Discharge Hemoglobin Level and 30-Day Readmission Rates After Coronary Artery Bypass Surgery

BACKGROUND: Restrictive transfusion strategies supported by large randomized trials are resulting in decreased blood utilization in cardiac surgery. What remains to be determined, however, is the impact of lower discharge hemoglobin (Hb) levels on readmission rates. We assessed patients with higher versus lower Hb levels on discharge to compare 30-day readmission rates after coronary artery bypass grafting (CABG). METHODS: We retrospectively evaluated 1552 patients undergoing isolated CABG at our institution from January 2013 to May 2016. We evaluated 2 Hb cohorts: "high" (above) and "low" (below) the mean discharge Hb level of 9.4 g/dL, comparing patient characteristics, blood utilization, and clinical outcomes including 30-day readmission rates. We further evaluated the effects of the lowest (12 g/dL), "mild anemia" (10–11.9 g/dL), "moderate anemia" (8–9.9 g/dL), and "severe anemia" (

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Preventing Adverse Events in Cataract Surgery

No abstract available

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Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

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World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda’s Referral Hospitals

BACKGROUND: A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda's referral hospitals. METHODS: A multicentre prospective cohort study was conducted in 5 referral hospitals in Uganda. Using a questionnaire based on the WHO SSC, patients undergoing surgical operations were systematically recruited into the study from April 2016 to July 2016. The patients were followed up daily for 30 days or until discharge for the purpose of documentation of complications. Logistic regression and linear regression were used to assess for association between compliance and perioperative surgical outcomes. RESULTS: We recruited 859 patients into the study. Overall compliance with the WHO SSC was 41.7% (95% confidence interval [CI], 39.7–43.8) ranging from 11.9% to 89.8% across the different hospitals. Overall compliance with "sign in" was 44.7% (95% CI, 43–45.6), with "time out" was 42.0% (95% CI, 39.4–44.6), and with "sign out" was 33.3% (95% CI, 30.7–35.9). There was no association between compliance and perioperative surgical outcomes: length of hospital stay, adverse events, and mortality. CONCLUSIONS: This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively. Accepted for publication June 18, 2018. Funding: None. The authors declare no conflicts of interest. Study registration number: NCT03252860. Registry URL: ClinicalTrials.gov. Reprints will not be available from the authors. Address correspondence to Elizabeth N. Igaga, MBChB, Department of Anaesthesia, College of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda. Address e-mail to lyzaigaga@gmail.com. © 2018 International Anesthesia Research Society

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Is it time to pull epinephrine from the EMS formulary?

Our co-hosts discuss a recent study out of the UK that puts the use of epinephrine in prehospital cardiac arrest patients into question

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The development of a digital gamma-gamma coincidence/anticoincidence spectrometer and its applications to monitor low-level atmospheric 22Na/7Be activity ratios in Resolute Bay, Canada

Publication date: December 2018

Source: Journal of Environmental Radioactivity, Volume 192

Author(s): Weihua Zhang, Kenneth Lam, Kurt Ungar

Abstract

Using a previously developed digital gamma-gamma coincidence/anticoincidence spectrometer, daily aerosol samples collected at Resolute Bay, Canada (74.71°N, 94.97°W) from May 2016 to April 2017 were analysed for activity concentrations of ²²Na and ⁷Be. The spectrometer design allows a more selective measurement of ²²Na with a significant background reduction by gamma-gamma coincidence events processing. It has been demonstrated that the improved spectrometer provides a more sensitive and effective way to quantify trace amounts of ²²Na and ⁷Be with a critical limit of 3 mBq and 5 Bq respectively for a 20 h counting. The ⁷Be/²²Na ratio data set obtained in this study showed significant annual variation, which has a distinct spring (typically from February to May) maximum and winter (from September to February of next calendar year) minimum, which suggest that it could be used as a radiochronometer for studying the atmospheric processes. The ⁷Be/²²Na ratios are most likely connected to deep stratosphere-to-troposphere transport (STT) exchange events where air with a higher ⁷Be/²²Na ratio originates from downward flow from stratosphere to the troposphere. The aerosols with lower ⁷Be/²²Na ratios located between two oscillation peaks may have longer residence time. The correlations between ⁷Be and ²²Na activity concentration were the high during these time periods. Compared with other studies based on weekly collected aerosol samples, the techniques greatly improve the temporal resolution of ⁷Be/²²Na data set that will be able to provide more detailed information to study various atmospheric phenomena.

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Provider Counseling About Secondhand Smoke Exposure for Urban Children With Persistent or Poorly Controlled Asthma

Urban children continue to be exposed to secondhand smoke (SHS), and this is particularly concerning for children with asthma. The objective of this study is to describe SHS exposure among urban children with asthma and assess SHS counseling delivered at primary care visits. We interviewed caregivers of 318 children (2–12 years) with persistent asthma at the time of a health care visit and reviewed medical records. We found that one third (32%) of children lived with a caregiver who smoked and that 15% lived with other smokers.

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