of this apparatus prevents backstreaming of gases under investigation which are flowing past the mouth of the mounting tube which would otherwise deposit on the windows. Lengthy spectroscopic investigations and analyses can thereby be performed without the necessity of interrupting the procedures in order to clean or replace contaminated windows.

  20. Professional Windows Embedded Compact 7

    CERN Document Server

    Phung, Samuel; Joubert, Thierry; Hall, Mike

    2011-01-01

    Learn to program an array of customized devices and solutions As a compact, highly efficient, scalable operating system, Windows Embedded Compact 7 (WEC7) is one of the best options for developing a new generation of network-enabled, media-rich, and service-oriented devices. This in-depth resource takes you through the benefits and capabilities of WEC7 so that you can start using this performance development platform today. Divided into several major sections, the book begins with an introduction and then moves on to coverage of OS design, application development, advanced application developm

  1. Perioperative Ketamine Administration for Thoracotomy Pain.

    Science.gov (United States)

    Moyse, Daniel W; Kaye, Alan D; Diaz, James H; Qadri, Muhammad Y; Lindsay, David; Pyati, Srinivas

    2017-03-01

    Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. We reviewed the evidence for the efficacy of intravenous and epidural administration of ketamine in acute post-thoracotomy pain management, and its effectiveness in reducing chronic post-thoracotomy pain. Systematic literature review and an analytic study of a data subset were performed. We searched PubMed, Embase, and Cochrane reviews using the key terms "ketamine," "neuropathic pain," "postoperative," and "post-thoracotomy pain syndrome." The search was limited to human trials and included all studies published before January 2015. Data from animal studies, abstracts, and letters were excluded. All studies not available in the English language were excluded. The manuscript bibliographies were reviewed for additional related articles. We included randomized controlled trials and retrospective studies, while excluding individual case reports. This systematic literature search yielded 15 randomized control trials evaluating the efficacy of ketamine in the treatment of acute post-thoracotomy pain; fewer studies assessed its effect on attenuating chronic post-thoracotomy pain. The majority of reviewed studies demonstrated that ketamine has efficacy in reduction of acute pain, but the evidence is limited on the long-term benefits of ketamine to prevent post-thoracotomy pain syndrome, regardless of the route of administration. A nested analytical study found there is a statistically significant reduction in acute post-thoracotomy pain with IV or

  2. Perioperative smoking cessation in vascular surgery

    DEFF Research Database (Denmark)

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.

    2015-01-01

    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According...

  3. Perioperative Beta Blockade - A Case Report

    Directory of Open Access Journals (Sweden)

    Sunitha K. Zachariah

    2009-10-01

    Full Text Available Continuation of antihypertensives preoperatively and their influence on intraoperative hemodynamics is a big concern among anesthesiologists. The Peri Operative Ischaemia Study Evaluation (POISE trial showed a significant reduction of myocardial infarction, need for coronary revascularization and the incidence of atrial fibrillation with metoprolol started 2-4 hours prior to surgery but a significant increase in total mortality and clinically significant hypotension and bradycardia. This is a case report of intraoperative severe bradycardia in a young patient on recently started beta blocker.

  4. Perioperative blood loss and diclofenac in major arthroplastic surgery

    Directory of Open Access Journals (Sweden)

    Ljiljana Gvozdenović

    2011-04-01

    Full Text Available Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg and also as intramuscular injection (75 mg preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05 compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

  5. Windows 2012 Server network security securing your Windows network systems and infrastructure

    CERN Document Server

    Rountree, Derrick

    2013-01-01

    Windows 2012 Server Network Security provides the most in-depth guide to deploying and maintaining a secure Windows network. The book drills down into all the new features of Windows 2012 and provides practical, hands-on methods for securing your Windows systems networks, including: Secure remote access Network vulnerabilities and mitigations DHCP installations configuration MAC filtering DNS server security WINS installation configuration Securing wired and wireless connections Windows personal firewall

  6. Image annotation under X Windows

    Science.gov (United States)

    Pothier, Steven

    1991-08-01

    A mechanism for attaching graphic and overlay annotation to multiple bits/pixel imagery while providing levels of performance approaching that of native mode graphics systems is presented. This mechanism isolates programming complexity from the application programmer through software encapsulation under the X Window System. It ensures display accuracy throughout operations on the imagery and annotation including zooms, pans, and modifications of the annotation. Trade-offs that affect speed of display, consumption of memory, and system functionality are explored. The use of resource files to tune the display system is discussed. The mechanism makes use of an abstraction consisting of four parts; a graphics overlay, a dithered overlay, an image overly, and a physical display window. Data structures are maintained that retain the distinction between the four parts so that they can be modified independently, providing system flexibility. A unique technique for associating user color preferences with annotation is introduced. An interface that allows interactive modification of the mapping between image value and color is discussed. A procedure that provides for the colorization of imagery on 8-bit display systems using pixel dithering is explained. Finally, the application of annotation mechanisms to various applications is discussed.

  7. The plant-window system

    International Nuclear Information System (INIS)

    Wood, R.T.; Mullens, J.A.; Naser, J.A.

    1995-01-01

    Power plant data, and the information that can be derived from it, provide the link to the plant through which the operations, maintenance and engineering staff understand and manage plant performance. The increasing use of computer technology in the U.S. nuclear power industry has greatly expanded the capability to obtain, analyze, and present data about the plant to station personnel. However, it is necessary to transform the vast quantity of available data into clear, concise, and coherent information that can be readily accessed and used throughout the plant. This need can be met by an integrated computer workstation environment that provides the necessary information and software applications, in a manner that can be easily understood and used, to the proper users throughout the plant. As part of a Cooperative Research and Development Agreement with the Electric Power Research Institute, the Oak Ridge National Laboratory has developed functional requirements for a Plant-Wide Integrated Environment Distributed On Workstations (Plant-Window) System. The Plant-Window System (PWS) can serve the needs of operations, engineering, and maintenance personnel at nuclear power stations by providing integrated data and software applications (e.g., monitoring, analysis, diagnosis, and control applications) within a common environment. The PWS requirements identify functional capabilities and provide guidelines for standardized hardware, software, and display interfaces to define a flexible computer environment that permits a tailored implementation of workstation capabilities and facilitates future upgrades

  8. MS Windows domēna darbstaciju migrācija no MS Windows XP uz Windows Vista.

    OpenAIRE

    Tetere, Agate

    2009-01-01

    Kvalifikācijas darbā izpētīju darbstaciju migrācijas no Windows XP uz Windows Vista plusus un mīnusus. Darba gaitā tika veikti sekojoši uzdevumi: 1.Veikta Windows XP un Windows Vista darbstaciju instalācija, iestatījumu konfigurēšana un tika pārbaudīta sistēmas darbība 2.Veikta Windows Server 2003 un Windows Server 2008 instalācija, iestatījumu konfigurēšana un tika pārbaudīta sistēmas darbība 3.Izstrādāts migrācijas modelis 4.Veikta migrācijas optimizēšana 5.Veikta datu migrāc...

  9. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia.

    Science.gov (United States)

    Campbell, Gillian; Alderson, Phil; Smith, Andrew F; Warttig, Sheryl

    2015-04-13

    Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because of interference with normal temperature regulation by anaesthetic drugs, exposure of skin for prolonged periods and receipt of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause significant heat loss. Warming intravenous and irrigation fluids to core body temperature or above might prevent some of this heat loss and subsequent hypothermia. To estimate the effectiveness of preoperative or intraoperative warming, or both, of intravenous and irrigation fluids in preventing perioperative hypothermia and its complications during surgery in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE Ovid SP (1956 to 4 February 2014), EMBASE Ovid SP (1982 to 4 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 4 February 2014), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCOhost (1980 to 4 February 2014) and reference lists of identified articles. We also searched the Current Controlled Trials website and ClinicalTrials.gov. We included randomized controlled trials or quasi-randomized controlled trials comparing fluid warming methods versus standard care or versus other warming methods used to maintain normothermia. Two review authors independently extracted data from eligible trials and settled disputes with a third review author. We contacted study authors to ask for additional details when needed. We collected data on adverse events only if they were reported in the trials. We included in this review 24 studies with a total of 1250 participants. The trials included various numbers and types of participants. Investigators used a range of methods to warm fluids to temperatures between 37°C and 41°C. We found that evidence was of moderate quality because descriptions of trial design were

  10. OSIS: A Windows 3 Oil Spill Information System

    International Nuclear Information System (INIS)

    Leech, M.; Walker, M.; Wiltshire, M.; Tyler, A.

    1993-01-01

    An oil spill modelling and analysis system called the Oil Spill Information System (OSIS) has recently been developed. OSIS uses a model of oceanographic processes to predict three-dimensional spreading and transport of an oil slick under the influence of wind, waves, tide, turbulence, and shear diffusion. Oil weathering and fate processes of emulsification, evaporation, and dispersion are also simulated. The physical models have been tested against data obtained from sea trials and spill incidents. OSIS uses an object-oriented programming technique and presents model output as maps, graphs, and tables in multiple windows and can link to other Windows packages to create a suite of spill information management tools. 15 refs., 12 figs

  11. Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint Arthroplasty.

    Science.gov (United States)

    Day, Molly A; Anthony, Christopher A; Bedard, Nicholas A; Glass, Natalie A; Clark, Charles R; Callaghan, John J; Noiseux, Nicolas O

    2018-01-01

    Automated mobile phone messaging has not been reported in total joint arthroplasty (TJA). Our purpose was to compare Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between TJA patients who did and did not receive perioperative automated mobile phone messages. Patients were prospectively enrolled and received messages for 1 week prior until 2 weeks after TJA. Message content included reminders, activity, and pain control. Patients answered select PG/HCAHPS and questions regarding their experience with the automated communication platform. Average PG/HCAHPS scores were compared to historical TJA patients in the 3-year window prior (control group) with significance P communication via automated mobile phone messaging had improved patient satisfaction scores postoperatively. Patients perceived this form of communication was useful and kept them better informed. Automated mobile phone messaging can be an easily integrated, helpful adjunct to surgeons, healthcare systems, and case managers to more effectively communicate with patients undergoing TJA in this era of value-based care. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems.

    Science.gov (United States)

    Epstein, Richard H; Dexter, Franklin; Hofer, Ira S; Rodriguez, Luis I; Schwenk, Eric S; Maga, Joni M; Hindman, Bradley J

    2018-02-01

    Perioperative hypothermia may increase the incidences of wound infection, blood loss, transfusion, and cardiac morbidity. US national quality programs for perioperative normothermia specify the presence of at least 1 "body temperature" ≥35.5°C during the interval from 30 minutes before to 15 minutes after the anesthesia end time. Using data from 4 academic hospitals, we evaluated timing and measurement considerations relevant to the current requirements to guide hospitals wishing to report perioperative temperature measures using electronic data sources. Anesthesia information management system databases from 4 hospitals were queried to obtain intraoperative temperatures and intervals to the anesthesia end time from discontinuation of temperature monitoring, end of surgery, and extubation. Inclusion criteria included age >16 years, use of a tracheal tube or supraglottic airway, and case duration ≥60 minutes. The end-of-case temperature was determined as the maximum intraoperative temperature recorded within 30 minutes before the anesthesia end time (ie, the temperature that would be used for reporting purposes). The fractions of cases with intervals >30 minutes between the last intraoperative temperature and the anesthesia end time were determined. Among the hospitals, averages (binned by quarters) of 34.5% to 59.5% of cases had intraoperative temperature monitoring discontinued >30 minutes before the anesthesia end time. Even if temperature measurement had been continued until extubation, averages of 5.9% to 20.8% of cases would have exceeded the allowed 30-minute window. Averages of 8.9% to 21.3% of cases had end-of-case intraoperative temperatures <35.5°C (ie, a quality measure failure). Because of timing considerations, a substantial fraction of cases would have been ineligible to use the end-of-case intraoperative temperature for national quality program reporting. Thus, retrieval of postanesthesia care unit temperatures would have been necessary. A

  13. Instant Windows PowerShell

    CERN Document Server

    Menon, Vinith

    2013-01-01

    Get to grips with a new technology, understand what it is and what it can do for you, and then get to work with the most important features and tasks. A practical, hands-on tutorial approach that explores the concepts of PowerShell in a friendly manner, taking an adhoc approach to each topic.If you are an administrator who is new to PowerShell or are looking to get a good grounding in these new features, this book is ideal for you. It's assumed that you will have some experience in PowerShell and Windows Server, as well being familiar with the PowerShell command-line.

