114 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

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    Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

    Post-collisional H-type granitoid magmatism in Central Anatolia and time-space relation with Fe-oxide mineralization

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    7th Biennial SGA Meeting -- AUG 24-28, 2003 -- Athens, GREECEWOS: 000221378600076The distribution, in both space and time, of the mineral deposits of the Central Anatolia reveals some interesting and enigmatic features of mineralization in a collision related setting. Central Anatolia is a polymetallic metallogenic province hosting mineral deposits of various size and type. Present study concerns with the formation and distribution of the Fe-oxide mineralization in terms of granite metallogeny, and reveals the genetic coexistence of H-type post-collisional granitoid magmatisin and Fe-oxide mineralization.Soc Geol App

    Tectonic setting and petrogenesis of the Celebi granitoid, (Kirikkale-Turkey) and comparison with world skarn granitoids

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    WOS: 000178679500003Many studies have shown systematic correlations between the composition of plutons worldwide and the metal content of associated skarns. This is the first report of similar correlations between the composition of Celebi granitoid and skarns of the Celebi district in Central Anatolia, Turkey. The Celebi district is well known for its polymetallic Fe-Wand Cu vein ores. These are hosted by calcic skarn zones. Both exoskarns (pyroxene-gamet) and endoskarns (epidote-pyroxene) occur in the district formed mainly along the granitoid contacts and along the fractures within the marble. Based on mineralogy, petrology and geochemistry, two different igneous rocks were recognized in the Celebi granitoid, referred to as leucocratic (felsic) and mesocratic (intermediate) Celebi granitoid. The leucocratic Celebi occurs as dominant rock type, and is classified as granite. The mesocratic Celebi is not widespread and is classified as adamellite, tomalite, quartz monzonite and quartz monzodiorite. The mesocratic Celebi has I-type characteristics, and have subalkaline, calc-alkaline and metaluminous characteristics like most worldwide skarn granitoids. A post-collisional tectonic setting is proposed on the basis of field evidence, the relative timing of intrusions with respect to metamorphic and obducted ophiolitic rocks and trace element geochemistry. The high abundance of La and Ce and the enrichment of V in mafic components suggest that Celebi granitoids are formed by partial melting of mantle rocks, but have been contaminated by interaction with continental crust involving possible magma mixing processes (i.e. mixing of coexisting felsic and mafic magmas). In the district, the mesocratic type and mafic microgranular enclaves (MME) mainly within leucocratic type represent a mafic underplating magma that was mixed with and/or injected into felsic magma of the leucocratic type. The present study shows that Fe mineralization is associated with mesocratic Celebi type, whereas W mineralization is associated with leucocratic type. Mesocratic Celebi granitoid is significantly different from the worldwide average of plutons associated with Fe skarns. In particular, MgO vs. SiO2, FeOt+CaO+Na2O/K2O vs. SiO2, Fe2O3/Fe2O3+FeO vs. SiO2 and V vs. Ni vary from typical values (are lower than values typical for plutons associated with Fe skarns) for plutons associated with Fe skarns. Instead, it resembles the geochemical characteristics of plutons associated with worldwide Cu and possibly An skarns. This suggests new exploration possibilities for copper and gold in the Celebi district. (C) 2002 Elsevier Science B.V. All rights reserved

    Geochemical signatures of granitoids associated with skarns in central Anatolia

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    WOS: 000172227300006Many studies have shown systematic correlations between the composition of plutons worldwide and the metal contents of associated skarns. This is the first report of similar correlations between plutons and the skarns of the Akdagmadeni, Akcakisla, and Keskin districts in Central Anatolia. Herein, die genetic associations of skarn occurrences are investigated using the geochemical compositions of the intrusives. In terms of major- and trace-element data, the granitoids associated with skarns show important differences. Three general groups of plutons, are distinguished, and the distinction among them is based largely on major-element data. In general, the granitoids associated with Pb-Zn skarns in all three districts are classified as subalkaline/calc-alkaline, based on TAS and AFM diagrams, respectively. The Akdagmadeni and Keskin granitoids display S-type characteristics, and those of Akcakisla display I-type characteristics. As a whole, the granitoids in all districts display major-element geochemical characteristics (Harker diagrams) that typify plutons associated with worldwide Zn, W, Mo, and Sn skarns. These data probably indicate that some other elements, like W in the Akdagmadeni district, and Mo + Sn in the Keskin district, could be associated with these skarns. Similarly, the granitoids of Akdagmadeni and Akcakisla have trace-element geochemical signatures (Zr versus Ba and Zr versus Rb/Sr diagrams) that typify plutons associated worldwide with Zn, Cu, Mo, and W skarns. This also helps to underline the possible association of W and Mo skarns in the Akdagmadeni district, and Cu skarns in the Akcakisla district. The average K2O/Na2O ratios of the plutons also serve to differentiate the granitoids associated with different types of skarns. The average K2O/Na2O ratio of the Keskin pluton it; 1.23, close to that of plutons associated with major Mo and Sn skarns. On the other hand, the average K2O/Na2O ratio of Akcakisla granite is very close to 1.0, close to that of plutons associated with major Cu (and W?) as well as Pb and Zn. Therefore, these skarns should be investigated in terms of the potential for those elements. This suggests new exploration possibilities for the Akcakisla, Akdagmadeni, and Keskin districts
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