Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital

Background: With the increasing use of minimally invasive techniques for gynecologic procedures, women are at a low risk for peri-operative complications. The purpose of this study was to determine the incidence of and risk factors for major intra or postoperative complications among women undergoing benign gynecologic surgeries. Methods: We conducted a retrospective observational study of all women who underwent benign gynecologic surgery in 2016-2017 at a University-Affiliated community hospital. Pregnant women, malignancy cases, and hysteroscopic or minor vulvar procedures were excluded. Primary outcome was composite intraoperative and/or 30-day postoperative complications requiring medical or surgical management. Logistic regression identified significant patient, peri-operative and surgeon risk factors associated with complications. Results: Of 975 patients included, 53 patients experienced major intra or postoperative complications (5.4%). Mean age was 47.7 ± 13.8 years. Mean BMI was 27.1 ± 5.8 kg/m2. Prior abdominal surgery (laparotomy or laparoscopy) (adjusted odds ratio [OR]= 2.01, 95%CI 1.05-3.83) and emergency surgery (adjusted OR= 19.54, 95%CI 2.99-127.54) were significantly associated with major complications. Surgeon volume of 1-2 operative days per month (adjusted OR=0.30, 95%CI 0.10 - 0.87) and age 40-64 years (adjusted OR=0.24, 95%CI 0.11- 0.56) had a protective effect on the risk of major complications. Conclusions: Among patients in our sample, 5.4% experienced major complications from a benign gynecologic surgery. Complications from benign gynecologic surgery are rare, even in the absence of robotic equipment. Center-specific data and a discussion of the increased morbidity associated with with prior abdominal surgery and emergency surgery should be considered for pre-operative patient counselling

Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial

BACKGROUND: Major depression is a frequent and serious disorder in older medical inpatients. Because the condition goes undetected and untreated in most of these patients, we conducted a randomized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population. METHODS: Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule (DIS) within 48 hours after admission. Patients found to have major depression were randomly allocated to receive the intervention or usual care. The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient's family physician. Research assistants, blind to group allocation, collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale (HAMD), the Medical Outcomes 36-item Short Form (SF-36), the DIS, the Mini-Mental State Examination (MMSE), the Older Americans Resources and Services (OARS) questionnaire to assess basic and instrumental activities of daily living (OARS-ADL and OARS-IADL) and the Rating Scale for Side Effects. Data on the severity of illness, length of hospital stay, health services and medication use, mortality and process of care were also collected. The primary outcome measures were the HAMD and SF-36. RESULTS: Of 1500 eligible patients who were screened, 157 were found to have major depression and consented to participate (78 in the intervention group and 79 in the usual care group). At randomization, there were no clinically or statistically significant differences between the 2 groups. Sixty-four patients completed follow-up to 6 months, 57 withdrew, and 36 died. At 6 months, there were no clinically or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures. INTERPRETATION: We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical inpatients

Data for An evaluation of the suitability, readability, and quality of online resources for the self-management of depression

Data for results of paper entitled "An evaluation of the suitability, readability, and quality of online resources for the self-management of depression." Objective: To evaluate online depression self-management (SM) resources based on their readability, suitability, and quality to determine their appropriateness for use by patients. Methods: A Google search using patients’ most frequently searched terms was conducted. Resources were evaluated using readability indices, the Suitability Assessment of Materials (SAM), and the DISCERN tool. The number of SM skills and other contributing factors (e.g., resource format) were also evaluated. Results: The mean readability score across the sample was grade 10 (SD 1.5, range 8-14) and 22.2% of resources (n=6) met the criteria for superior suitability. The sample mean scores were 58.8% (SD 11.6, range 36%-81%) for the DISCERN and 4.4 for SM skills (SD 1.6, range 2-8). SAM and DISCERN scores were found to be significantly correlated (Pearson correlation-coefficient 0.70). A cluster analysis of SAM and DISCERN scores suggested two groups that were significantly different (t-test, P < 0.001): 8 resources in a “high quality” cluster and 19 resources in a “medium/low” quality cluster. Conclusion: Eight publicly available online resources scored highly. However, the readability of all the resources evaluated exceeded recommended levels. Practice Implications: Resources that are accessible to people with lower literacy levels and increased user-friendliness are needed

