Hartmann’s Procedure for Left Side Large Bowel Emergencies

Background: Colonic emergency situations which need an intervention in emergency are quite common, especially in the left side of the abdomen. The aim of this study is to investigate the importance of Hartmann’s procedure, which has been used for years in such cases. Method: One hundred and fifty-six cases which underwent Hartmann’s procedure due to a left side emergency, either malignant or benign, during over a 15-year period. Results: One hundred and fifty-six patients met the inclusion criteria in the final analysis. Fifty one point nine percent were operated due to malignancy, most of them at an advanced stage (65,4%). Half of them were treated for colonic perforation. Conclusion: Left sided large bowel emergencies are mainly caused by complicated cancer and diverticulitis of the left colon. Hartmann’s procedure remains a safe, simple and fast operation with an acceptable percentage of morbidity and mortality. Also, it continues to play a vital role in elderly and severely ill patients

Postoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma

INTRODUCTION : The influence of trauma- and surgical stress-induced decrease of CD4 count on anastomotic leaks after penetrating abdominal trauma has to date not been investigated. A prospective study was performed to explore the effect of CD4 count 24 h after surgery on the anastomotic leak rate and to identify risk factors for anastomotic leaks. METHODS : This was a prospective study including 98 patients with small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma. Univariate analysis identified risk factors for the development of anastomotic leak and also investigated the predictive value of the CD4 count for this complication. RESULTS : Of the 98 patients 23 patients (23%) were HIV-infected. The overall leak rate was 13%. Univariate analysis including all potential risk factors with p-values6units and delayed anastomosis after damage control surgery. Survival rates were analysed with the χ2 test and did not show a significantly higher mortality rate in patients with low CD4 count. The negative impact of trauma and subsequent surgery on the cell mediated immunity was demonstrated by the fact that 55 (73%) of the HIV-negative patients had a CD4 count less than 500 cells/μl 24 h postoperatively. HIV-infection had no significant influence on the leak rate, however all HIV infected patients that developed an anastomotic leak died. CONCLUSION : A low post-operative CD4 count is a predictor for anastomotic leaks irrespective of HIV-serostatus. Low postoperative serum albumin, high injury severity, gunshot wound as mechanism of injury, blood transfusion requirement >6 units and delayed anastomosis were further risk factors for anastomotic complications. Postoperative CD4 count and serum albumin should be considered in the decision making process of performing an anastomosis or diverting stoma for patients after “clip and drop” of the bowel as part of damage control surgery.http://www.elsevier.com/ /locate/injury2019-11-16hj2018Surger

Advanced trauma life support course for medical students. A new era?

IntroductionTrauma represents a major public health issue and is one of the leading causes of death and disability worldwide. A systematic approach toward dealing with trauma patients was facilitated through the ATLS program, which has become a milestone in trauma care. Our new ATLS course for medical students was set in motion in 2015. Our aim was to make medical students familiar with trauma patients interactively, through a program like ATLS, and here we present the results of this endeavor.MethodsA two-day ATLS-Medical Student (MS) course was offered from November 2015 to July 2018, and analysis was performed retrospectively on the data gathered over a three-month period through online questionnaires. Before graduating, 261 newly qualified medical doctors were interviewed and evaluated as part of the ATLS course.ResultsAfter the course, the vast majority of medical students (251 MSs; 96.16%) felt more capable of managing severely injured patients and 58% of students felt that the medical services they offered were better due to the ATLS training. Regarding the educational fee for the course, 56.7% of the students reported that they felt the fee of 100 euros was fair.DiscussionThe interactive format of the course, which differs from more traditional methods of teaching, has been endorsed by medical students. Though they lack clinical experience, that does not prohibit them from acquiring more specialized or specific knowledge, enabling them to excel. Most of the students improved their skillset either in theoretical knowledge, practical skills, or even in the emotional component of the course, i.e., dealing with treating a severely injured patient. It was decided that the program would be re-evaluated and extended to all Greek Medical Schools.ConclusionThe advantage of providing doctors with trauma training at the beginning of their careers is evident. For that reason, it was decided that the program would be re-evaluated and extended to all Greek Medical Schools

