Patient satisfaction during and following procedural sedation for ambulatory surgery

Background: Patient satisfaction is multidimensional. The clinician's perspective of a good outcome and the patient's experience of a satisfactory service are often two different end-points. The primary aim of our study was to assess the perioperative experience of patients undergoing procedural sedation. A secondary aim was to create a postoperative questionnaire which could be used as a measurement tool. The questions could also be used as an audit to assist with adherence to quality assurance and clinical governance. Method: A questionnaire was compiled to attempt to assess the perioperative aspects of procedural sedation. Five hundred consecutive patients undergoing procedural sedation for dental-related outpatient procedures were asked to complete a questionnaire. Patients who didn't complete it were excluded. Ninety-eight per cent of the patients returned the questionnaire and 489 questionnaires were evaluated. Results: A total of 489 patients were included. Ninetythree per cent of the patients expressed a good (7+/10) overall experience of procedural sedation, and 92.6% indicated that they would recommend it to others. Conclusion: Our study population showed a high level of satisfaction with their sedation experience. It is suggested that the devised questionnaire could be used successfully in future as an assessment tool or audit of patient satisfaction following procedural sedation for ambulatory surgery.DHE

Patient satisfaction during and following procedural sedation for ambulatory surgery

Background: Patient satisfaction is multidimensional. The clinician’s perspective of a good outcome and the patient’s experience of a satisfactory service are often two different end-points. The primary aim of our study was to assess the perioperative experience of patients undergoing procedural sedation. A  secondary aim was to create a postoperative questionnaire which could be used as a measurement tool. The questions could also be used as an audit to assist with adherence to quality assurance and clinical governance.Method: A questionnaire was compiled to attempt to assess the perioperative aspects of procedural  sedation. Five hundred consecutive patients undergoing procedural sedation for dental-related outpatient  procedures were asked to complete a questionnaire. Patients who didn’t complete it were excluded.  Ninety-eight per cent of the patients returned the questionnaire and 489 questionnaires were evaluated.Results: A total of 489 patients were included. Ninety-three per cent of the patients expressed a good (7+/10) overall experience of procedural sedation, and 92.6% indicated that they would recommend it to others.Conclusion: Our study population showed a high level of satisfaction with their sedation experience. It is suggested that the devised questionnaire could be used successfully in future as an assessment tool or audit of patient satisfaction following procedural sedation for ambulatory surgery.Keywords: patient satisfaction, postoperative questionnaire, procedural sedatio

A Transgenic Model for Conditional Induction and Rescue of Portal Hypertension Reveals a Role of VEGF-Mediated Regulation of Sinusoidal Fenestrations

Portal hypertension (PH) is a common complication and a leading cause of death in patients with chronic liver diseases. PH is underlined by structural and functional derangement of liver sinusoid vessels and its fenestrated endothelium. Because in most clinical settings PH is accompanied by parenchymal injury, it has been difficult to determine the precise role of microvascular perturbations in causing PH. Reasoning that Vascular Endothelial Growth Factor (VEGF) is required to maintain functional integrity of the hepatic microcirculation, we developed a transgenic mouse system for a liver-specific-, reversible VEGF inhibition. The system is based on conditional induction and de-induction of a VEGF decoy receptor that sequesters VEGF and preclude signaling. VEGF blockade results in sinusoidal endothelial cells (SECs) fenestrations closure and in accumulation and transformation of the normally quiescent hepatic stellate cells, i.e. provoking the two processes underlying sinusoidal capillarization. Importantly, sinusoidal capillarization was sufficient to cause PH and its typical sequela, ascites, splenomegaly and venous collateralization without inflicting parenchymal damage or fibrosis. Remarkably, these dramatic phenotypes were fully reversed within few days from lifting-off VEGF blockade and resultant re-opening of SECs' fenestrations. This study not only uncovered an indispensible role for VEGF in maintaining structure and function of mature SECs, but also highlights the vasculo-centric nature of PH pathogenesis. Unprecedented ability to rescue PH and its secondary manifestations via manipulating a single vascular factor may also be harnessed for examining the potential utility of de-capillarization treatment modalities

Rising environmental temperatures and polluted surface waters: the prelude to the rise of mycoses in South Africa

South Africa’s rivers are frequently used by communities lacking proper sanitation infrastructure for domestic purposes; however, these surface waters may pose a health risk to immunocompromised individuals due to the presence of opportunistic pathogenic fungi in the polluted water. Although only a few studies have focused on the presence of clinically relevant fungal species in South African rivers, many known opportunistic pathogenic species were found to be predominant in these waters. Furthermore, strong evidence exists that increased numbers of clinically relevant species may be observed in future due to fungi acquiring thermotolerance in response to the global increase in temperature. Thermotolerance is a major factor contributing to pathogenesis in fungi, due to the generally low tolerance of most fungi toward mammalian body temperatures. It is therefore contended that combinatorial effects of water pollution and rising environmental temperatures could lead to an increase in the incidence of mycoses in South Africa. This is especially concerning since a relatively large population of immunocompromised individuals, represented mostly by HIV-infected people, resides in the country

