Perioperative Factors Associated With Postoperative Delirium in Patients Undergoing Noncardiac Surgery:An Individual Patient Data Meta-Analysis

IMPORTANCE: Postoperative delirium (POD) is a common and serious complication after surgery. Various predisposing factors are associated with POD, but their magnitude and importance using an individual patient data (IPD) meta-analysis have not been assessed.OBJECTIVE: To identify perioperative factors associated with POD and assess their relative prognostic value among adults undergoing noncardiac surgery.DATA SOURCES: MEDLINE, EMBASE, and CINAHL from inception to May 2020.STUDY SELECTION: Studies were included that (1) enrolled adult patients undergoing noncardiac surgery, (2) assessed perioperative risk factors for POD, and (3) measured the incidence of delirium (measured using a validated approach). Data were analyzed in 2020.DATA EXTRACTION AND SYNTHESIS: Individual patient data were pooled from 21 studies and 1-stage meta-analysis was performed using multilevel mixed-effects logistic regression after a multivariable imputation via chained equations model to impute missing data.MAIN OUTCOMES AND MEASURES: The end point of interest was POD diagnosed up to 10 days after a procedure. A wide range of perioperative risk factors was considered as potentially associated with POD.RESULTS: A total of 192 studies met the eligibility criteria, and IPD were acquired from 21 studies that enrolled 8382 patients. Almost 1 in 5 patients developed POD (18%), and an increased risk of POD was associated with American Society of Anesthesiologists (ASA) status 4 (odds ratio [OR], 2.43; 95% CI, 1.42-4.14), older age (OR for 65-85 years, 2.67; 95% CI, 2.16-3.29; OR for &gt;85 years, 6.24; 95% CI, 4.65-8.37), low body mass index (OR for body mass index &lt;18.5, 2.25; 95% CI, 1.64-3.09), history of delirium (OR, 3.9; 95% CI, 2.69-5.66), preoperative cognitive impairment (OR, 3.99; 95% CI, 2.94-5.43), and preoperative C-reactive protein levels (OR for 5-10 mg/dL, 2.35; 95% CI, 1.59-3.50; OR for &gt;10 mg/dL, 3.56; 95% CI, 2.46-5.17). Completing a college degree or higher was associated with a decreased likelihood of developing POD (OR 0.45; 95% CI, 0.28-0.72).CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of individual patient data, several important factors associated with POD were found that may help identify patients at high risk and may have utility in clinical practice to inform patients and caregivers about the expected risk of developing delirium after surgery. Future studies should explore strategies to reduce delirium after surgery.</p

Electromagnetic interference issues of power, electronics systems with wide band gap, semiconductor devices

© 2015 IEEE. In this paper electromagnetic interference issues of power electronics systems with Wide Band Gap devices have been studied. The main advantages of these power switches are fast switching transient and high switching frequency capabilities which can improve efficiency of power electronics systems and reduce sizes of passive elements such as inductors and capacitors. Several conducted and radiated emission tests and efficiency measurement have been carried out to analyze the switching frequency and transient effects on harmonic emission and switching losses. The results have been compared with the same drive configuration, layout and enclosure but with conventional power switches (Si switches)

Instrument for assessing mobile technology acceptability in diabetes self-management: a validation and reliability study

Mirela Frandes,1 Anca V Deiac,2 Bogdan Timar,1,3 Diana Lungeanu1,2 1Department of Functional Sciences, &ldquo;Victor Babes&rdquo; University of Medicine and Pharmacy of Timisoara, 2Department of Mathematics, Polytechnic University of Timisoara, 3Third Medical Clinic, Emergency Hospital of Timisoara, Timisoara, Romania Background: Nowadays, mobile technologies are part of everyday life, but the lack of instruments to assess their acceptability for the management of chronic diseases makes their actual adoption for this purpose slow.Objective: The objective of this study was to develop a survey instrument for assessing patients&rsquo; attitude toward and intention to use mobile technology for diabetes mellitus (DM) self-management, as well as to identify sociodemographic characteristics and quality of life factors that affect them.Methods: We first conducted the documentation and instrument design phases, which were subsequently followed by the pilot study and instrument validation. Afterward, the instrument was administered 103 patients (median age: 37&nbsp;years; range: 18&ndash;65&nbsp;years) diagnosed with type 1 or type 2 DM, who accepted to participate in the study. The reliability and construct validity were assessed by computing Cronbach&rsquo;s alpha and using factor analysis, respectively.Results: The instrument included statements about the actual use of electronic devices for DM management, interaction between patient and physician, attitude toward using mobile technology, and quality of life evaluation. Cronbach&rsquo;s alpha was 0.9 for attitude toward using mobile technology and 0.97 for attitude toward using mobile device applications for DM self-management. Younger patients (Spearman&rsquo;s &rho;=-0.429; P&lt;0.001) with better glycemic control (Spearman&rsquo;s &rho;=-0.322; P&lt;0.001) and higher education level (Kendall&rsquo;s &tau;=0.51; P&lt;0.001) had significantly more favorable attitude toward using mobile assistive applications for DM control. Moreover, patients with a higher quality of life presented a significantly more positive attitude toward using modern technology (Spearman&rsquo;s &rho;=0.466; P&lt;0.001).Conclusion: The instrument showed good reliability and internal consistency, making it suitable for measuring the acceptability of mobile technology for DM self-management. Additionally, we found that even if most of the patients showed positive attitude toward mobile applications, only a moderate level of intention to indeed use them was observed. Moreover, the study indicated that barriers were truthfulness and easiness to use. Keywords: mobile technology, mobile health, mHealth, Internet, disease management, diabetes, quality of lif

Ultrasonographic findings of child acute appendicitis incorporated into a scoring system

INTRODUCTION This study aimed to investigate the ultrasonographic features of paediatric acute appendicitis and incorporate them into a scoring algorithm that will quantify the risk of complications and the strength of recommendation for surgical intervention. METHODS 179 patients with suspected appendicitis who had undergone ultrasonographic examination were included in this study. Based on their medical evaluation and post-surgical histopathological results, patients were categorised into confirmed appendicitis (n = 101) and non-appendicitis (n = 78) groups. RESULTS In the appendicitis group, the appendix was visualised in 66 (65.3%) patients. In cases where the appendix was not visualised, we looked out for secondary inflammatory signs, which were present in 32 (31.7%) patients. Using stepwise logistic regression, Blumberg’s sign, free fluid or collection, hyperaemia, non-compressible appendix and an appendix diameter &gt; 7 mm were found to be significant predictive factors for appendicitis. A new scoring system called POPs was developed, combining inflammatory predictors and ultrasonography findings, with an area under the receiver operating characteristic curve of 0.958 (95% confidence interval 0.929–0.986). CONCLUSION The newly developed POPs-based diagnosis scheme proved a promising alternative to existing scoring systems such as the Alvarado score. Although further calibration would be beneficial, the proposed scoring scheme is simple and easy to understand, memorise and apply in the emergency room.</jats:p