Survey on worldwide trauma team activation requirement

PURPOSE : trauma team activation (TTA) is thought to be essential for advanced and specialized care of very severely injured patients. However, non-specific TTA criteria may result in overtriage that consumes valuable resources or endanger patients in need of TTA secondary to undertriage. Consequently, criterion standard definitions to calculate the accuracy of the various TTA protocols are required for research and quality assurance purposes. Recently, several groups suggested a list of conditions when a trauma team is considered to be essential in the initial care in the emergency room. The objective of the survey was to post hoc identify trauma-related conditions that are thought to require a specialized trauma team that may be widely accepted, independent from the country’s income level. METHODS : A set of questions was developed, centered around the level of agreement with the proposed post hoc criteria to define adequate trauma team activation. The participants gave feedback before they answered the survey to improve the quality of the questions. The finalized survey was conducted using an online tool and a word form. The income per capita of a country was rated according to the World Bank Country and Lending groups. RESULTS : The return rate was 76% with a total of 37 countries participating. The agreement with the proposed criteria to define post hoc correct requirements for trauma team activation was more than 75% for 12 of the 20 criteria. The rate of disagreement was low and varied between zero and 13%. The level of agreement was independent from the country’s level of income. CONCLUSIONS : The agreement on criteria to post hoc define correct requirements for trauma team activation appears high and it may be concluded that the proposed criteria could be useful for most countries, independent from their level of income. Nevertheless, more discussions on an international level appear to be warranted to achieve a full consensus to define a universal set of criteria that will allow for quality assessment of over- and undertriage of trauma team activation as well as for the validation of field triage criteria for the most severely injured patients worldwide.http://link.springer.com/journal/68am2022Surger

Διαστρωματική μελέτη της χρήσης των υπηρεσιών υγείας σε άτομα με συνήθεις ψυχικές διαταραχέςσε αντιπροσωπευτικό δείγμα του πληθυσμού της Λευκωσίας,Κύπρος

Ιστορικό: Σκοπός της μελέτης ήταν να εξετάσει τον επιπολασμό των συνήθων ψυχικών διαταραχών και τη σχέση τους με τη χρήση των υπηρεσιών υγείας σε ενήλικες που ζουν στην Κύπρο. Πιο συγκεκριμένα, ερευνούμε τη σχέση μεταξύ των διαγνωσμένων ψυχικών διαταραχών και της αυτοαναφερόμενης συμπτωματολογίας μιας ΣΨΔ στην χρήση υπηρεσιών υγείας και των παραγόντων που συμβάλλουν σε αυτές διαταραχές. Μέθοδος: Ένα αντιπροσωπευτικό, στρωματοποιημένο δείγμα 1002 ατόμων από την Κύπρο συλλέχθηκε μεταξύ του Απριλίου 2013 και Απριλίου του 2014. Οι δομημένες, προσωπικές συνεντεύξεις χρησιμοποιήθηκαν για να αξιολογηθεί η χρήση των υπηρεσιών υγείας από τους συμμετέχοντες, με τη διαγνωσμένη από ψυχίατρο ΣΨΔ και την αυτοαναφερόμενη ΣΨΔ να αποτελούν τις μεταβλητές ενδιαφέροντος μας. Η συσχέτιση της χρήσης υπηρεσιών υγείας και ΣΨΔ έγινε μέσω της δοκιμασίας chi-square του Pearson, ενώ, προκειμένου να διερευνηθεί η σχέση ΣΨΔ με κοινωνικοοικονομικούς παράγοντες, χρησιμοποιήσαμε πολυπαραγοντικά μοντέλα λογαριθμιστικής παλινδρόμησης. Αποτελέσματα: Ο επιπολασμός της διαγνωσμένης από ψυχίατρο ΣΨΔ ήταν 3,5% και η συμπτωματολογία ΣΨΔ ήταν 29,8%. Η εισαγωγή σενοσοκομείο κατά τη διάρκεια των τελευταίων 12 μηνών ήταν 28,6% μεταξύ των διαγνωσθέντων με ΣΨΔ περιπτώσεων, σε σύγκριση με το 6,4% σε μη διαγνωσμένες περιπτώσεις ΣΨΔ. Επιπλέον, τα ποσοστά επισκέψεων σε ιατρό ήταν 54,3% μεταξύ των ατόμων με ΣΨΔ, σε σύγκριση με 23,1% σε μη διαγνωσμένους με ΣΨΔ συμμετέχοντες. Παρόμοια, αποτελέσματα παρουσιάζονται επίσης για τη συμπτωματολογία ΣΨΔ ενώ στις πολυπαραγοντικές αναλύσεις λογαριθμιστικής παλινδρόμησης αναγνωρίστηκαν οι παράγοντες πρόβλεψης της διάγνωσμένης ΣΨΔ και της συμπτωματολογίας ΣΨΔ. Συμπεράσματα: Η αναγνώριση, η διάγνωση και η σωστή διαχείριση των πληθυσμών που διατρέχουν κίνδυνο για μια ΣΨΔ είναι ιδιαίτερου ενδιαφέροντος, λαμβάνοντας υπόψη τους κοινωνικοοικονομικούς παράγοντες με τους οποίους σχετίζονται.Background: The aim of the study was to examine the prevalence of common mental disorders (CMD) and their relationship with the health services use in adults living in Cyprus. More specifically, among many of the health-related behaviours addressed in this paper, we investigate the association between diagnosed mental disorders and self-reported CMD via the use of health services and the factors contributing to those disorders. Methods: A representative, stratified sample of 1002 people from Cyprus was collected between April 2013 and April 2014. Structured, face-to-face interviews were used to assess people’s use of the health services, psychiatrist-diagnosed depression, anxiety and self-reported depression and anxiety. Associations of health services use and CMD were made via Pearson’s chi-square test and, in order toinvestigate the CMD relationship with socioeconomic factors further, we used multivariate logistic regression models. Results: The prevalence of psychiatrist-diagnosed CMD was 3.5%, and CMD symptomatology was 29.8%. Hospital admission within the last 12 months was 28.6% among CMD-diagnosed cases, compared to 6.4% in non-CMD cases. Further, doctor visit rates were 54.3% among those with CMD, compared to 23.1% in non-CMD participants. Relative results are also shown for CMD symptomatology. Multivariate logistic regression analyses identified the predictive factors for CMD diagnoses and CMD symptomatology. Conclusions: Recognition, diagnosis and proper management of populations at risk for a CMD is of special interest, with respect to their associations with socioeconomic factors