  14. Editorial - Opening windows onto data

    Directory of Open Access Journals (Sweden)

    Judith Winters

    2012-05-01

    Full Text Available One of Internet Archaeology's strengths and 'unique selling points' not yet replicated by (many other e-journals, is that data is integrated into articles rather than being 'supplementary' or offered for download. The aim has always been for the narrative to be a wave driving readers towards the underlying data. Opening windows onto the data from within the text is one of the things I think the journal does best and is a feature used throughout Emma Durham's article 'Depicting the gods: metal figurines in Roman Britain'. Archaeological data does not speak for itself. It needs a narrative. It needs context. But by intermeshing data with interpretation, readers can dip into the data and start to explore it while reading the article, allowing a more immediate understanding of the bigger picture.

  15. Windows VPN Set Up | High-Performance Computing | NREL

    Science.gov (United States)

    Windows VPN Set Up Windows VPN Set Up To set up Windows for HPC VPN, here are the steps: Download your version of Windows. Note: We only support the the Endian Connect software when connecting to the a VPN connection to the HPC systems. Windows Version Connect App Windows 10

  16. Hybrid window layer for photovoltaic cells

    Science.gov (United States)

    Deng, Xunming

    2010-02-23

    A novel photovoltaic solar cell and method of making the same are disclosed. The solar cell includes: at least one absorber layer which could either be a lightly doped layer or an undoped layer, and at least a doped window-layers which comprise at least two sub-window-layers. The first sub-window-layer, which is next to the absorber-layer, is deposited to form desirable junction with the absorber-layer. The second sub-window-layer, which is next to the first sub-window-layer, but not in direct contact with the absorber-layer, is deposited in order to have transmission higher than the first-sub-window-layer.

  17. Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty.

    Science.gov (United States)

    Zhang, Linda; Weizer, Jennifer S; Musch, David C

    2017-02-23

    Glaucoma is the international leading cause of irreversible blindness. Intraocular pressure (IOP) is the only currently known modifiable risk factor; it can be reduced by medications, incisional surgery, or laser trabeculoplasty (LTP). LTP reduces IOP by 25% to 30% from baseline, but early acute IOP elevation after LTP is a common adverse effect. Most of these IOP elevations are transient, but temporarily elevated IOP may cause further optic nerve damage, worsening of glaucoma requiring additional therapy, and permanent vision loss. Antihypertensive prophylaxis with medications such as acetazolamide, apraclonidine, brimonidine, dipivefrin, pilocarpine, and timolol have been recommended to blunt and treat the postoperative IOP spike and associated pain and discomfort. Conversely, other researchers have observed that early postoperative IOP rise happens regardless of whether people receive perioperative glaucoma medications. It is unclear whether perioperative administration of antiglaucoma medications may be helpful in preventing or reducing the occurrence of postoperative IOP elevation. To assess the effectiveness of medications administered perioperatively to prevent temporarily increased intraocular pressure (IOP) after laser trabeculoplasty (LTP) in people with open-angle glaucoma (OAG). We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 11), MEDLINE Ovid (1946 to 18 November 2016), Embase.com (1947 to 18 November 2016), PubMed (1948 to 18 November 2016), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 18 November 2016), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com); last searched 17 September 2013, ClinicalTrials.gov (www.clinicaltrials.gov); searched 18 November 2016 and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 18 November 2016. We did not use any date or language restrictions. We included

  18. Analysis of surface contaminants on beryllium windows

    International Nuclear Information System (INIS)

    Gmur, N.F.

    1986-12-01

    It is known that various crystalline and liquid compounds form on the downstream surfaces of beryllium windows exposed to air. It is also known that the integrity of such windows may be compromised resulting in leaks through the window. The purpose of this report is to document the occurrences described as they pertain to the NSLS and to analyze, where possible, the various substances formed

  19. Windows PowerShell 20 Bible

    CERN Document Server

    Lee, Thomas; Schill, Mark E; Tanasovski, Tome

    2011-01-01

    Here's the complete guide to Windows PowerShell 2.0 for administrators and developers Windows PowerShell is Microsoft's next-generation scripting and automation language. This comprehensive volume provides the background that IT administrators and developers need in order to start using PowerShell automation in exciting new ways. It explains what PowerShell is, how to use the language, and specific ways to apply PowerShell in various technologies. Windows PowerShell is Microsoft's standard automation tool and something that every Windows administrator will eventually have to understand; this b

  20. Scott Brothers Windows and Doors Information Sheet

    Science.gov (United States)

    Scott Brothers Windows and Doors (the Company) is located in Bridgeville, Pennsylvania. The settlement involves renovation activities conducted at property constructed prior to 1978, located in Pittsburgh, Pennsylvania.

  1. Mastering Windows Server 2008 Networking Foundations

    CERN Document Server

    Minasi, Mark; Mueller, John Paul

    2011-01-01

    Find in-depth coverage of general networking concepts and basic instruction on Windows Server 2008 installation and management including active directory, DNS, Windows storage, and TCP/IP and IPv4 networking basics in Mastering Windows Server 2008 Networking Foundations. One of three new books by best-selling author Mark Minasi, this guide explains what servers do, how basic networking works (IP basics and DNS/WINS basics), and the fundamentals of the under-the-hood technologies that support staff must understand. Learn how to install Windows Server 2008 and build a simple network, security co

  2. Windows 7 Annoyances Tips, Secrets, and Solutions

    CERN Document Server

    Karp, David

    2010-01-01

    Windows 7 may be faster and more stable than Vista, but it's a far cry from problem-free. David A. Karp comes to the rescue with the latest in his popular Windows Annoyances series. This thorough guide gives you the tools you need to fix the troublesome parts of this operating system, plus the solutions, hacks, and timesaving tips to make the most of your PC. Streamline Windows Explorer, improve the Search tool, eliminate the Green Ribbon of Death, and tame User Account Control promptsExplore powerful Registry tips and tools, and use them to customize every aspect of Windows and solve its sho

  3. Aerodynamic window for a laser fusion device

    International Nuclear Information System (INIS)

    Masuda, Wataru

    1983-01-01

    Since the window of a laser system absorbs a part of the laser energy, the output power is determined by the characteristics of the window. The use of an aerodynamic window has been studied. The required characteristics are to keep the large pressure difference. An equation of motion of a vortex was presented and analyzed. The operation power of the system was studied. A multi-stage aerodynamic window was proposed to reduce the power. When the jet flow of 0.3 of the Mach number is used, the operation power will be several Megawatt, and the length of an optical path will be about 100 m. (Kato, T.)

  4. Windows 8.1 for dummies

    CERN Document Server

    Rathbone, Andy

    2013-01-01

    The bestselling book on Windows, now updated for the new 8.1 features Microsoft has fine-tuned Windows 8 with some important new features, and veteran author Andy Rathbone explains every one in this all-new edition of a long-time bestseller. Whether you're using Windows for the first time, upgrading from an older version, or just moving from Windows 8 to 8.1, here's what you need to know. Learn about the dual interfaces, the new Start button, how to customize the interface and boot operations, and how to work with programs and files, use the web and social media, manage music and photos, and

  5. Microsoft Windows 7 Administration Instant Reference

    CERN Document Server

    Panek, William

    2010-01-01

    An on-the-spot reference for Windows 7 administrators. Hundreds of thousands of IT administrators, network administrators, and IT support technicians work daily with Windows 7. This well-organized, portable reference covers every facet of Windows 7, providing no-nonsense instruction that is readily accessible when you need it. Designed for busy administrators, it features thumb tabs and chapter outlines to make answers easy to find.: Windows 7 administrative and support personnel need quick answers to situations they confront each day; this Instant Reference is designed to provide information,

  6. Modelling window opening behaviour in Danish dwellings

    DEFF Research Database (Denmark)

    Andersen, Rune Vinther; Olesen, Bjarne W.; Toftum, Jørn

    2011-01-01

    In this paper we present and analyse data from two studies of window opening behaviour in residential buildings in Denmark. Based on measurements of indoor environment, weather and window opening behaviour in 15 dwellings, we propose a model that will predict window opening behaviour. The data...... showed that other factors than thermal effects impact the behaviour of the occupants. Some of these factors were included in the model. We present data from repeated questionnaire surveys that show that occupants tend to adjust heating setpoints, adjust clothing and operate windows when feeling thermally...

  7. Intravenous sub-anesthetic ketamine for perioperative analgesia

    Directory of Open Access Journals (Sweden)

    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  8. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

    .9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...... (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery.......In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO...

  9. Inhaled therapy for the management of perioperative pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    C A Thunberg

    2015-01-01

    Full Text Available Patients with pulmonary hypertension (PH are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP. Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO, has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil, NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite, and phosphodiesterase inhibitors (milrinone, sildenafil may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators.

  10. Using YouTube in perioperative nursing education.

    Science.gov (United States)

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  11. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    Directory of Open Access Journals (Sweden)

    Priyanka Bhateja

    2014-01-01

    Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.

  12. Validation of computerized sniffer for monitoring perioperative normothermia.

    Science.gov (United States)

    Giri, Jyothsna; Li, Man; Pickering, Brian; Subramanian, Arun; Kor, Daryl J; Herasevich, Vitaly

    2013-01-01

    The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. The clinical tool (alert) was found to be 97 % sensitive.

  13. Fluid therapy in the perioperative setting-a clinical review

    DEFF Research Database (Denmark)

    Voldby, Anders Winther; Brandstrup, Birgitte

    2016-01-01

    BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review...... aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well...... for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being....

  14. Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

    Science.gov (United States)

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  15. 胰岛素强化治疗对胃癌围手术期营养代谢的影响:随机对照研究%Effect of Intensive Insulin Therapy on Perioperative Nutrition Substrates Metabolism in Patients Undergoing Radical Distal Gastrectomy:A Randomized Controlled Trial

    Institute of Scientific and Technical Information of China (English)

    刘汉成; 周岩冰; 陈栋; 牛兆建; 于洋

    2011-01-01

    目的:探讨胃癌围手术期能量及营养物质的代谢特点,研究强化胰岛素治疗对围手术营养代谢的影响.方法:选取胃中、下部癌病理诊断明确并且外科病房ICU住院时间不少于24h的患者64例,取得知情同意后随机分到强化胰岛素治疗(IIT)血糖控制在4.4~6.1 mmol/L.和传统治疗(CIT)组血糖控制在10mmol/L以下;应用CCM营养代谢监测系统测定围手术期静息能量消耗(REE),呼吸商(RQ),每公斤体重静息能量消耗(REE/kg)和脂肪氧化比率,应用多频人体生物电阻抗分析仪测定围手术期人体组分的变化及应用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR).结果:64例病人入选,每组32例,手术创伤引起术后第1、3天REE水平增加约22%和12%,呼吸商降低至0.759和0.791,REE/kg增加28 kcal/kg和26 kcal/kg,脂肪氧化比率增加至78%和65%,Ln-HOMA-IR明显增加(P<0.05);IIT治疗能降低术后第1、3天Ln-HOMA-IR和REE/kg水平;术后人体指标如细胞内液、脂肪组织、蛋白组织、肌肉组织、瘦体组织和体质量较术前水平明显降低(P<0.05);IIT能明显减少脂肪组织、蛋白组织和细胞内液的消耗量(P=0.009,t=0.026).结论:IIT能够有效降低胃癌围手术期胰岛素抵抗程度、降低静息能量消耗的水平和减少脂肪及蛋白质的消耗.%Objective: To investigate perioperative metabolic characteristic of gastric cancer and to assess effect of intensive insulin therapy on the perioperative nutritional substrate metabolism. Methods: Within 24 h of ICU management, patients of gastric cancer were enrolled after written informed consent and randomized to intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or conventional insulin therapy (CIT) group to keep levels less than 10mmol/L. resting energy expenditure (REE), respiratory quotient (RQ), resting energy expenditure per kilometer (REE/kg), and lipids oxidation rate were monitored by Indirect

  16. Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea MD, PhD

    2014-01-01

    Full Text Available Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics.

