RESUMEN

BACKGROUND: Health care systems use auditing processes to monitor compliance with evidence-based practices. The auditing process for a bundle targeting central line-associated bloodstream infection prevention at a large children's hospital was suboptimal. The purpose of this project was to implement a revised audit and feedback data collection process. The specific aims of the project were to evaluate (1) the number of completed audits and, (2) central line maintenance bundle compliance rates before and after implementing a new process. METHODS: An innovative, electronic audit process was developed to allow data entry in real-time as central line-associated bloodstream infection prevention champions conducted audits. Data were fed into a robust electronic dashboard, allowing units to readily visualize their performance. Data was analyzed over a 52-month period (26 months pre- and post-implementation). RESULTS: The number of central line maintenance bundle audits significantly increased post-implementation from an average of 36 to 64 per month, P = .001. Central line maintenance bundle compliance scores also increased from an average compliance score of 76.3% to 89.3%, P = .001. Special cause variation was also noted in the statistical process control charts. DISCUSSION: This project demonstrated the effectiveness of using an electronic process to capture audit data to assist with quality improvement efforts. CONCLUSIONS: Other institutions may consider implementing a similar electronic audit process to capture infection prevention compliance data.

Asunto(s)

Infecciones Relacionadas con Catéteres , Catéteres Venosos Centrales , Sepsis , Niño , Humanos , Infecciones Relacionadas con Catéteres/prevención & control , Práctica Clínica Basada en la Evidencia , Mejoramiento de la Calidad

RESUMEN

BACKGROUND: A growing body of literature shows profound effects of the COVID-19 pandemic on mental health, among which increased rates of post-traumatic stress disorder (PTSD) and adjustment disorder (AD). However, current research efforts have largely been unilateral, focusing on psychopathology and not including well-being, and are dominated by examining average psychopathology levels or on disorder absence/presence, thereby ignoring individual differences in mental health. Knowledge on individual differences, as depicted by latent subgroups, in the full spectrum of mental health may provide valuable insights in how individuals transition between health states and factors that predict transitioning from resilient to symptomatic classes. Our aim is to (1) identify longitudinal classes (ie, subgroups of individuals) based on indicators of PTSD, AD and well-being in response to the pandemic and (2) examine predictors of transitioning between these subgroups. METHODS AND ANALYSIS: We will conduct a three-wave longitudinal online survey study of n≥2000 adults from the general Dutch population. The first measurement occasion takes place 6 months after the start of the pandemic, followed by two follow-up measurements with 6 months of intervals. Latent transition analysis will be used for data analysis. ETHICS AND DISSEMINATION: Ethical approval has been obtained from four Dutch universities. Longitudinal study designs are vital to monitor mental health (and predictors thereof) in the pandemic to develop preventive and curative mental health interventions. This study is carried out by researchers who are board members of the Dutch Society for Traumatic Stress Studies and is part of a pan-European study (initiated by the European Society for Traumatic Stress Studies) examining the impact of the pandemic in 11 countries. Results will be published in peer-reviewed journals and disseminated at conferences, via newsletters, and media appearance among (psychotrauma) professionals and the general public.

Asunto(s)

COVID-19 , Trastornos por Estrés Postraumático , Trastornos de Adaptación , Adulto , Humanos , Estudios Longitudinales , Pandemias , SARS-CoV-2 , Trastornos por Estrés Postraumático/epidemiología

RESUMEN

AIM: The aim of the study was to evaluate the usefulness of CA125 measurements in ovarian cancer diagnostics in pre- versus postmenopausal women. MATERIAL AND METHODS: The study group consisted of 99 serum specimens of women diagnosed with ovarian cancer (28 pre- and 71 postmenopausal). The control group consisted of 86 specimens collected from women without any ovarian pathology (34 pre- and 52 postmenopausal). CA 125 measurements were performed with Zymed Laboratories CA 125 ELISA Kit. Descriptive statistics, including mean values, standard deviation (SD) and 95CI of CA 125 among pre- and postmenopausal women, were calculated. The usefulness of CA 125 measurements in ovarian cancer diagnostics was assessed by calculating specificity sensitivity positive and negative predictive rates among pre- versus postmenopausal women. Statistical calculation was preformed with the use of STATISTICA 6.0 StatSoft Inc. (2001) software (wwwstatsoft. com). RESULTS: Higher CA 125 concentrations were observed in controls among pre- versus postmenopausal women (10.01 +/- 15.41; 95% CI: 4.63-15.39 IU/ml vs. 8.88 +/- 13.74; 95% CI: 5.06-12.71/U/ml, respectively NS). In contrary among women with ovarian cancer CA 125 levels were higher in postmenopausal women when compared to premenopausal (352.11 +/- 432.07; 95% CI: 184.57-519.65 vs. 541.59 +/- 547.98 95% CI: 411.89-671.29, respectively p < 0.05). In premenopausal group the CA 125 sensitivity was calculated at 64% whereas specificity 94.12% (FPR 5.9%; OR: 10.9), positive predictive value 90% and negative predictive value 94.12%. Among postmenopausal women results were as follows: sensitivity 88.73%, specificity 98.07% (FPR 1.9%, OR: 46.7), positive predictive value 98.44% and negative predictive value 86.44%. CONCLUSIONS: CA 125 measurements were more useful in the postmenopausal group. Higher CA 125 levels were observed in women with ovarian cancer diagnosis when compared to controls, in which lower CA 125 were observed. Higher sensitivity specificity and positive predictive values were observed in the postmenopausal group.