An Evaluation of Interactive mHealth Applications for Adults Living with Cancer

This study evaluated the quality and usefulness of interactive mobile health (mHealth) applications (apps) for adults with cancer. The PRISMA guidelines were followed to add rigor to the search, as well as to the data collection and analysis. The apps available in the most used app stores (Google Play and Apple) with interactive tailored features were identified. To supplement this, a Google web search was also conducted. The apps were evaluated for their quality using the validated Mobile App Rating Scale (MARS) and for their usefulness using a checklist of end users‘ desired features derived from the literature. The searches returned 3046 apps and 17 were retained for evaluation. The average quality score of the apps across the sample was 3.62/5 (SD 0.26, range: 3.14–4.06), with Outcomes4me scoring the highest. On average, the apps scored 50% (SD 2.5, range: 31–88%) on the usefulness checklist, with Cancer.net scoring the highest. The lowest-scoring categories were communications features on the usefulness checklist and “information” on the MARS, indicating areas for future work. The findings identified the apps of an acceptable quality and usefulness that could be recommended to those with cancer

A mixed methods exploration of family members’/friends’ roles in a self-care intervention for depressive symptoms

The aims of this exploratory study were to examine the: (1) family and friend (F/F) support patients reported receiving and F/F reported providing to patients while participating in a self-care intervention (SCI) for depressive symptoms and (2) associations between different types of F/F support and patients’ use of the self-care tools in the SCI

Varicocele and Male Factor Infertility Treatment:A New Meta-analysis and Review of the Role of Varicocele Repair

Context: Varicocele is a common condition, found in many men who present for infertility evaluation. Objective: To assess the effect of varicocelectomy on male infertility. Evidence acquisition: A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed. Evidence synthesis: Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p = 0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p <0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p <0.0001) and 9.69% (95% CI, 4.86-14.52; p = 0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques. Conclusions: Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved

Development of a delirium risk screening tool for long-term care facilities.

Objectives: To develop a delirium risk screening tool for use in long-term care (LTC) facilities. Methods: The sample comprised residents aged 65 and over of 7 LTC facilities in Montreal and Quebec City, Canada, admitted for LTC. Primary analyses were conducted among residents without delirium at baseline. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Risk factors, all measured at or prior to baseline, included the following 6 groups: sociodemographic, medical, cognitive status, physical function, agitated behaviour, and symptoms of depression. Variables were analyzed individually and by group using Cox regression models. Clinical judgement was used to select the most feasible among similarly performing factors. Results: The cohort comprised 206 residents without delirium at baseline; 69 cases of incident delirium were observed (rate 7.6 per 100 person-weeks). The best-performing screening tool comprised 5 items, with an overall area under the curve of 0.82 (95% CI 0.76, 0.88). These items included brief measures of cognitive status, physical function, behavioral, and emotional problems. Using cut-points of 2 (or 3) over 5,Objectives: To develop a delirium risk screening tool for use in long-term care (LTC) facilities. Methods: The sample comprised residents aged 65 and over of 7 LTC facilities in Montreal and Quebec City, Canada, admitted for LTC. Primary analyses were conducted among residents without delirium at baseline. Incident delirium was diagnosed using multiple data sources during the 6-month follow-up. Risk factors, all measured at or prior to baseline, included the following 6 groups: sociodemographic, medical, cognitive status, physical function, agitated behaviour, and symptoms of depression. Variables were analyzed individually and by group using Cox regression models. Clinical judgement was used to select the most feasible among similarly performing factors. Results: The cohort comprised 206 residents without delirium at baseline; 69 cases of incident delirium were observed (rate 7.6 per 100 person-weeks). The best-performing screening tool comprised 5 items, with an overall area under the curve of 0.82 (95% CI 0.76, 0.88). These items included brief measures of cognitive status, physical function, behavioral, and emotional problems. Using cut-points of 2 (or 3) over 5, the scale has a sensitivity of 90% (63%), specificity of 59% (85%), and positive predictive value of 52% (66%). Conclusion: This brief screening tool allows nurses to identify LTC residents at increased risk for delirium. These residents can be targeted for closer monitoring and preventive interventions