Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery

INTRODUCTION: With the increasing aging population demographics and life expectancies the number of very elderly patients (age ≥ 80) undergoing emergency surgery is expected to rise. This investigation examines the outcomes in very elderly patients undergoing emergency general surgery, including predictors of in-hospital mortality and morbidity. METHODS: A retrospective study of patients aged 80 and above undergoing emergency surgery between 2008 and 2010 at a tertiary care facility in Canada was conducted. Demographics, comorbidities, surgical indications, and perioperative risk assessment data were collected. Outcomes included length of hospitalization, discharge destination, and in-hospital mortality and morbidity. Multivariable logistic regression was used to identify predictors of in-hospital mortality and complications. RESULTS: Of the 170 patient admissions, the mean age was 84 years and the in-hospital mortality rate was 14.7%. Comorbidities were present in 91% of this older patient population. Over 60% of the patients required further services or alternate level of care on discharge. American Society of Anesthesiologist Physical Status (ASA) Classification (OR 5.30, 95% CI 1.774-15.817, p = 0.003) and the development of an in-hospital complications (OR 2.51, 95% CI 1.210-5.187, p = 0.013) were independent predictors of postoperative mortality. Chronological age or number of comorbidities was not predictive of surgical outcome. CONCLUSIONS: Mortality, complication rates and post-discharge care requirements were high in very elderly patients undergoing emergency general surgery. Advanced age and medical comorbidities alone should not be the limiting factors for surgical referral or treatment. This study illustrates the importance of preventing an in-hospital complication in this very vulnerable population. ASA class is a robust tool which is predictive of mortality in the very elderly population and can be used to guide patient and family counseling in the emergency setting

An Examination of Factors That Influence the Program Choice of Graduate Students in the Pharmaceutical Sciences.

Objectives: The objectives of study were to: 1) identify factors considered important by pharmaceutical sciences graduate students during the application and acceptance phases of the admission process; 2) identify differences in the evaluative criteria for the two admission phases and for international and domestic students and 3) identify differences in the evaluative criteria for the two admission phases based on prior graduate school experience. Methods: Focus groups and depth interviews were conducted exploring issues surrounding the application and selection decisions of pharmaceutical sciences graduate students. Based on the results of this qualitative work and a review of the literature, an Internet-based survey was created. An email message requesting distribution of the invitation letter and survey link was sent to graduate program coordinators, department chairs, associate deans, or school of pharmacy deans at colleges/schools of pharmacy that were reported to have a graduate program in any of the pharmaceutical science disciplines. Results: A total of 277 complete and usable responses were received. 122 (44%) were domestic students and 155 (56%) were international students. Twenty-two evaluative criteria were considered important in both the application phase and acceptance phase of the admission process. Some of the notable important evaluative criteria included “interest in program being offered”, “interest in research being conducted”, “availability of scholarship”, “amount of stipend”, “cost of living”, and “job prospects after graduation”. Overall, significant differences were found in the importance of evaluative criteria for the application phase and the acceptance phase. However, this was not the case with US graduate students; a within subject multivariate analysis of domestic students responses shono significant differences in the evaluative criteria between application and acceptance phase. A multivariate test of significance (p=0.001) revealed that domestic and international students differed in their important evaluative criteria for both phases of the admission process. Likewise, students with prior graduate education differed in their evaluative criteria (p=0.002) from students without prior graduate education at the application phase. In addition, students with prior graduate school experience had no differences in importance of evaluative criteria between application and acceptance phase. Implications: The results suggest that graduate programs in the pharmaceutical sciences should have different strategies for the recruitment and acquisition of graduate student talent from the United States and abroad. Overall, the results of this study will assist graduate program coordinators, department chairs, and international program coordinators in the planning and execution of recruitment and acquisition programs that will cater to the needs of aspiring graduate students, regardless of background

Lifestyle interventions for weight loss in adults with severe obesity: a systematic review

Severe obesity is an increasingly prevalent condition and is often associated with long-term comorbidities, reduced survival and higher healthcare costs. Non-surgical methods avoid the side effects, complications and costs of surgery, but it is unclear which non-surgical method is most effective. The objective of this article was to systematically review the effectiveness of lifestyle interventions compared to standard or minimal care for weight loss in adults with severe obesity. MEDLINE, EMBASE, CENTRAL, databases of on-going studies, reference lists of any relevant systematic reviews and the Cochrane Library database were searched from inception to February 2016 for relevant randomized controlled trials (RCTs). Inclusion criteria were participants with severe obesity (body mass index [BMI] > 40 kg/m(2) or BMI > 35 kg/m(2) with comorbidity) and interventions with a minimal duration of 12 weeks that were multi-component combinations of diet, exercise and behavioural therapy. Risk of bias was evaluated using the Cochrane risk of bias criteria. Meta-analysis was not possible because of methodological heterogeneity. Seventeen RCTs met the inclusion criteria. Weight change in kilograms of participants from baseline to follow-up was reported for 14 studies. Participants receiving the lifestyle intervention had a greater decrease in weight than participants in the control group for all studies (1.0-11.5 kg). Lifestyle interventions varied greatly between the studies. Overall lifestyle interventions with combined diet and exercise components achieved the greatest weight loss. Lifestyle interventions for weight loss in adults with severe obesity were found to result in increased weight loss when compared to minimal or standard care, especially those with combined diet and exercise components