Health risk posed by direct ingestion of yeasts from polluted river water

River water is an essential human resource that may be contaminated with hazardous microorganisms. However, the risk of yeast infection through river water exposure is unclear because it is highly dependant on individual susceptibility and has therefore not been well-studied, to date. To evaluate this undefined risk, we analysed the fungal communities in less polluted (LP) and highly polluted (HP) river water, as determined using principal coordinate analysis of pollution indicators. We enumerated culturable yeasts using a thermally selective isolation procedure (37 °C) and thus promoted the growth of potentially opportunistic species. Yeast species identified as clinically relevant were then tested for antifungal resistance. In addition, we propose a quantitative microbial risk assessment (QMRA) framework to quantitatively assess the potential risk of yeast infection. Our results indicated that pollution levels significantly altered fungal communities (p = 0.007) and that genera representing opportunistic and pathogenic members were significantly more abundant in HP waters (p = 0.038). Additionally, the yeast species Candida glabrata and Clavispora lusitaniae positively correlated with other pollution indicators, demonstrating the species' indicator potential. Our QMRA results further indicate that higher risk of infection is associated with increased water pollution levels (considering both physicochemical and bacterial indicators). Furthermore, yeast species with higher pathogenic potential present an increased risk of infection despite lower observed concentrations in the river water. Interestingly, the bloom of Meyerozyma guilliermondii during the wet season suggests that other environmental factors, such as dissolved oxygen levels and water turbulence, might affect growth characteristics of yeasts in river water, which consequently affects the distribution of annual infection risks. The presence of antifungal resistant yeasts, observed in this study, could further contribute to variation in risk distribution. Research on the ecophysiology of yeasts in these environments is therefore necessary to ameliorate the uncertainty and sensitivity of the proposed QMRA model. In addition to the vital knowledge on opportunistic and pathogenic yeast occurrence in river water and their observed association with pollution, this study provides valuable methods and insights to initiate future QMRAs of yeast infections.This work was supported by the Water Research Commission (WRC) of South Africa (Project No: K5/2019/2020–00137). Ms Heidi Steffen received personal funding from the National Research Foundation (South Africa). The work of João Brandão received financial support from CESAM (UID/AMB/50017-POCI-01–0145-FEDER-007638) and CITAB (UID/AGR/04033/2019), via FCT/MCTES, from national funds (PIDDAC), co-founded by FEDER, (PT2020 Partnership Agreement and Compete 2020).info:eu-repo/semantics/publishedVersio

Novel stool-based protein biomarkers for improved colorectal cancer screening : a case-control study

Background: The fecal immunochemical test (FIT) for detecting hemoglobin is used widely for noninvasive colorectal cancer (CRC) screening, but its sensitivity leaves room for improvement. Objective: To identify novel protein biomarkers in stool that outperform or complement hemoglobin in detecting CRC and advanced adenomas. Design: Case-control study. Setting: Colonoscopy-controlled referral population from several centers. Participants: 315 stool samples from one series of 12 patients with CRC and 10 persons without colorectal neoplasia (control samples) and a second series of 81 patients with CRC, 40 with advanced adenomas, and 43 with nonadvanced adenomas, as well as 129 persons without colorectal neoplasia (control samples); 72 FIT samples from a third independent series of 14 patients with CRC, 16 with advanced adenomas, and 18 with nonadvanced adenomas, as well as 24 persons without colorectal neoplasia (control samples). Measurements: Stool samples were analyzed by mass spectrometry. Classification and regression tree (CART) analysis and logistic regression analyses were performed to identify protein combinations that differentiated CRC or advanced adenoma from control samples. Antibody-based assays for 4 selected proteins were done on FIT samples. Results: In total, 834 human proteins were identified, 29 of which were statistically significantly enriched in CRC versus con-trol stool samples in both series. Combinations of 4 proteins reached sensitivities of 80% and 45% for detecting CRC and advanced adenomas, respectively, at 95% specificity, which was higher than that of hemoglobin alone (P < 0.001 and P = 0.003, respectively). Selected proteins could be measured in small sample volumes used in FIT-based screening programs and discriminated between CRC and control samples (P < 0.001). Limitation: Lack of availability of antibodies prohibited validation of the top protein combinations in FIT samples. Conclusion: Mass spectrometry of stool samples identified novel candidate protein biomarkers for CRC screening. Several protein combinations outperformed hemoglobin in discriminating CRC or advanced adenoma from control samples. Proof of concept that such proteins can be detected with antibody-based assays in small sample volumes indicates the potential of these biomarkers to be applied in population screening

Recurrence of primary biliary cholangitis after liver transplantation affects graft survival : a multi-center study from the Global PBC study group

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Optimizing asset and capital adequacy management in banking

http://dx.doi.org/10.1007/s10957-007-9322-xhttp://www.springerlink.com/content/818904555rv3564w/fulltext.pd