Satisfaction with healthcare services and health resources allocation in Patras, Western Greece Prefecture

The primary aim of the study was to examine the factors associated with health services use and overall satisfaction with healthcare in adults living in Patras, Greece. Additionally, we investigated the equality of the distribution of health resources, between hospitals and primary care sector in Western Greece region. Methods: Date were collected primarily, leading to a sample of 312 people from Patras was collected between January 2011 and June 2011. Structured, face-to-face interviews were used to assess people’s use of the health services, subjective perception of health status and satisfaction with healthcare services. Univariate associations with Pearson’s chi-square test and Student’s t-test were followed by multivariate logistic regression models of health services use and satisfaction with socioeconomic factors. Also, data were provided by Hellenic Statistical Authority for the years 2010 to 2013. We used number of institutions, number beds and number of health workers as indicators of health resources and then we calculated Gini coefficients based on population and geographic size. Results: A 17,9% of respondents have used at least once a healthcare service within the last 12 months, self-assessment of health status above average were reported by 66.3% of respondents and 61.2 % were satisfied with healthcare services. Multivariate logistic regression analyses identified the predictive factors for healthcare visit, subjective perception of health status and satisfaction with healthcare services. Remarkable geographic distribution inequality of health resources was found for the hospital sector, with a Gini coefficient between 0.40 to 0.49 while in the primary care sector a Gini coefficient was around 0.21 indicating a good equality in distribution of health resources. Conclusions: Females, of higher educational status and subjective health status above average they had a greater likelihood of satisfaction with health services. In addition, the distribution of the primary health sector resources in Western Greece demonstrated a good equality whereas in hospital sector inequality was remarkable. Thus, focus on peoples’ needs dealing with inequalities is necessary in order to achieve a universal health system.Πρωταρχικός στόχος της μελέτης ήταν προσβασιμότητα και η γενική ικανοποίηση από την υγειονομική περίθαλψη σε ενήλικες που ζουν στην Πάτρα. Επιπρόσθετα, ερευνήσαμε την ισότητα της κατανομής των πόρων υγείας μεταξύ των νοσοκομείων και της πρωτοβάθμιας φροντίδας στην περιοχή της Περιφέρειας της Δυτικής Ελλάδας. Μέθοδοι: Συγκεντρώθηκαν δεδομένα από πρωτογενείς και δευτερογενείς πηγές, με αποτέλεσμα να συλλεχθεί δείγμα 312 ατόμων από την Πάτρα από τον Ιανουάριο του 2011 έως τον Ιούνιο του 2011. Οι προσωπικές συνεντεύξεις χρησιμοποιήθηκαν για να εκτιμηθεί η χρήση των υπηρεσιών υγείας από τους χρήστες καθώς και η ικανοποίηση από τις υπηρεσίες υγειονομικής περίθαλψης. Οι συσχετίσεις ελέγχου πραγματοποιήθηκαν με την δοκιμή chi-square και την t-δοκιμή ακολουθήθηκαν από πολυπαραγοντικά μοντέλα λογικής παλινδρόμησης. Επίσης, συλλέχθηκαν στοιχεία από την Ελληνική Στατιστική Αρχή για τα έτη 2010 έως 2013. Χρησιμοποιήσαμε τον αριθμό των ιδρυμάτων, τον αριθμό