Asunto(s)

Biomarcadores de Tumor/sangre , Antígeno Ca-125/sangre , Neoplasias Ováricas/metabolismo , Posmenopausia/metabolismo , Premenopausia/metabolismo , Adulto , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Polonia , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad

RESUMEN

OBJECTIVE: The purpose of the research was to provide a review of the efficacy of the TVT-O technique for the surgical treatment of stress urinary incontinence (SUI) and to assess surgical and postsurgical complications related to this technique. STUDY DESIGN: An initial assessment was carried out on 44 women who underwent TVT-O surgery between 16 September 2004 and 1 February 2005. The follow-ups after 3 and 12 months were attended by 37 and 35 patients, respectively. All 44 patients were included for the statistical estimation of intra- and postoperative complications, whereas improvement in the quality of life was assessed only in those patients who came for a follow-up visit. To assess the efficacy of the treatment, the participants were surveyed using the King questionnaire on the day preceding surgery and during a follow-up visit 3 and 12 months after surgery. The participants whose scores from the two questionnaires changed > or =90% were deemed to be cured. A considerable improvement in quality of life was recorded when the score was 89-75%. With scores of 74-50%, there was a reduction in SI symptoms. However, when the score was 50-0%, no improvement in quality of life was reported, and in participants with scores <0% the quality of life deteriorated. Statistical analysis was carried out using the Statistical Package for Social Sciences (SPSS) V. 10.0, with the Spearman correlation and Chi-squared tests. The results were considered statistically significant when P<0.05. RESULTS: After 12 months, total cure was achieved in 15 participants (42.8%), significant improvement was noted in 6 (17.1%), SUI symptoms abated in 4 (11.4%), no improvement was noted in 7 (20%), and quality of life deteriorated in 3 (8.7%). CONCLUSION: TVT-O surgery is an efficient and reasonably safe method of SUI treatment in women. The ease of use, short duration of surgery and hospitalisation, minor postsurgical discomfort and a small proportion of complications make this method acceptable to patients. With regard to the results of treatment, additional patients should be analysed for a longer period of time.

Asunto(s)

Calidad de Vida , Cabestrillo Suburetral/efectos adversos , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/efectos adversos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Humanos , Persona de Mediana Edad , Satisfacción del Paciente

RESUMEN

Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART). The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS) in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function). Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications.

Asunto(s)

Enfermedad Iatrogénica , Síndrome de Hiperestimulación Ovárica/diagnóstico , Adulto , Albúminas/administración & dosificación , Albúminas/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Peso Corporal , Coloides/administración & dosificación , Coloides/efectos adversos , Soluciones Cristaloides , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , Femenino , Fluidoterapia , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Derivados de Hidroxietil Almidón/efectos adversos , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/efectos adversos , Tamaño de los Órganos , Síndrome de Hiperestimulación Ovárica/complicaciones , Síndrome de Hiperestimulación Ovárica/tratamiento farmacológico , Ovario/diagnóstico por imagen , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Ultrasonografía

RESUMEN

In 2004 the first livebirth after cryopreserved ovarian tissue transplantation has been reported which is a turning point in fertility preservation after anticancer treatment and a result of almost 50 years of research. However transplantation of cryopreserved ovary is still experimental method and further study needs to be done on the risk of cancer cell reimplantation, this method is very promising for cancer patients who wants to preserve fertility after cancer treatment. This is a review of methods used for cryopreserved ovarian tissue.

Asunto(s)

Criopreservación/métodos , Infertilidad Femenina/cirugía , Preservación de Órganos/métodos , Ovario/trasplante , Antineoplásicos/efectos adversos , Femenino , Humanos , Recién Nacido , Infertilidad Femenina/inducido químicamente , Neoplasias/tratamiento farmacológico , Neoplasias/radioterapia , Oocitos , Embarazo , Radioterapia/efectos adversos , Trasplante Autólogo

RESUMEN

In most higher plants sexual interactions are mediated by animal pollinators that affect the number and differential reproductive success of mates. The number and sex of breeding individuals in populations are central factors in evolutionary theory, but the quantitative effect of plant population size on pollinator-mediated mating is understudied. We investigated variation in pollen removal (male function) and fruit set (female function) among flowering populations of different size of two bumblebee-and one butterfly-pollinated, rewardless, pollen-limited, hermaphroditic orchid species in Sweden. As the amount of pollen removed from plants by insects (either absolute or proportional) increased, so did the number of pollinations, whereas the proportions of plants with different pollinator-designated functional sex (male, female, hermaphrodite) depended primarily on the ratio between the amount of fruit set and pollen removed within populations. A larger population size was found to have several effects: (1) the total numbers of pollinia removed and fruits set increased; (2) the proportion of pollen removed from plants decreased; (3) the proportion of flowers pollinated decreased in the butterfly-but was not affected in the bumblebee-pollinated species; (4) the ratio between fruits set and pollinia removed increased linearly in the bumblebee-pollinated species but reached a maximum at c. 80 individuals in the butterfly-pollinated species; (5) the numbers of pollinator-designated pure male and hermaphrodite individuals increased; and (6) the variance in pollinium removal, but not fruit set, increased among individuals. These findings empirically verify the basic importance of population size for the mating structure of outcrossing plants, and indicate that selection for female sexual traits is reinforced when population size is smaller while selection for male sexual traits is reinforced when population size is larger.