  17. Ontology-based specification, identification and analysis of perioperative risks.

    Science.gov (United States)

    Uciteli, Alexandr; Neumann, Juliane; Tahar, Kais; Saleh, Kutaiba; Stucke, Stephan; Faulbrück-Röhr, Sebastian; Kaeding, André; Specht, Martin; Schmidt, Tobias; Neumuth, Thomas; Besting, Andreas; Stegemann, Dominik; Portheine, Frank; Herre, Heinrich

    2017-09-06

    Medical personnel in hospitals often works under great physical and mental strain. In medical decision-making, errors can never be completely ruled out. Several studies have shown that between 50 and 60% of adverse events could have been avoided through better organization, more attention or more effective security procedures. Critical situations especially arise during interdisciplinary collaboration and the use of complex medical technology, for example during surgical interventions and in perioperative settings (the period of time before, during and after surgical intervention). In this paper, we present an ontology and an ontology-based software system, which can identify risks across medical processes and supports the avoidance of errors in particular in the perioperative setting. We developed a practicable definition of the risk notion, which is easily understandable by the medical staff and is usable for the software tools. Based on this definition, we developed a Risk Identification Ontology (RIO) and used it for the specification and the identification of perioperative risks. An agent system was developed, which gathers risk-relevant data during the whole perioperative treatment process from various sources and provides it for risk identification and analysis in a centralized fashion. The results of such an analysis are provided to the medical personnel in form of context-sensitive hints and alerts. For the identification of the ontologically specified risks, we developed an ontology-based software module, called Ontology-based Risk Detector (OntoRiDe). About 20 risks relating to cochlear implantation (CI) have already been implemented. Comprehensive testing has indicated the correctness of the data acquisition, risk identification and analysis components, as well as the web-based visualization of results.

  18. Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

    Science.gov (United States)

    O'Brien, Brid; Andrews, Tom; Savage, Eileen

    2018-01-01

    To explore and explain how nurses minimise risk in the perioperative setting. Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. Classic grounded theory. Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting. © 2017 John Wiley & Sons Ltd.

  19. Does concomitant tricuspid annuloplasty increase perioperative mortality and morbidity when correcting left-sided valve disease?

    Science.gov (United States)

    Zhu, Tie-Yuan; Wang, Jian-Gang; Meng, Xu

    2015-01-01

    A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences

  20. Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany

    Directory of Open Access Journals (Sweden)

    Froessler B

    2018-04-01

    Full Text Available Bernd Froessler,1,2 Alexandra M Rueger,3,4 Mark P Connolly5,6 1Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; 2Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia; 3Vifor Pharma, Munich, Germany; 4Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany; 5Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands; 6Global Market Access Solutions Sàrl, St-Prex, Switzerland Background: Perioperative administration of ferric carboxymaltose (FCM was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA. In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling.Materials and methods: The model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis.Results: The average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day.Conclusion: Perioperative administration

  1. Perioperative fasting and children: A review article

    Directory of Open Access Journals (Sweden)

    Bahareh Imani

    2014-12-01

    Full Text Available This review provides an overview of the present knowledge on the aspects of preoperative fasting with the assessment of the evidence quality. A systematic research was conducted in electronic databases in order to identify trials published between 1990 and 2014 concerning preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. The publications were classified in terms of their evidence level, scientific validity and clinical relevance. The key recommendations are that children be encouraged to drink clear fluids within up to 2 hours before elective surgery (including Caesarean section and all but one member of the guideline groups consider that tea or coffee, with milk added (up to about one fifth of the total volume, are still clear fluids .Furthermore, solid food consumption should be prohibited for up to 6 hours before elective surgery for children. However, patients should not have their operation cancelled or delayed only because they are chewing gums or sucking a boiled sweet immediately prior to the induction of anaesthesia. These recommendations also apply to those patients with obesity, gastro-oesophageal reflux and diabetes. There is insufficient evidence to support the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients. Infants should be fed before elective surgery. Breast milk is considered a safe option for up to 4 hours and other kinds of milk for up to 6 hours. The present review takes into account the safety and possible benefits of preoperative carbohydrates while offering advice on the postoperative resumption of oral intake.

  2. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  3. Nutrition in peri-operative esophageal cancer management.

    Science.gov (United States)

    Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

    2017-07-01

    Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

  4. Perioperative care following complex laryngotracheal reconstruction in infants and children

    Directory of Open Access Journals (Sweden)

    Gupta Punkaj

    2010-01-01

    Full Text Available Laryngotracheal reconstruction (LTR involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (single-stage LTR. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.

  5. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Science.gov (United States)

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.

  6. Risk Factors for Perioperative Complications in Endoscopic Surgery with Irrigation

    Directory of Open Access Journals (Sweden)

    João Manoel Silva, Jr.

    2013-07-01

    Full Text Available Background and objectives: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. Method: A cohort study of six months duration. Patients aged ≥ 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. Results: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively. When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048, serum sodium (OR = 0.962, and volume of irrigation fluid administered during surgery (OR = 1.001 were independent variables. Keywords: Anesthesia, Endoscopy, Hyponatremia, Postoperative Complications, Risk Assessment, Risk Factors.

  7. Perioperative feedback in surgical training: A systematic review.

    Science.gov (United States)

    McKendy, Katherine M; Watanabe, Yusuke; Lee, Lawrence; Bilgic, Elif; Enani, Ghada; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C

    2017-07-01

    Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Update on perioperative management of the child with asthma

    Directory of Open Access Journals (Sweden)

    Francesco Dones

    2012-04-01

    Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  9. Safety and efficacy of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Hua P

    2018-02-01

    Full Text Available Ping Hua,1 Jianyang Liu,2 Jun Tao,1 Xifeng Lin,1 Rongjun Zou,1 Dingwen Zhang,1 Songran Yang3,4 1Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 2Department of Vascular Surgery, Henan Provincial People’s Hospital, Zhengzhou, 3The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 4Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China Objective: Retrospective studies and a meta-analysis were performed to evaluate the safety and effectiveness of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP during cardiac surgery under extracorporeal circulation. Methods: Computerized literature searches were performed in Medline, Embase, The Cochrane Library, CNKI, CBM, and WANFANG to find randomized controlled trials (RCTs related to the perioperative administration of rhBNP during cardiac surgery starting from the database inception until December 2016. Two researchers independently performed study screening, information extraction, and quality evaluation according to the inclusion/exclusion criteria, and a meta-analysis was performed using RevMan 5.2 software. Results: A total of 12 studies were analyzed, including 12 RCTs and 727 patients. The meta-analysis results indicated that the perioperative administration of rhBNP could reduce the occurrence rate of postoperative complications, length of intensive care unit (ICU stay, length of hospital stay, and serum creatinine (Scr levels, and increase the 24-hour urine volume; however, it did not affect the postoperative mortality rate. Conclusion: The perioperative administration of rhBNP during cardiac surgery was safe and effective, and could improve the prognosis of the patients. Keywords: recombinant human brain natriuretic peptide, perioperative administration, meta-analysis

  10. The Nicest way to migrate your Windows computer ( The Windows 2000 Migration Task Force)

    CERN Document Server

    2001-01-01

    With Windows 2000, CERN users will discover a more stable and reliable working environment and will have access to all the latest applications. The Windows 2000 Migration Task Force - a representative from each division.

  11. Effect of the perioperative infusion of dexmedetomidine on chronic pain after breast surgery

    Directory of Open Access Journals (Sweden)

    Gaurav Jain

    2015-04-01

    Full Text Available Background: This prospective double-blind trial was undertaken to analyze the role of perioperatively administered dexmedetomidine on the occurrence of chronic pain in cases undergoing surgery for breast cancer. Subjects and Methods: Eighty-six cases were randomly assigned to two groups to receive either dexmedetomidine (2 μg/ml in group D or saline in group C, in a loading dose of 0.5 ml/kg, intravenous (IV, 30 min prior to induction, followed by a continuous infusion of 0.25 ml/kg/h IV till the completion of surgery, and then the dose tapered to 0.1 ml/kg/h for up to 24 h. The standardized questionnaires that measured chronic pain (Brief Pain Inventory, BPI; Short Form McGill Pain Questionnaire, SF-MPQ2 and quality of life (Quality of Life Scale, QOLS were gathered after 3 months of surgery as a primary outcome. Pain (verbal numerical score, VNS, sedation scores (Ramsay scoring, and analgesic requirements were also assessed for 72 h postoperatively. Results: In total, 84 cases (n=42 were analyzed for acute pain and 69 (34 in group D and 35 in group C for chronic pain. The consumption of isoflurane/fentanyl intra-operatively and paracetamol postoperatively was significantly lower in Group D. The sedation scores were non-significant between the groups. The VNS at rest and after movement was significantly lower in group D at corresponding times (except at 60 min throughout the assessment period. The BPI and SF-MPQ2 scores were significantly lower in group D in most of the factors. The QOLS score was significantly better in group D in all items except for relationships, friends, and learning. Conclusion: The perioperative infusion of dexmedetomidine has a pivotal role in attenuating the incidence and severity of chronic pain and improving the quality of life in cases undergoing breast cancer surgery.

  12. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

    Science.gov (United States)

    Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

    2016-01-01

    Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

  13. Effect of perioperative administration of dexketoprofen on opioid requirements and inflammatory response following elective hip arthroplasty.

    LENUS (Irish Health Repository)

    Iohom, G

    2012-02-03

    BACKGROUND: In this double-blind, randomized, placebo-controlled trial, the safety and analgesic efficacy of perioperative dexketoprofen were evaluated. METHODS: Thirty ASA I or II patients undergoing elective hip arthroplasty were randomized to one of two groups. One group (D) received dexketoprofen 25 mg tds for 24 h before and 48 h after surgery; the second group (P) received placebo tablets at equivalent times. Hyperbaric 0.5% bupivacaine (17.5 mg if greater than 70 kg and 15 mg if less than 70 kg) and preservative-free morphine (0.6 mg) were administered intrathecally. Postoperatively, PCA was provided (bolus morphine sulphate 1 mg; lockout 5 min; no continuous infusion). RESULTS: The two groups were similar in terms of age, gender, weight, height, ASA class, duration of operation, and level of sensory block on arrival to the recovery room. Groups were also similar in terms of blood loss, transfusion requirements, ventilatory frequency, and haemodynamic variables. According to visual analogue pain scores patients in group D experienced less pain at 15 h (P=0.02) postoperatively. Cumulative morphine consumption was also less in group D compared with group P at 6 (0.06 (0.2) vs 0.85 (1.4) mg, P=0.04) and 48 h postoperatively (10.1 (8) vs 26.2 (20) mg, P<0.01). Plasma interleukin 6 concentrations increased postoperatively to a significantly lesser extent in group D than in group P (P=0.02). Nausea and vomiting were less (P<0.01) in group D compared with group P at 18 h postoperatively. Sedation scores were less (P=0.03) in group D. CONCLUSIONS: Perioperative administration of dexketoprofen 25 mg 8 hourly markedly improves analgesia and decreases opioid requirements (and associated adverse effects) following hip arthroplasty. It appears that this regimen decreases the postoperative pro-inflammatory response.

  14. Musculoskeletal Problems Among Greek Perioperative Nurses in Regional Hospitals in Southern Peloponnese : Musculoskeletal Problems in Perioperative Nurses.

    Science.gov (United States)

    Bakola, Helen; Zyga, Sofia; Stergioulas, Apostolos; Kipreos, George; Panoutsopoulos, George

    2017-01-01

    The surgery unit is a particularly labor-intensive environment in the hospital. Studies reflect the correlation of labor risk factors for musculoskeletal injuries among nurses but few have investigated the relationship to perioperative nurses. The purpose of this study is the identification and definition of ergonomic risk factors in the operating room and their connection with musculoskeletal disorders in perioperative nurses in regional hospitals in Greece. Forty four Greek perioperative nurses working in regional hospitals in southern Peloponnese participated. Anonymous self-administered questionnaire was used to collect the data, which consisted of three parts (investigating musculoskeletal symptoms, description of work, psychometric evaluation). The analysis was done with the statistical program SPSS.19. Symptoms of musculoskeletal problems emerged. Specifically, 54.4% in the lumbar, 47.7% in the neck, 45.5% in the shoulder, followed by smaller percentages of the hip, knee, elbow and ankle. 6.8% of participants indicated no musculoskeletal symptoms in the last year while 74.9% of those who had symptoms presented them in two or more areas. Activities rated as a major problem among others were the manual handling, tools with weight and vibration etc. 100% of respondents agreed that the work in the surgery unit is demanding and has anxiety. The lack of support from the government (81.8%), combined with the low perioperative nurses (6.8%) having the opportunity to participate in administrative decisions concerning them were related to problems in the organization and management of work. Apart from engineers target factors, a main aim should be the organization of work within the framework of a national policy based on European directives on the protection and promotion of the health and safety of workers.

