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

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

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)

Diagnosis reliability of combined flexible sigmoidoscopy and fecal-immunochemical test in colorectal neoplasia screening

Dana Iovanescu,1 Mirela Frandes,2 Diana Lungeanu,2 Amelia Burlea,3 Bogdan P Miutescu,4 Eftimie Miutescu1 1Department of Gastroenterology, Faculty of Medicine, Pharmacy and Dental Medicine, &ldquo;Vasile Goldis&rdquo; West University of Arad, 2Department of Functional Sciences, &ldquo;Victor Babes&rdquo; University of Medicine and Pharmacy of Timisoara, 3Department of Pathology, County Hospital of Arad, 4Department of Gastroenterology, &ldquo;Victor Babes&rdquo; University of Medicine and Pharmacy of Timisoara, Romania Background: Employing colonoscopy, the gold standard in colorectal cancer (CRC) diagnosis testing, for CRC screening presents a significant risk of complications. Alternative methods with a lower invasive-level and fewer risks are proposed in combination, though each with lower diagnosis performance when applied separately. The main objective of this cross-sectional pilot study was to evaluate the feasibility of a CRC screening program using combined flexible sigmoidoscopy and fecal-immunochemical test (FIT).Methods: The patient population consisted of 2,201 consecutive-case symptomatic patients attending the gastroenterology outpatient clinic with mild complaints between 2012 and 2014. They were referred for FIT. A sample of 252 individuals underwent a subsequent colonoscopy, blind to FIT results, and theoretical sigmoidoscopy was simulated. On a subsample of 57 patients, real sigmoidoscopy was additionally performed. Prior probabilities in terms of patients&rsquo; compliance and CRC prevalence were estimated, together with predictive ability of FIT and sigmoidoscopy in screening population. We assessed the merit of a screening strategy employing two-stage serial multiple testing: a) first stage by combining two parallel tests, that is, flexible sigmoidoscopy and FIT and b) colonoscopy as the second diagnosis test. The scheme was validated using the actual predictive values derived from the study population.Results: Colonoscopy found 75 (29.76%) individuals with advanced neoplasia. FIT was positive in 30.3% of advanced neoplasia cases, while between 23.73% and 28.28% met the theoretical sigmoidoscopy simulation criteria, with good concordance between real and theoretical sigmoidoscopy. The colonoscopy referral compliance rate was 52% among FIT-positives. Sensitivity and specificity of the first-stage test combination were better than sigmoidoscopy alone (McNemar test: P&lt;0.001). Negative predictive values for low prevalence levels were between 81.5% and 90.12%.Conclusion: Combining less resource challenging and less invasive testing procedures is worthwhile in colorectal neoplasia detection, improving sensitivity and specificity of either test alone, and leading to better posterior probabilities in usual screening scenarios. Keywords: colorectal cancer, test combination, predicted values, screenin

A Computational Intelligence Approach for Ranking Risk Factors in Preterm Birth

Abstract- The aim of this paper is to propose a filter, based on a multi-objective evolutionary algorithm, for attributes ’ ranking in the context of a data mining task. The behavior of this filter is analyzed for the problem of ranking risk factors in preterm birth. The results obtained by applying the proposed evolutionary approach are compared with rankings obtained by applying some classical attributes selection methods and a logistic regression procedure. The influence of the ranking on a supervised classification (based on a radial basis function neural network) is also analyzed and the results suggest that the evolutionary approach provides a good quality ranking. I