των κλινών και τον αριθμό των εργαζομένων στον τομέα της υγείας ως δείκτες των πόρων υγείας και στη συνέχεια υπολογίσαμε τους συντελεστές Gini με βάση τον πληθυσμό και το γεωγραφικό μέγεθος. Αποτελέσματα: Το 17,9% των ερωτηθέντων χρησιμοποίησε τουλάχιστον μία φορά μια υπηρεσία υγειονομικής περίθαλψης τους τελευταίους 12 μήνες, η αυτοαξιολόγηση της κατάστασης υγείας υπερβαίνει κατά μέσο όρο το 66,3% των ερωτηθέντων και το 61,2% ικανοποίησε τις υπηρεσίες υγειονομικής περίθαλψης. Πολυμεταβλητές αναλύσεις λογικής παλινδρόμησης προσδιόρισαν τους παράγοντες πρόβλεψης για την επίσκεψη στις υπηρεσίες υγειονομικής περίθαλψης, την υποκειμενική αντίληψη της κατάστασης της υγείας και την ικανοποίηση από τις υπηρεσίες υγείας. Παρατηρήθηκε αξιοσημείωτη γεωγραφική ανισοκατανομή των πόρων υγείας στον νοσοκομειακό τομέα, με συντελεστή Gini μεταξύ 0,40 και 0,49, ενώ στον τομέα της πρωτοβάθμιας φροντίδας ο συντελεστής Gini ήταν περίπου 0,21, δείχνοντας μια καλή ισότητα στην κατανομή. Συμπεράσματα: Προσδιορίζεται το προφίλ των χρηστών με την μεγαλύτερη ανάγκη, έτσι, οι γυναίκες με υψηλό μορφωτικό επίπεδο και αυτοξιολογούμενη κατάσταση της υγείας τους άνω του μετρίου είχαν μεγαλύτερη πιθανότητα ικανοποίησης από τις υπηρεσίες υγείας. Επιπλέον, η κατανομή των πόρων του πρωτογενούς τομέα υγείας στη Δυτική Ελλάδα κατέδειξε μια καλή ισότητα, ενώ στον νοσοκομειακό τομέα η ανισότητα ήταν αξιοσημείωτη. Έτσι, η εστίαση στις ανάγκες των λαών για την αντιμετώπιση ανισοτήτων είναι απαραίτητη για την επίτευξη καθολικού συστήματος υγείας

Computer Vision and Pattern Recognition for the Analysis of 2D/3D Remote Sensing Data in Geoscience: A Survey

Historically, geoscience has been a prominent domain for applications of computer vision and pattern recognition. The numerous challenges associated with geoscience-related imaging data, which include poor imaging quality, noise, missing values, lack of precise boundaries defining various geoscience objects and processes, as well as non-stationarity in space and/or time, provide an ideal test bed for advanced computer vision techniques. On the other hand, the developments in pattern recognition, especially with the rapid evolution of powerful graphical processing units (GPUs) and the subsequent deep learning breakthrough, enable valuable computational tools, which can aid geoscientists in important problems, such as land cover mapping, target detection, pattern mining in imaging data, boundary extraction and change detection. In this landscape, classical computer vision approaches, such as active contours, superpixels, or descriptor-guided classification, provide alternatives that remain relevant when domain expert labelling of large sample collections is often not feasible. This issue persists, despite efforts for the standardization of geoscience datasets, such as Microsoft’s effort for AI on Earth, or Google Earth. This work covers developments in applications of computer vision and pattern recognition on geoscience-related imaging data, following both pre-deep learning and post-deep learning paradigms. Various imaging modalities are addressed, including: multispectral images, hyperspectral images (HSIs), synthetic aperture radar (SAR) images, point clouds obtained from light detection and ranging (LiDAR) sensors or digital elevation models (DEMs)