  15. Importance of Perioperative Glycemic Control in General Surgery

    Science.gov (United States)

    Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David

    2014-01-01

    Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best adverse outcomes. Conclusions Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than

  16. Android is the new Windows

    CERN Multimedia

    Computer Security Team

    2013-01-01

    Do you recall the early virus attacks in the early 2000s? “Blaster”, “I love you” and “Slammer” were attacking the pretty much unprotected Microsoft Windows operating system.   While Microsoft has been hit hard in the past, they have tried to improve and are now on a par with other software vendors. Today, they can even be happy that Android is taking over the baton - at least on mobile platforms. According to the Sophos 2013 Security Threat Report “Android [is] today’s the biggest target” and Android devices in Australia and the U.S. experienced even more malware attacks, whether successful or unsuccessful, than PCs during the past three months. The Kaspersky security company recently added that 99% of all mobile threats target Android. Lucky you if you use an iPhone, or a good old Nokia with no Internet connectivity at all. But why is that? It is partly down to the same fac...

  17. Humeral windows in revision total elbow arthroplasty.

    Science.gov (United States)

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  18. What are windows on language evolution?

    NARCIS (Netherlands)

    Botha, Rudolf

    2008-01-01

    This chapter offers an elucidation of the idea that certain phenomena provide windows on language evolution. Non-metaphorically, such windows are shown to be conceptual constructs used for making inferences about aspects of language evolution from data or assumptions about properties of

  19. Thermal Bridge Effects in Window Grooves

    DEFF Research Database (Denmark)

    Rose, Jørgen

    1997-01-01

    In this report thermal bridge effects in window grooves are analyzed. The analysis is performed using different thicknesses of the window groove insulation, to evaluate what the optimal solution is.All analysis in the report is performed using both 2- and 3-dimensional numerical analysis....

  20. Automatic Water Sensor Window Opening System

    KAUST Repository

    Percher, Michael

    2013-01-01

    A system can automatically open at least one window of a vehicle when the vehicle is being submerged in water. The system can include a water collector and a water sensor, and when the water sensor detects water in the water collector, at least one window of the vehicle opens.

  1. Measure Guideline: Window Repair, Rehabilitation, and Replacement

    Energy Technology Data Exchange (ETDEWEB)

    Baker, P.

    2012-12-01

    This measure guideline provides information and guidance on rehabilitating, retrofitting, and replacing existing window assemblies in residential construction. The intent is to provide information regarding means and methods to improve the energy and comfort performance of existing wood window assemblies in a way that takes into consideration component durability, in-service operation, and long term performance of the strategies.

  2. On the inverse windowed Fourier transform

    OpenAIRE

    Rebollo Neira, Laura; Fernández Rubio, Juan Antonio

    1999-01-01

    The inversion problem concerning the windowed Fourier transform is considered. It is shown that, out of the infinite solutions that the problem admits, the windowed Fourier transform is the "optimal" solution according to a maximum-entropy selection criterion. Peer Reviewed

  3. Automatic Water Sensor Window Opening System

    KAUST Repository

    Percher, Michael

    2013-12-05

    A system can automatically open at least one window of a vehicle when the vehicle is being submerged in water. The system can include a water collector and a water sensor, and when the water sensor detects water in the water collector, at least one window of the vehicle opens.

  4. Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment.

    Science.gov (United States)

    Munday, Judy; Hines, Sonia Jane; Chang, Anne M

    2013-12-01

    The prevention of inadvertent perioperative hypothermia (IPH) remains an important issue in perioperative healthcare. The aims of this project were to: (i) assess current clinical practice in the management of IPH and (ii) promote best practice in the management of IPH in adult operating theatres. This project from August 2010 to March 2012 utilised a system of audit and feedback to implement best practice recommendations. Data were collected via chart audits against criteria developed from best practice recommendations for managing IPH. Evidence-based best practices, such as consistent temperature monitoring and patient warming, were implemented using multifaceted interventions. Perioperative records for 73 patients (baseline) and 72 patients (post-implementation) were audited. Post-implementation audit showed an increase in patients with temperatures >36°C admitted to the post-anaesthetic care unit (PACU) (8%) and discharged from PACU (28%). The percentage of patients receiving preoperative temperature monitoring increased (38%); however, low levels of intraoperative monitoring remained (31% of patients with surgery of 30 min or longer duration). Small increases were found in patient warming of 5% intraoperatively and 8% postoperatively. Preoperative warming was not successfully implemented during this phase of the project. Temperature monitoring, warming and rates of normothermia improved; however, barriers to best practice of IPH management were experienced, which negatively impacted on the project. Further stages of implementation and audit were added to further address IPH management in this department. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  5. Energy Gaining Windows for Residental Buildings

    DEFF Research Database (Denmark)

    Kragh, Jesper; Laustsen, Jacob Birck; Svendsen, Svend

    2008-01-01

    This paper presents some of the research done during the last 8 years at the Technical University of Denmark developing improved low-energy window solutions. The focus has been on maximizing the net energy gain of windows for residential buildings. The net energy gain of windows is the solar gain...... minus the heat loss integrated over the heating season. It is assumed that in northern cold climates all of the solar gain during the heating season can be utilized for space heating. Problems with overheating in the summer period must be solved with overhang or moveable solar shading devices. Two...... and longer durability of the window. The glazing in these fiber reinforced polyester windows is both unsealed and sealed triple glazing units. To increase the net energy gain slim frame profiles have been developed to increase the glazing area and thereby the solar gain. The challenge when developing slim...

  6. Mastering Windows Server 2012 R2

    CERN Document Server

    Minasi, Mark; Booth, Christian; Butler, Robert; McCabe, John; Panek, Robert; Rice, Michael; Roth, Stefan

    2013-01-01

    Check out the new Hyper-V, find new and easier ways to remotely connect back into the office, or learn all about Storage Spaces-these are just a few of the features in Windows Server 2012 R2 that are explained in this updated edition from Windows authority Mark Minasi and a team of Windows Server experts led by Kevin Greene. This book gets you up to speed on all of the new features and functions of Windows Server, and includes real-world scenarios to put them in perspective. If you're a system administrator upgrading to, migrating to, or managing Windows Server 2012 R2, find what you need to

  7. Compact UHV valve with field replaceable windows

    International Nuclear Information System (INIS)

    Johnson, E.D.; Freeman, J.; Powell, F.

    1991-01-01

    There are many applications in synchrotron radiation research where window valves can be usefully employed. Examples include gas cells for monochromator calibration, filters for high order light rejection, and as vacuum isolation elements between machine and experimental vacua. Often these devices are fairly expensive, and have only fixed (ie non-removable) windows. The development of a new type of seal technology by VAT for their series 01 valves provides a gate surface which is free from obstructions due to internal mechanical elements. This feature allows a threaded recess to be machined into the gate to receive a removable window frame which can carry standard size Luxel thin film windows. The combination of these features results in a DN 40 (2.75in. conflat flange) valve which provides a clear aperture of 21mm diameter for the window material. 8 refs., 2 figs

  8. Windows 8 app projects XAML and C#

    CERN Document Server

    Vermeir, Nico

    2013-01-01

    Become a leading Windows 8 app developer by using Windows 8 App Projects - XAML and C# Edition to learn techniques, tools, and ideas to create successful, 5-star apps. Windows 8 App Projects - XAML and C# Edition shows you the nuts and bolts of the Windows 8 development ecosystem. Then, through a series of example driven chapters, you'll discover how to leverage the platform's unique features. With each project, you'll be one step closer to building full-featured, responsive, and well designed apps that feel like they're a part of the operating system. Windows 8 App Projects - XAML and C# Edit

  9. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bradley Yudelowitz

    2016-12-01

    Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

  10. Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

    International Nuclear Information System (INIS)

    Yang Yang; Wang Feng; Li Ke; Li Cheng; Ji Donghua

    2010-01-01

    Objective: To study the effect of perioperative nursing on the living quality of patients with diabetic foot who are treated with endovascular interventional therapy. Methods: Specific perioperative nursing care plan was accordingly designed for 43 patients with diabetic foot. Endovascular balloon angioplasty and stent implantation were formed in these patients to treat their diabetic foot. The clinical results were observed. Results: Perioperative nursing effectively improved patient's limb blood supply, enhanced the healing of diabetic foot ulceration and increased the possibility of limb preservation. Conclusion: Endovascular therapy combined with corresponding perioperative nursing care can benefit more patients with diabetic foot. (authors)

  11. Focal plane scanner with reciprocating spatial window

    Science.gov (United States)

    Mao, Chengye (Inventor)

    2000-01-01

    A focal plane scanner having a front objective lens, a spatial window for selectively passing a portion of the image therethrough, and a CCD array for receiving the passed portion of the image. All embodiments have a common feature whereby the spatial window and CCD array are mounted for simultaneous relative reciprocating movement with respect to the front objective lens, and the spatial window is mounted within the focal plane of the front objective. In a first embodiment, the spatial window is a slit and the CCD array is one-dimensional, and successive rows of the image in the focal plane of the front objective lens are passed to the CCD array by an image relay lens interposed between the slit and the CCD array. In a second embodiment, the spatial window is a slit, the CCD array is two-dimensional, and a prism-grating-prism optical spectrometer is interposed between the slit and the CCD array so as to cause the scanned row to be split into a plurality of spectral separations onto the CCD array. In a third embodiment, the CCD array is two-dimensional and the spatial window is a rectangular linear variable filter (LVF) window, so as to cause the scanned rows impinging on the LVF to be bandpass filtered into spectral components onto the CCD array through an image relay lens interposed between the LVF and the CCD array.

  12. AN INTRODUCTION TO WINDOWS 2000 AT CERN

    CERN Document Server

    2001-01-01

    A demonstration of the new supported Windows environment for all the CERN personal computers (PC) will be given which is based on Windows 2000. This presentation will assume little or no familiarity with the PC, or NICE, and will concentrate on the services being offered to the users of PCs at CERN. How NICE 2000 can facilitate the work of all users, eventually becoming the key access point to all activities in the laboratory will be demonstrated. Date Title Language Location Speaker Fri 1/6 10:00 Une introduction à Windows 2000 au CERN F IT Auditorium (31/3-004) Alberto Pace Tue 5/6 10:00 Une introduction à Windows 2000 au CERN F LHC Auditorium (30/7th floor) Frederic Hemmer Tue 5/6 14:00 Une introduction à Windows 2000 au CERN F SL Auditorium (864/1s floor) Michel Bornand Tue 5/6 14:00 An introduction to Windows 2000 at CERN E IT Auditorium (31/3-004) Andreas Wagner Wed 6/6 14:00 Une introduction à Windows 2000 au CERN F SL ...

  13. Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion.

    Science.gov (United States)

    Carless, Paul A; Rubens, Fraser D; Anthony, Danielle M; O'Connell, Dianne; Henry, David A

    2011-03-16

    Concerns regarding the safety of transfused blood have generated considerable enthusiasm for the use of technologies intended to reduce the use of allogeneic blood (blood from an unrelated donor). Platelet-rich plasmapheresis (PRP) offers an alternative approach to blood conservation. To examine the evidence for the efficacy of PRP in reducing peri-operative allogeneic red blood cell (RBC) transfusion, and the evidence for any effect on clinical outcomes such as mortality and re-operation rates. We identified studies by searching MEDLINE (1950 to 2009), EMBASE (1980 to 2009), The Cochrane Library (Issue 1, 2009), the Internet (to March 2009) and the reference lists of published articles, reports, and reviews. Controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to PRP, or to a control group which did not receive the intervention. Primary outcomes measured were: the number of patients exposed to allogeneic RBC transfusion, and the amount of RBC transfused. Other outcomes measured were: the number of patients exposed to allogeneic platelet transfusions, fresh frozen plasma, and cryoprecipitate, blood loss, re-operation for bleeding, post-operative complications (thrombosis), mortality, and length of hospital stay. Treatment effects were pooled using a random-effects model. Trial quality was assessed using criteria proposed by Schulz et al (Schulz 1995). Twenty-two trials of PRP were identified that reported data for the number of patients exposed to allogeneic RBC transfusion. These trials evaluated a total of 1589 patients. The relative risk (RR) of exposure to allogeneic blood transfusion in those patients randomised to PRP was 0.73 (95%CI 0.59 to 0.90), equating to a relative risk reduction (RRR) of 27% and a risk difference (RD) of 19% (95%CI 10% to 29%). However, significant heterogeneity of treatment effect was observed (p transfused (weighted mean difference [WMD] -0.69, 95%CI -1.93 to 0.56 units). Trials

  14. Teach yourself visually Windows 8 tablets

    CERN Document Server

    McFedries, Paul

    2012-01-01

    A visual guide to all the features of the new Windows 8 Tablet This must-have resource features visually rich, step-by-step instructions that show you how to get the most enjoyment from your Windows 8 tablet. Learn about the exciting new Metro UI, optimized specifically for touch devices. The most popular and commonly used apps and functions are covered too, along with the basics of syncing with a network, setting up e-mail, watching videos, listening to music, and common productivity tasks. This book provides all the guidance needed to enjoy all the best the new Windows 8 tablets have to offe

  15. Window Shopping, Granada, 1930s”

    Directory of Open Access Journals (Sweden)

    Mae Claxton

    2010-02-01

    Full Text Available “Window Shopping, Granada, 1930s,” Photographs, p. 16, with the gracious permission of the Eudora Welty FoundationAn African American woman, dressed in her Saturday go-to-town-best, stands outside a store window, chin in hand, contemplating the contents in the window. The image is reflective and thoughtful. What is she thinking? And what lies beyond the frame of this photograph? In Mississippi in the 1930s, could she walk into this store, perhaps try on clothes or hats, and make a purchase? I...

  16. Conceptual design of proton beam window

    International Nuclear Information System (INIS)

    Teraoku, Takuji; Kaminaga, Masanori; Terada, Atsuhiko; Ishikura, Syuichi; Kinoshita, Hidetaka; Hino, Ryutaro

    2001-01-01

    In a MW-scale neutron scattering facility coupled with a high-intensity proton accelerator, a proton beam window is installed as the boundary between a high vacuum region of the proton beam transport line and a helium environment around the target assembly working as a neutron source. The window is cooled by water so as to remove high volumetric heat generated by the proton beam. A concept of the flat-type proton beam window consisting of two plates of 3 mm thick was proposed, which was found to be feasible under the proton beam power of 5 MW through thermal-hydraulic and structural strength analyses. (authors)

  17. CSS for Windows 8 app development

    CERN Document Server

    Foster, Jeremy

    2013-01-01

    CSS for Windows 8 App Development is your learning guide for CSS - the language of great Windows 8-style apps. Learn the built-in styles that make the built-in controls shine, how to define them, and how to use CSS to give your custom app assets that beautiful Modern UI style. CSS (Cascading Style Sheets) is the clear standard for styling web applications, and with HTML, CSS, and JavaScript now powering apps on Windows 8, it's the clear standard there as well. CSS is a powerful styling and layout language that greatly simplifies the selection of page elements and their visual display, layout,

  18. Managing customer arrivals with time windows

    DEFF Research Database (Denmark)

    Chen, Gang; Jiang, Liping

    2016-01-01

    Due to increasing container traffic and mega-ships, many seaports face challenges of huge amounts of truck arrivals and congestion problem at terminal gates, which affect port efficiency and generate serious air pollution. To solve this congestion problem, we propose a solution of managing truck...... arrivals with time windows based on the truck-vessel service relationship, specifically trucks delivering containers for the same vessel share one common time window. Time windows can be optimized with different strategies. In this paper, we first propose a framework for installing this solution...

  19. Windows 8 & Office 2010 for dummies

    CERN Document Server

    Rathbone, Andy

    2012-01-01

    Two complete e-books covering Windows and Office for one low price! This unique value-priced e-book set brings together two bestselling For Dummies books in a single e-book file. Including a comprehensive table of contents and the full text of each book, complete with cover, this e-book set gives you in-depth information on the leading PC productivity tools: Windows 8 and Office 2010. Best of all, you'll pay less than the cost of each book purchased separately. You'll get the complete text of: Windows 8 For Dummies, which covers The core component

  20. A Memristor Model with Piecewise Window Function

    Directory of Open Access Journals (Sweden)

    J. Yu

    2013-12-01

    Full Text Available In this paper, we present a memristor model with piecewise window function, which is continuously differentiable and consists of three nonlinear pieces. By introducing two parameters, the shape of this window function can be flexibly adjusted to model different types of memristors. Using this model, one can easily obtain an expression of memristance depending on charge, from which the numerical value of memristance can be readily calculated for any given charge, and eliminate the error occurring in the simulation of some existing window function models.

  1. Prototype solid-state electrochromic window devices

    International Nuclear Information System (INIS)

    Dao, L.H.; Nguyen, M.T.

    1989-01-01

    This paper discusses electrochromic smart windows which are prospective devices for the control of light transmission in response to the variation of brightness of the environment. The fabrication of electrochromic windows based on cathodically coloring transition metal oxides and anodically coloring conducting polymers are described. The device consists of gel or glassy polymer electrolytes sandwiches by a pair of transparent conducting glass coated respectively with a thin film of WO 3 or MoO 3 prepared by electrodeposition, and with a thin film of ploy(aniline) derivatives obtained by electropolymerization or solution casting. The electrochromic properties of the five-layer smart window devices are presented

  2. Microsoft Windows Server 2012 administration instant reference

    CERN Document Server

    Hester, Matthew

    2013-01-01

    Fast, accurate answers for common Windows Server questions Serving as a perfect companion to all Windows Server books, this reference provides you with quick and easily searchable solutions to day-to-day challenges of Microsoft's newest version of Windows Server. Using helpful design features such as thumb tabs, tables of contents, and special heading treatments, this resource boasts a smooth and seamless approach to finding information. Plus, quick-reference tables and lists provide additional on-the-spot answers. Covers such key topics as server roles and functionality, u

  3. Time Modeling: Salvatore Sciarrino, Windows and Beclouding

    Directory of Open Access Journals (Sweden)

    Acácio Tadeu de Camargo Piedade

    2017-08-01

    Full Text Available In this article I intend to discuss one of the figures created by the Italian composer Salvatore Sciarrino: the windowed form. After the composer's explanation of this figure, I argue that windows in composition can open inwards and outwards the musical discourse. On one side, they point to the composition's inner ambiences and constitute an internal remission. On the other, they instigate the audience to comprehend the external reference, thereby constructing intertextuality. After the outward window form, I will consider some techniques of distortion, particularly one that I call beclouding. To conclude, I will comment the question of memory and of compostition as time modeling.

  4. Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes.

    Science.gov (United States)

    Eyraud, Rémi; Long, Jean-Alexandre; Snow-Lisy, Devon; Autorino, Riccardo; Hillyer, Shahab; Klink, Joseph; Rizkala, Emad; Stein, Robert J; Kaouk, Jihad H; Haber, Georges-Pascal

    2013-06-01

    To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for hilar vs nonhilar tumors. The study retrospectively reviewed 364 patients with available computed tomography scans undergoing RAPN. Demographic data and perioperative outcomes results were compared between the hilar (group 1, n = 70) and nonhilar tumors (group 2, n = 294). Multivariate analysis was used to identify predictors of warm ischemia time (WIT), estimated blood loss (EBL), major perioperative complications, and postoperative renal function. There were no differences with respect to demographic variables. Hilar tumors had higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) scores (P hilar tumors were associated with greater operative time (210 vs 180 minutes, P hilar vs nonhilar patients on postoperative day 3 (70.12 vs 74.71 mL/min/1.73 m(2), P = .31) or at last follow-up (72.62 vs 75.78 mL/min/1.73 m(2), P = .40), respectively. Multivariate analysis found hilar location was independently associated with increased WIT without significant changes in EBL, major complications, or postoperative renal function. RAPN represents a safe and effective procedure for hilar tumors. Hilar location for patients undergoing RAPN in a high-volume institution seems not be associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients.

    Science.gov (United States)

    Orłowski, Krzysztof; Lisowska, Grażyna; Misiołek, Hanna; Paluch, Zbigniew; Misiołek, Maciej

    2016-01-01

    While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

  6. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. © The Author(s) 2015.

  7. Perioperative Care of the Patient With the Total Artificial Heart.

    Science.gov (United States)

    Yaung, Jill; Arabia, Francisco A; Nurok, Michael

    2017-05-01

    Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.

  8. Minimally Invasive Placement of Spinal Cord Stimulator Paddle Electrodes Is Associated With Improved Perioperative and Long-Term Experience Among Neuropathic Pain Patients.

    Science.gov (United States)

    Shamji, Mohammed F; Paul, Darcia; Mednikov, Alina

    2018-03-01

    Prospective, observational cohort study. This study compared in-hospital and long-term outcomes among spinal cord stimulation (SCS) patients undergoing paddle insertion by open or minimally invasive surgery (MIS) approaches. Patients with treatment-refractory extremity neuropathic pain may benefit from SCS. Conventional placement of surgical paddles for an external neurostimulation trial is through open laminectomy, but MIS techniques may offer advantages. Twenty SCS patients were prospectively assessed. Open patients underwent caudal thoracic laminectomy for multicolumnar electrode paddle placement. MIS patients underwent paddle placement through interlaminar flavectomy using tubular retractors. Demographic data included age, sex, underlying diagnosis, and preoperative visual analog scale (VAS) extremity scores. Intraoperative data included operative duration, blood loss, and number of device passages to achieve final position. Perioperative data included VAS back pain scores; trial data included time-to-trial and time-to-decision. Postoperative data included 1 month VAS back pain scores and 1 year follow-up device complications. No demographic differences were observed among surgical cohorts. MIS procedures had shorter operative duration (P = 0.03), less blood loss (P patients reported less perioperative surgical back pain (P patients who also made sooner decision whether to implant the SCS device (2.8 ± 1.4 vs 4.3 ± 1.0 days, P = 0.013). Similar 1 month back pain scores were reported between surgical cohorts (P = 0.08). MIS techniques for SCS surgical paddle implantation is associated with less perioperative morbidity and surgical site back pain, shorter external neurostimulator trial duration, and long-term device stability benefits. 2.

  9. Window selection for dual photopeak window scatter correction in Tc-99m imaging

    International Nuclear Information System (INIS)

    Vries, D.J. de; King, M.A.

    1994-01-01

    The width and placement of the windows for the dual photopeak window (DPW) scatter subtraction method for Tc-99m imaging is investigated in order to obtain a method that is stable on a multihead detector system for single photon emission computed tomography (SPECT) and is capable of providing a good scatter estimate for extended objects. For various window pairs, stability and noise were examined with experiments using a SPECT system, while Monte Carlo simulations were used to predict the accuracy of scatter estimates for a variety of objects and to guide the development of regression relations for various window pairs. The DPW method that resulted from this study was implemented with a symmetric 20% photopeak window composed of a 15% asymmetric photopeak window and a 5% lower window abutted at 7 keV below the peak. A power function regression was used to relate the scatter-to-total ratio to the lower window-to-total ratio at each pixel, from which an estimated scatter image was calculated. DPW demonstrated good stability, achieved by abutting the two windows away from the peak. Performance was assessed and compared with Compton window subtraction (CWS). For simulated extended objects, DPW generally produced a less biased scatter estimate than the commonly used CWS method with k = 0.5. In acquisitions of a clinical SPECT phantom, contrast recovery was comparable for both DPW and CWS; however, DPW showed greater visual contrast in clinical SPECT bone studies

  10. Upstate Windows and Exteriors Information Sheet

    Science.gov (United States)

    Upstate Windows and Exteriors (the Company) is located in Greenville, South Carolina. The settlement involves renovation activities conducted at properties constructed prior to 1978, located in Greenville and Easley, South Carolina.

  11. UV conformal window for asymptotic safety

    Science.gov (United States)

    Bond, Andrew D.; Litim, Daniel F.; Vazquez, Gustavo Medina; Steudtner, Tom

    2018-02-01

    Interacting fixed points in four-dimensional gauge theories coupled to matter are investigated using perturbation theory up to three loop order. It is shown how fixed points, scaling exponents, and anomalous dimensions are obtained as a systematic power series in a small parameter. The underlying ordering principle is explained and contrasted with conventional perturbation theory and Weyl consistency conditions. We then determine the conformal window with asymptotic safety from the complete next-to-next-to-leading order in perturbation theory. Limits for the conformal window arise due to fixed point mergers, the onset of strong coupling, or vacuum instability. A consistent picture is uncovered by comparing various levels of approximation. The theory remains perturbative in the entire conformal window, with vacuum stability dictating the tightest constraints. We also speculate about a secondary conformal window at strong coupling and estimate its lower limit. Implications for model building and cosmology are indicated.

  12. Microsoft Windows 2000 Router Configuration Guide

    National Research Council Canada - National Science Library

    Richburg, Florence

    2001-01-01

    The purpose of this guide is to provide technical guidance to network administrators of small to medium size networks in the configuration and integration of Microsoft Windows 2000 Server Router features...

  13. Microsoft Windows 2000 Network Architecture Guide

    National Research Council Canada - National Science Library

    Bartock, Paul

    2000-01-01

    The purpose of this guide is to inform the reader about the services that are available in the Microsoft Windows 2000 environment and how to integrate these services into their network architecture...

  14. Windows XP Operating System Security Analysis

    National Research Council Canada - National Science Library

    Goktepe, Meftun

    2002-01-01

    .... The purpose of this research is to determine if Windows XP, when used as a workstation operating system in domain- based networks, provides adequate security policy enforcement for organizations...

  15. Characteristics of Air Flow through Windows

    DEFF Research Database (Denmark)

    Heiselberg, Per; Dam, Henrik; Sørensen, Lars C.

    This paper describes the first results of a series of laboratory investigations that is performed to characterise three different window types. The results show the air flow conditions for different ventilation strategies and temperature differences. For one of the windows values of the discharge...... coefficient are shown for both isothermal and non-isothermal flow conditions and the thermal comfort conditions are evaluated by measurements of velocity and temperature levels in the air flow in the occupied zone.......This paper describes the first results of a series of laboratory investigations that is performed to characterise three different window types. The results show the air flow conditions for different ventilation strategies and temperature differences. For one of the windows values of the discharge...

  16. Translational nanomedicine--through the therapeutic window.

    Science.gov (United States)

    Pierce, Robin L

    2015-01-01

    Translational nanomedicine occurs only through the successful integration of multiple inputs and iterative modifications. The therapeutic window plays a pivotal role in the trajectory of translational nanomedicine. Often defined in terms of the range of dosage for safe and effective therapeutic effect, a second definition of the therapeutic window refers to the often narrow temporal window in which a therapeutic effect can be obtained. Expanding the second definition to explicitly include the spatial dimension, this article explores aspects of the therapeutic spaces created by nanomedicine that shift the traditional dimensions of symptom, sign and pathology. This article analyzes three aspects of the therapeutic window in nanomedicine - temporal, spatial and manner of construction and their impact on the dimensions of modern medicine.

  17. Microsoft Windows Server 2003: Security Enhancements and New Features

    National Research Council Canada - National Science Library

    Montehermoso, Ronald

    2004-01-01

    .... Windows NT and Windows 2000 were known to have numerous security vulnerabilities; hence Microsoft focused on improving security by making Windows Server 2003 secure by design, secure by default, secure in deployment...

  18. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults.

    Science.gov (United States)

    Madrid, Eva; Urrútia, Gerard; Roqué i Figuls, Marta; Pardo-Hernandez, Hector; Campos, Juan Manuel; Paniagua, Pilar; Maestre, Luz; Alonso-Coello, Pablo

    2016-04-21

    Inadvertent perioperative hypothermia is a phenomenon that can occur as a result of the suppression of the central mechanisms of temperature regulation due to anaesthesia, and of prolonged exposure of large surfaces of skin to cold temperatures in operating rooms. Inadvertent perioperative hypothermia has been associated with clinical complications such as surgical site infection and wound-healing delay, increased bleeding or cardiovascular events. One of the most frequently used techniques to prevent inadvertent perioperative hypothermia is active body surface warming systems (ABSW), which generate heat mechanically (heating of air, water or gels) that is transferred to the patient via skin contact. To assess the effectiveness of pre- or intraoperative active body surface warming systems (ABSW), or both, to prevent perioperative complications from unintended hypothermia during surgery in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 9, 2015); MEDLINE (PubMed) (1964 to October 2015), EMBASE (Ovid) (1980 to October 2015), and CINAHL (Ovid) (1982 to October 2015). We included randomized controlled trials (RCTs) that compared an ABSW system aimed at maintaining normothermia perioperatively against a control or against any other ABSW system. Eligible studies also had to include relevant clinical outcomes other than measuring temperature alone. Several authors, by pairs, screened references and determined eligibility, extracted data, and assessed risks of bias. We resolved disagreements by discussion and consensus, with the collaboration of a third author. We included 67 trials with 5438 participants that comprised 79 comparisons. Forty-five RCTs compared ABSW versus control, whereas 18 compared two different types of ABSW, and 10 compared two different techniques to administer the same type of ABSW. Forced-air warming (FAW) was by far the most studied intervention.Trials varied widely regarding whether the interventions were

  19. Cascaded Window Memoization for Medical Imaging

    OpenAIRE

    Khalvati , Farzad; Kianpour , Mehdi; Tizhoosh , Hamid ,

    2011-01-01

    Part 12: Medical Applications of ANN and Ethics of AI; International audience; Window Memoization is a performance improvement technique for image processing algorithms. It is based on removing computational redundancy in an algorithm applied to a single image, which is inherited from data redundancy in the image. The technique employs a fuzzy reuse mechanism to eliminate unnecessary computations. This paper extends the window memoization technique such that in addition to exploiting the data...

  20. Windows in Low Energy Houses. Size Matters

    Energy Technology Data Exchange (ETDEWEB)

    Persson, Mari-Louise

    2004-06-01

    A generally accepted way of building passive houses has been to have small windows facing north and a large glass facade to the south. This is to minimize losses on the north side while gaining as much solar heat as possible on the south. In spring 2001, twenty terraced houses were built outside Goeteborg partly in this way. The indoor temperature is kept at a comfortable level by passive methods, using solar gains and internal gains from household appliances and occupants. Heat losses are very low, since the building envelope is well insulated and since modern coated triple-glazed windows have been installed. The purpose of this work is to investigate how decreasing the window size facing south and increasing the window size facing north in low energy houses will influence the energy consumption and maximum power needed to keep the indoor temperature between 23 and 26 deg C. Different climates and orientations have been investigated and so have the influence of occupancy and window type. A dynamic building simulation tool, DEROB, has been used and the simulations indicate an extremely low energy demand for the houses. The results show that the size of the energy efficient windows does not have a major influence on the heating demand in winter, but is of relevant signification looking at the cooling need in summer. This indicates that instead of the traditional technique of building passive houses it is possible to enlarge the window area facing north and get better lighting conditions. To decrease the energy need for cooling, there is an optimal window size facing south that is smaller than the original size of the investigated buildings.

  1. USB Storage Device Forensics for Windows 10.

    Science.gov (United States)

    Arshad, Ayesha; Iqbal, Waseem; Abbas, Haider

    2018-05-01

    Significantly increased use of USB devices due to their user-friendliness and large storage capacities poses various threats for many users/companies in terms of data theft that becomes easier due to their efficient mobility. Investigations for such data theft activities would require gathering critical digital information capable of recovering digital forensics artifacts like date, time, and device information. This research gathers three sets of registry and logs data: first, before insertion; second, during insertion; and the third, after removal of a USB device. These sets are analyzed to gather evidentiary information from Registry and Windows Event log that helps in tracking a USB device. This research furthers the prior research on earlier versions of Microsoft Windows and compares it with latest Windows 10 system. Comparison of Windows 8 and Windows 10 does not show much difference except for new subkey under USB Key in registry. However, comparison of Windows 7 with latest version indicates significant variances. © 2017 American Academy of Forensic Sciences.

  2. AN INTRODUCTION TO WINDOWS 2000 AT CERN

    CERN Multimedia

    2001-01-01

    A demonstration of the new supported Windows environment for all the CERN personal computers (PC) will be given which is based on Windows 2000. This presentation will assume little or no familiarity with the PC, or NICE, and will concentrate on the services being offered to the users of PCs at CERN. How NICE 2000 can facilitate the work of all users, eventually becoming the key access point to all activities in the laboratory will be demonstrated. Information: http://winservices.web.cern.ch/winservices/Seminars/Tutorials/ Date Title Language Location Speaker Fri 1/6 10:00 Une introduction à Windows 2000 au CERN F IT Auditorium (31/3-004) Alberto Pace Tue 5/6 10:00 Une introduction à Windows 2000 au CERN F LHC Auditorium (30/7th floor) Frederic Hemmer Tue 5/6 14:00 Une introduction à Windows 2000 au CERN F SL Auditorium (864/1s floor) Michel Bornand Tue 5/6 14:00 An introduction to Windows 2000 at CERN E IT Auditorium (31/3-004) Andreas Wagner ...

  3. Window Size Impact in Human Activity Recognition

    Directory of Open Access Journals (Sweden)

    Oresti Banos

    2014-04-01

    Full Text Available Signal segmentation is a crucial stage in the activity recognition process; however, this has been rarely and vaguely characterized so far. Windowing approaches are normally used for segmentation, but no clear consensus exists on which window size should be preferably employed. In fact, most designs normally rely on figures used in previous works, but with no strict studies that support them. Intuitively, decreasing the window size allows for a faster activity detection, as well as reduced resources and energy needs. On the contrary, large data windows are normally considered for the recognition of complex activities. In this work, we present an extensive study to fairly characterize the windowing procedure, to determine its impact within the activity recognition process and to help clarify some of the habitual assumptions made during the recognition system design. To that end, some of the most widely used activity recognition procedures are evaluated for a wide range of window sizes and activities. From the evaluation, the interval 1–2 s proves to provide the best trade-off between recognition speed and accuracy. The study, specifically intended for on-body activity recognition systems, further provides designers with a set of guidelines devised to facilitate the system definition and configuration according to the particular application requirements and target activities.

  4. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  5. In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration

    NARCIS (Netherlands)

    Blom, M T; de Jonghe, A; van Munster, B C; de Rooij, S E; Tan, H L; van der Velde, Nathalie; Jansen, S.

    2015-01-01

    OBJECTIVES: Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated

  6. A 10-year review of perioperative complications in pharyngeal flap surgery

    NARCIS (Netherlands)

    Hofer, SOP; Dhar, BK; Robinson, PH; Goorhuis-Brouwer, SM; Nicolai, JPA

    2002-01-01

    A 10-year retrospective study was undertaken to investigate perioperative complications in pharyngeal flap surgery in one institution using inferiorly and superiorly based flaps. In this fashion the current practice of surgical technique based on local findings and perioperative care, through

  7. Perioperative versus postoperative measurement of Taylor Spatial Frame mounting parameters.

    Science.gov (United States)

    Sökücü, Sami; Demir, Bilal; Lapçin, Osman; Yavuz, Umut; Kabukçuoğlu, Yavuz S

    2014-01-01

    The aim of this study was to determine the differences, if any, between application parameters for the Taylor Spatial Frame (TSF) system obtained during surgery under fluoroscopy and after surgery from digital radiography. This retrospective study included 17 extremities of 15 patients (8 male, 7 female; mean age: 21.9 years, range: 10 to 55 years) who underwent TSF after deformity and fracture. Application parameters measured by fluoroscopy at the end of surgery after mounting the fixator were compared with parameters obtained from anteroposterior and lateral digital radiographs taken 1 day after surgery. Fixator was applied to the femur in 8 patients, tibia in 6 and radius in 3. Mean time to removal of the frame was 3.5 (range: 3 to 7) months. Mean perioperative anteroposterior, lateral and axial frame offsets of patients were 9.1 (range: 3 to 20) mm, 18.1 (range: 5 to 37) mm and 95.3 (range: 25 to 155) mm, respectively. Mean postoperative anteroposterior, lateral and axial frame offset radiographs were 11.8 (range: 2 to 30) mm, 18 (range: 6 to 47) mm and 109.5 (range: 28 to 195) mm, respectively. There was no statistically significant difference between the groups (p>0.05). While measurements taken during operation may lengthen the duration in the operation room, fluoroscopy may provide better images and is easier to perform than digital radiography. On the other hand, there is no difference between measurements taken during perioperative fluoroscopy and postoperative digital radiography.

  8. Perioperative nutritional status changes in gastrointestinal cancer patients.

    Science.gov (United States)

    Shim, Hongjin; Cheong, Jae Ho; Lee, Kang Young; Lee, Hosun; Lee, Jae Gil; Noh, Sung Hoon

    2013-11-01

    The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (pgastric cancer patients, postoperative severe malnourishment increased significantly (p60, pgastric cancer (pgastric cancer, and open surgery remained significant as risk factors of severe malnutrition. The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.

  9. Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Jochen Gille

    2012-01-01

    Full Text Available Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia. Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.

  10. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  11. High-dose buprenorphine: perioperative precautions and management strategies.

    Science.gov (United States)

    Roberts, D M; Meyer-Witting, M

    2005-02-01

    Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.

  12. Neurologic Evaluation and Management of Perioperative Nerve Injury.

    Science.gov (United States)

    Watson, James C; Huntoon, Marc A

    2015-01-01

    Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management. Studies pertinent to the recognition, evaluation, and treatment of neurologic assessment of perioperative nerve injury and published since the last advisory on the topic are reviewed and a new structured algorithmic approach is proposed. The evolving literature on postoperative inflammatory neuropathies is reviewed to help define the clinical criteria and to identify patients who would benefit from early neurological evaluation. New sections review potential acute interventions to improve neurologic outcome and long-term management of neuropathic pain resulting from perioperative nerve injury.

  13. Perioperative factors associated with pressure ulcer development after major surgery

    Science.gov (United States)

    2018-01-01

    Background Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. Results The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P pressure ulcer development after surgery. PMID:29441175

  14. [Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass].

    Science.gov (United States)

    Uji, Makiko; Terada, Yuki; Noguchi, Teruo; Nishida, Takaya; Hasuwa, Kyoko; Shinohara, Kozue; Kumano, Hotaka; Ishimura, Naoko; Nishiwada, Makoto

    2012-08-01

    Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period. The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit. For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1). Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.

  15. Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

    2018-04-01

    Interhospital competition has been shown to influence the adoption of surgical techniques and approaches, clinical patient outcomes, and health care resource use for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery. This investigation sought to examine the relationship between interhospital competitive intensity and perioperative outcomes following lumbar spinal fusion. This study used the Nationwide Inpatient Sample dataset, years 2003, 2006, and 2009. Patients were included based on the presence of the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI). The outcome measures are perioperative complications, defined using an ICD-9-CM coding algorithm. The HHI, a validated measure of competition within a market, was used to assess hospital market competitiveness. The HHI was calculated based on the hospital cachement area. Multiple regression was performed to adjust for confounding variables including patient age, gender, primary payer, severity of illness score, primary versus revision fusion, anterior versus posterior approach, national region, hospital bed size, location or teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications. In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099-0.724). The average patient age was 55.4 years (standard error=0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998) and fusions with a posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or the Midwest (27.0%, n=112,758) regions. In the multiple regression analysis, increased hospital

  16. Perioperative effects of oral midazolam premedication in children undergoing skin laser treatment: a double-blinded randomized placebo-controlled trial Efeitos peroperatórios da premedicação oral de midazolam em crianças submetidas a tratamento de pele por laser: estudo duplo-cego randomizado e controlado

    Directory of Open Access Journals (Sweden)

    Mehrdad Shoroghi

    2011-08-01

    Full Text Available PURPOSE: To investigate and compare the efficacy of oral midazolam with two different dosages in orange juice on perioperative hemodynamics and behavioral changes in children who underwent skin laser treatment in an academic educational Hospital. METHODS: Ninety children, candidates for skin laser treatment were randomly assigned to 1 of 3 groups of 30 each: the placebo group received 0.1 ml/kg orange flavored juice, group 2 and 3 receiving 0.5 and 1 mg/kg of injectable midazolam mixed with an equal volume of orange juice, respectively. The main outcome measures included the mask acceptance, patients' behavioral scales and postoperative events. RESULTS: There were no significant differences in heart rate, respiratory rate, and systolic blood pressure among the three groups. However, arterial oxygen saturation was significantly reduced in those given 1 mg.kg-1 midazolam. The median scores of anxiety, separation from parent, preparing an intravenous line, acceptance of the oxygen mask, good sedation, crying reduction and consciousness level were better in midazolam group. Postoperative agitation and re-crying were also more frequent in placebo receivers. Those given 1 mg.kg-1 midazolam were significantly more optimal for sedation, crying, consciousness, preparing an intravenous line, and postoperative re-crying compared with 0.5 mg.kg-1 midazolam receivers. CONCLUSION: As a preanaesthetic medication, the 1 mg.kg-1 dose of orally given midazolam especially in a volume of orange juice and can optimize the children's behavior during skin laser treatment with no serious adverse effects, enhancing their parents' satisfactions about the sedative protocol.OBJETIVO:Investigar e comparar a eficácia do uso oral de midazolam com duas diferentes doses de suco de laranja na hemodinâmica peropeatória e mudanças de desempenho em crianças submetidas tratamento de pele por laser em Hospital educacional e acadêmico. MÉTODOS:Noventa crianças candidatas a

  17. Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

    Science.gov (United States)

    Rudolfsson, Gudrun

    2014-08-01

    The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study. © 2013 Wiley Publishing Asia Pty Ltd.

  18. Designing for Windows 8 fundamentals of great design in Windows Store apps

    CERN Document Server

    Schooley, Brent

    2013-01-01

    Designing for Windows 8 is a fast-paced, 150-page primer on the key design concepts you need to create successful Windows 8 apps. This book will help you design a user interface that is both delightful and effective, feels 'right' to your users, and encapsulates a great Windows 8 experience. In this book, you will: Meet the building blocks of solid Windows 8 UI design in a well-designed sample app. Learn how to incorporate key design elements into your apps, such as the app bar, charms and subtle animations from the animation library. Find out how to deliver the core experience that your users

  19. Transforming the market for residential windows: design considerations for DOE's Efficient Window Collaborative

    Energy Technology Data Exchange (ETDEWEB)

    Eto, J.; Arasteh, D.; Selkowitz, S.

    1998-08-01

    Market adoption of recent, commercially available technological advances that improve the energy performance of windows will lead to immediate economic and energy savings benefits to the nation. This paper is a scoping study intended to inform the design of a major DOE initiative to accelerate market adoption of these windows in the residential sector. We describe the structure of the US residential window market and the interests of the various market players. We then briefly review five recent market transformation initiatives. Finally, we summarize our findings in a list of considerations we believe will be important for the DOE's initiative to transform the US residential window market.

  20. Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.

    Science.gov (United States)

    Sadhasivam, Senthilkumar; Cohen, Lindsey L; Hosu, Liana; Gorman, Kristin L; Wang, Yu; Nick, Todd G; Jou, Jing Fang; Samol, Nancy; Szabova, Alexandra; Hagerman, Nancy; Hein, Elizabeth; Boat, Anne; Varughese, Anna; Kurth, Charles Dean; Willging, J Paul; Gunter, Joel B

    2010-04-01

    Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments. The PACBIS was used to assess the perioperative behaviors of 89 children aged 3 to 12 years presenting for adenotonsillectomy and their parents. Assessments using the PACBIS were made during perioperative events likely to prove distressing to children and/or parents (perioperative measurement of blood pressure, induction of anesthesia, and removal of the IV catheter before discharge). Static measurements of perioperative anxiety and behavioral compliance during anesthetic induction were made using the modified Yale Preoperative Anxiety Scale and the Induction Compliance Checklist (ICC). Each event was videotaped for later scoring using the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) and Observational Scale of Behavioral Distress (OSBD). Interrater reliability using linear weighted kappa (kappa(w)) and multiple validations using Spearman correlation coefficients were analyzed. The PACBIS demonstrated good to excellent

  1. A continuous wave RF vacuum window

    International Nuclear Information System (INIS)

    Walton, R.

    1999-09-01

    An essential part of an ICRF system to be used in fusion reactor is the RF window. This is fitted in a coaxial transmission line. It forms a vacuum and tritium boundary between the antenna, situated inside the machine, and the transmission line, which feeds it. A double window is required with a vacuum inter-space. The dielectric, which forms the vacuum boundary, must be brazed into its housing. The window must be of a robust construction, and capable of withstanding both axial and radial loads. The vacuum boundaries should be thick walled in order act as a suitable tritium barrier. A further requirement is that the window is capable of continuous operation. The design of such a window is presented below. A half scale prototype has been manufactured, which has successfully completed RF, vacuum, and mechanical testing at JET, but has no water cooling, which is a requirement for continuous operation. The design presented here is for a window to match the existing 30 Ω main transmission lines at JET. It employs two opposed ceramic dielectric cones with a much increased angle of incidence compared with existing JET windows. The housing is machined from titanium. Small corona rings are used, and the tracking distance along the ceramic surface is large. The geometry minimizes the peak electric field strength. The design uses substantial pre-stressing during manufacture, to produce a compressive stress field throughout the dielectric material. Significant tensile stresses in the ceramic, and therefore the possibility of fracture due to applied thermal and mechanical loading, are eliminated in this way. A full-scale actively cooled RF window using this basic design should be capable of continuous use at 50 kV in the 20 - 90 MHz range. A half scale, inertially cooled prototype window has been designed, built and tested successfully at JET to 48 kV for up to 20 seconds. The prototype uses alumina for the dielectric, whereas beryllia is more appropriate for continuous

  2. VIS-IR transmitting BGG glass windows

    Science.gov (United States)

    Bayya, Shyam S.; Chin, Geoff D.; Sanghera, Jasbinder S.; Aggarwal, Ishwar D.

    2003-09-01

    BaO-Ga2O3-GeO2 (BGG) glasses have the desired properties for various window applications in the 0.5-5 μm wavelength region. These glasses are low cost alternatives to the currently used window materials. Fabrication of a high optical quality 18" diameter BGG glass window has been demonstrated with a transmitted wave front error of λ/10 at 632 nm. BGG substrates have also been successfully tested for environmental weatherability (MIL-F-48616) and rain erosion durability up to 300 mph. Preliminary EMI grids have been successfully applied on BGG glasses demonstrating attenuation of 20dB in X and Ku bands. Although the mechanical properties of BGG glasses are acceptable for various window applications, it is demonstrated here that the properties can be further improved significantly by the glassceramization process. The ceramization process does not add any significant cost to the final window material. The crystallite size in the present glass-ceramic limits its transmission to the 2-5 μm region.

  3. Optimising window parameters for energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Boland, J. [South Australia Univ., Adelaide, SA (Australia); Luther, M. [Deakin Univ., Geelong, VIC (Australia)

    1996-12-31

    Large north facing windows act a solar collectors, with the heat being stored in the building mass and being released later in the day. This study examines one of the elements of this paradigm, that increasing the size of equatorially facing windows necessarily improves the energy efficiency of a dwelling. This question and that of whether there is a case for using double glazing in Australia were examined for a number of locations ranging from cool temperate to warm temperate and for several types of construction from lightweight to heavyweight. Simulations were performed using the modelling tool Cheetah. It was found that the optimal window size on equatorially facing walls was smaller than expected for singly glazed windows. Double glazing was found to be effective in most situations and increased the optimum size of the window substantially. Changing the operational pattern of the house (specifically when cooling equipment may be employed) considerably affects conclusions about single and double glazing. (author). 3 tabs., 3 figs., 13 refs.

  4. Optimising the performance of the window

    Energy Technology Data Exchange (ETDEWEB)

    Luther, M.B. [Deakin Univ., Geelong, VIC (Australia); Boland, J. [South Australia Univ., Adelaide, SA (Australia)

    1996-12-31

    Glass is a versatile material in the design and performance of windows. Advancements in the technologies of the glass material have produced variable degrees of window thermal performance. A closer look at the glazing system itself in reference to overall building thermal performance will hopefully explain when, where and how the window is a benefit under specific climatic conditions. The optimization of equatorially facing window area for either single or double glazing systems is investigated in another paper in this conference, and it is now queried as to how the design of the window itself can benefit the annual performance of a residence. Two locations were investigated, each for a hot summer and cold winter week. Separate glazing analysis programs are also used independent of the thermal residential program CHEETAH. Three glazing systems, single 3 mm, double 3 mm, and a spectrally-selective double 3 mm system were investigated. There appears to be little difference in the total overall performance between a clear and a selective double insulated glazing system. It is further suggested that there is room for future improvement to thermal simulation programs by incorporating rigorous glazing simulation. 9 figs., 8 refs.

  5. Bispectral analysis: comparison of two windowing functions

    Science.gov (United States)

    Silvagni, D.; Djerroud, C.; Réveillé, T.; Gravier, E.

    2018-02-01

    Amongst all the normalized forms of bispectrum, the bicoherence is shown to be a very useful diagnostic tool in experimental studies of nonlinear wave interactions in plasma, as it measures the fraction of wave power due to the quadratic wave coupling in a self-excited fluctuation spectrum [1, 2]. In order to avoid spectral leakage, the application of a windowing function is needed during the bicoherence computation. Spectral leakage from statistically dependent components are of crucial importance in the discrimination between coupled and uncoupled modes, as they will introduce in the bicoherence spectrum phase-coupled modes which in reality do not exist. Therefore, the windowing function plays a key role in the bicoherence estimation. In this paper, two windowing methods are compared: the multiplication of the initial signal by the Hanning function and the subtraction of the straight line which links the two extremities of the signal. The influence of these two windowing methods on both the power spectrum and the bicoherence spectrum is showed. Although both methods give precise results, the Hanning function appears to be the more suitable window.

  6. Hot Cell Window Shielding Analysis Using MCNP

    International Nuclear Information System (INIS)

    Pope, Chad L.; Scates, Wade W.; Taylor, J. Todd

    2009-01-01

    The Idaho National Laboratory Materials and Fuels Complex nuclear facilities are undergoing a documented safety analysis upgrade. In conjunction with the upgrade effort, shielding analysis of the Fuel Conditioning Facility (FCF) hot cell windows has been conducted. This paper describes the shielding analysis methodology. Each 4-ft thick window uses nine glass slabs, an oil film between the slabs, numerous steel plates, and packed lead wool. Operations in the hot cell center on used nuclear fuel (UNF) processing. Prior to the shielding analysis, shield testing with a gamma ray source was conducted, and the windows were found to be very effective gamma shields. Despite these results, because the glass contained significant amounts of lead and little neutron absorbing material, some doubt lingered regarding the effectiveness of the windows in neutron shielding situations, such as during an accidental criticality. MCNP was selected as an analysis tool because it could model complicated geometry, and it could track gamma and neutron radiation. A bounding criticality source was developed based on the composition of the UNF. Additionally, a bounding gamma source was developed based on the fission product content of the UNF. Modeling the windows required field inspections and detailed examination of drawings and material specifications. Consistent with the shield testing results, MCNP results demonstrated that the shielding was very effective with respect to gamma radiation, and in addition, the analysis demonstrated that the shielding was also very effective during an accidental criticality.

  7. The Diabetic Postoperative Mortality and Morbidity (DIPOM) trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Kofoed-Enevoldsen, Allan

    2004-01-01

    Recent trials suggest that perioperative beta-blockade reduces the risk of cardiac events in patients with a risk of myocardial ischemia who are undergoing noncardiac surgery. Patients with diabetes mellitus are at a high-risk for postoperative cardiac morbidity and mortality. They may, therefore...

  8. The Moving Window Technique: A Window into Developmental Changes in Attention during Facial Emotion Recognition

    Science.gov (United States)

    Birmingham, Elina; Meixner, Tamara; Iarocci, Grace; Kanan, Christopher; Smilek, Daniel; Tanaka, James W.

    2013-01-01

    The strategies children employ to selectively attend to different parts of the face may reflect important developmental changes in facial emotion recognition. Using the Moving Window Technique (MWT), children aged 5-12 years and adults ("N" = 129) explored faces with a mouse-controlled window in an emotion recognition task. An…

  9. Perioperative celecoxib administration for pain management after total knee arthroplasty – A randomized, controlled study

    Directory of Open Access Journals (Sweden)

    Lin Wei-Peng

    2008-06-01

    Full Text Available Abstract Background Non-steroidal anti-inflammatory drugs (NSAIDs are recommended for multimodal postoperative pain management. We evaluated opioid-sparing effects and rehabilitative results after perioperative celecoxib administration for total knee arthroplasty. Methods This was a prospective, randomized, observer-blind control study. Eighty patients that underwent total knee arthroplasty were randomized into two groups of 40 each. The study group received a single 400 mg dose of celecoxib, one hour before surgery, and 200 mg of celecoxib every 12 hours for five days, along with patient-controlled analgesic (PCA morphine. The control group received only PCA morphine for postoperative pain management. Visual analog scale (VAS pain scores, active range of motion (ROM, total opioid use and postoperative nausea/vomiting were analyzed. Results Groups were comparable for age, pre-operative ROM, operation duration and intraoperative blood loss. Resting VAS pain scores improved significantly in the celecoxib group, compared with controls, at 48 hrs (2.13 ± 1.68 vs. 3.43 ± 1.50, p = 0.03 and 72 hrs (1.78 ± 1.66 vs. 3.17 ± 2.01, p = 0.02 after surgery. Active ROM also increased significantly in the patients that received celecoxib, especially in the first 72 hrs [40.8° ± 17.3° vs. 25.8° ± 11.5°, p = 0.01 (day 1; 60.7° ± 18.1° vs. 45.0° ± 17.3°, p = 0.004 (day 2; 77.7° ± 15.1° vs. 64.3° ± 16.9°, p = 0.004 (day 3]. Opioid requirements decreased about 40% (p = 0.03 in the celecoxib group. Although patients suffering from post-operative nausea/vomiting decreased from 43% in control group to 28% in celecoxib group, this was not significant (p = 0.57. There were no differences in blood loss (intra- and postoperative between the groups. Celecoxib resulted in no significant increase in the need for blood transfusions. Conclusion Perioperative celecoxib significantly improved postoperative resting pain scores at 48 and 72 hrs, opioid

  10. Nursing team stress in the perioperative period: an integrative review

    Directory of Open Access Journals (Sweden)

    Dafne Eva Corrêa Brandão

    2013-09-01

    Full Text Available This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8 and stress coping strategies used by the nursing staff (n=6. Evidence suggests that stress in the workplace worsens the health of the nursing team, provoking undesirable effects both in the professional and personal lives of these professionals. The assessment of working conditions to identify the main stressing factors and the implementation of individual and organizational measures to reduce nursing teams stress may increase productivity and workers’ satisfaction, improving the assistance quality offered to surgical patients.

  11. Total hip and knee joint replacement: perioperative clinical aspects

    Directory of Open Access Journals (Sweden)

    Luciana Pereira Almeida de Piano

    2010-09-01

    Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

  12. PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Kwame Ofori Adjepong

    2018-05-01

    Full Text Available An estimated 30 million people worldwide have sickle cell disease (SCD.  Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.  Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss.  Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  13. Migraine and risk of perioperative ischemic stroke and hospital readmission

    DEFF Research Database (Denmark)

    Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D

    2017-01-01

    OBJECTIVE: To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN: Prospective hospital registry study. SETTING: Massachusetts General Hospital and two satellite campuses between...... was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS: 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.......9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). CONCLUSIONS: Surgical patients with a history of migraine are at increased...

  14. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    Directory of Open Access Journals (Sweden)

    Ravindra Pandey

    2011-01-01

    Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

  15. Perioperative complications of sleeve gastrectomy: Review of the literature.

    Science.gov (United States)

    Iannelli, Antonio; Treacy, Patrick; Sebastianelli, Lionel; Schiavo, Luigi; Martini, Francesco

    2018-05-04

    Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.

  16. 30 CFR 18.30 - Windows and lenses.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Windows and lenses. 18.30 Section 18.30 Mineral... § 18.30 Windows and lenses. (a) MSHA may waive testing of materials for windows or lenses except headlight lenses. When tested, material for windows or lenses shall meet the test requirements prescribed in...

  17. 49 CFR 238.114 - Rescue access windows.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Rescue access windows. 238.114 Section 238.114... § 238.114 Rescue access windows. (a) Number and location. Except as provided in paragraph (a)(1)(ii) of... rescue access windows. At least one rescue access window shall be located in each side of the car...

  18. Energy Gaining Windows for Residental Buildings

    DEFF Research Database (Denmark)

    Kragh, Jesper; Laustsen, Jacob Birck; Svendsen, Svend

    2008-01-01

    window is made of fiber-reinforced plastic (plastic reinforced by fine fibers made of glass). This composite material is a weatherproof material with very low thermal conductivity and high mechanical strength. These properties make the material very suitable for frame profiles due to lower heat loss...... minus the heat loss integrated over the heating season. It is assumed that in northern cold climates all of the solar gain during the heating season can be utilized for space heating. Problems with overheating in the summer period must be solved with overhang or moveable solar shading devices. Two...... and longer durability of the window. The glazing in these fiber reinforced polyester windows is both unsealed and sealed triple glazing units. To increase the net energy gain slim frame profiles have been developed to increase the glazing area and thereby the solar gain. The challenge when developing slim...

  19. Teach yourself visually Windows 8.1

    CERN Document Server

    McFedries, Paul

    2013-01-01

    A practical guide for visual learners eager to get started with Windows 8.1 If you learn more quickly when you can see how things are done, this Visual guide is the easiest way to get up and running on Windows 8.1. It covers more than 150 essential Windows tasks, using full-color screen shots and step-by-step instructions to show you just what to do. Learn your way around the interface and how to install programs, set up user accounts, play music and other media files, download photos from your digital camera, go online, set up and secure an e-mail account, and much more.The tried-and-true f

  20. Perioperative care for lumbar microdiscectomy: a survey of Australasian neurosurgeons

    Science.gov (United States)

    Lim, Kai Zheong; Ghosh, Peter; Goldschlager, Tony

    2018-01-01

    Background Lumbar microdiscectomy is the most commonly performed spine surgery procedure. Over time it has evolved to a minimally invasive procedure. Traditionally patients were advised to restrict activity following lumbar spine surgery. However, post-operative instructions are heterogeneous. The purpose of this report is to assess, by survey, the perioperative care practices of Australasian neurosurgeons in the minimally invasive era. Methods A survey was conducted by email invitation sent to all full members of the Neurosurgical Society of Australasia (NSA). This consisted of 11 multi-choice questions relating to operative indications, technique, and post-operative instructions for lumbar microdiscectomy answered by an electronically distributed anonymized online survey. Results The survey was sent to all Australasian Neurosurgeons. In total, 68 complete responses were received (28.9%). Most surgeons reported they would consider a period of either 4 to 8 weeks (42.7%) or 8 to 12 weeks (32.4%) as the minimum duration of radicular pain adequate to offer surgery. Unilateral muscle dissection with unilateral discectomy was practiced by 76.5%. Operative microscopy was the most commonly employed method of magnification (76.5%). The majority (55.9%) always refer patients to undergo inpatient physiotherapy. Sitting restrictions were advised by 38.3%. Lifting restrictions were advised by 83.8%. Conclusions Australasian neurosurgical lumbar microdiscectomy perioperative care practices are generally consistent with international practices and demonstrate a similar degree of heterogeneity. Recommendation of post-operative activity restrictions by Australasian neurosurgeons is still common. This suggests a role for the investigation of the necessity of such restrictions in the era of minimally invasive spine surgery. PMID:29732417