Measurement of Potassium Ion Diffusion through Dentine Using ISE

Objective: To measure the in vitro concentration of potassium ions (K+ ) on the opposite side of the dentine samples in real-time, using Potassium Ion Selective Electrodes (K+ ISE). Method: An assembly array was designed and different sections (n=4) of dentine were acid etched in 6% citric acid and ultra-sonicated for five minutes. They were subsequently fixed into a polypropylene tube using impression dental material and immersed into simulated dentine fluid (SDF) which consisted of 0.01 mol/dm3 potassium chloride (KCL) solution. The K+ ISE was placed external to the polypropylene tube, to measure changes in the potassium ion concentration [K+ ] in the SDF for 60 hrs continuously. Application of potassium nitrate (KNO3 ) solutions of concentrations between 0.05-3 mol/dm3 were applied to the exposed dentine samples in separate experiments. Results: Minimal changes in [K+ ] (<5 mmol/dm3 ) in the SDF (the opposite side of the sample) were measured by the K+ ISE when applying less than 600 mmol/dm3 of KNO3 solutions to the dentine sections. However, significant changes (P<0.05) in [K+ ] of 5-25 mmol/dm3 were measured in the SDF when applying a KNO3 solution of concentration more than 600 mmol/dm3 to the dentine samples, indicating greater penetration of K+ through the dentine matrix. Conclusion: ISE may be used to measure ionic transfer in dentinal tubules although questions arise due to the sensitivity of the ISE and its suitability. However, it was demonstrated that increasing the concentration of an applied KNO3 solution to exposed dentine increased the [K+ ] in the SDF which was on the opposite side in the dentine disk model and premolar tooth with a cut cavity. This was also the case when the fluid flow was in the opposite direction to diffusion. This study demonstrates that ISE may be suitable for real-time diffusion experiments in dentine for possible future research into dental therapeutics which involve ion exchange

Multimedia Storage System Providing QoS in Cloud Based Environment

Cloud computing and mobile computing are moderately new trend in Information Technology which are growing rapidly. Mobile devices are replacing personal computers by joining large mobile networks and are effortlessly switching between different network providers. Currently, to maintain network connectivity all the time different service handover mechanisms is used so that cloud services can be accessed by user without any interruption. In this scenario, if user mobility is considered, then he is connected to its local cloud to access the different cloud services. As user is moving from one geographical location to another because of this mobility factor network congestion increases which causes degradation in QoS. For this reason a framework is introduced which will deliver services to the users to improve QoS in order to provide better QoE to the clients. In this paper, we are further developing this framework in which an algorithm is designed in service delivery layer which will help for better solution to the efficient management of network resources while providing a high QoE for the clients. And as the demand for specific services increases in a location, using this framework it will be more efficient to move those services closer to that location. This framework will help to reduce high traffic loads due to multimedia streams and will offer service providers an automated resource allocation and management mechanism for their services

Impact of Income Generating Activities on Self-Help Groups Members of Mahabubnagar District of Telangana, India

Whereas there is ample evidence that the Self-Help Groups (SHG) approach is a very effective, efficient, and relevant tool for organizing and empowering the poor, do arise with the design, development, and introduction of programs to promote income-generating activities (IGAs) that will generate sufficient, sustainable and regular income. Mahabubnagar district is one of the 33 districts in the Indian state of Telangana. The district is situated in the Southern Telangana region of the state. The administrative headquarters of the district is situated at Mahabubnagar Urban. The wide range of agricultural activities and allied sources undertaken by the SHG members in the study 11.11 per cent of respondents had dairy and 8.33 per cent of respondents had piggery meager proportion of respondents 6.66 per cent had gone for goattery production. A maximum of less than half 34.44 per cent of the respondents had paddy cultivation as their primary occupation followed by vegetable cultivation engaged by 22.77 per cent of the respondents and 20.00 per cent of SHG members were also involved in sugarcane cultivation. More than one-tenth 15.00 per cent of respondents had gone for banana cultivation whereas a meager proportion of respondents 7.22 per cent had gone for vermicompost production. Several respondents were engaged in individual sources apart from their group to be involved in tailoring 18.88 per cent, pickles making 16.66 percent and toys making 13.88 per cent, Regarding group based activity, napkin preparation 15.00 per cent, curry leaf powder preparation 11.12 cent, foot mat preparation 10.00 per cent and areca plate preparation 10.55 per cent were the major income generating activities found in the study area

Study of adverse drug reactions in a tertiary care hospital

Background: The objectives of the study were to evaluate incidence and preventability of adverse drug events (ADEs) and potential ADEs and to analyse preventable events to develop prevention strategies.Methods: The study was retrospective observational study conducted at a rural tertiary care hospital at Maharashtra, for 12 months. Patients of both gender and all age group were included in the study. These entire adverse drug reactions were reported either by the PVPI assistance and/or hospital staff and their severity and causality assessments was performed as per Naranjo’s and Hartwig’s assessment criteria respectively. Data was analyzed by using Microsoft Excel.Results: There were total 256 ADR (adverse drug reactions) were reported in 12 months from January 2018 to December 2018 in various departments of the study center. Most of the adverse drug reactions were reported among age group of 21–40 years patients. Rash and itching (69) were most commonly reported ADR’s. ART (31.25%), antibiotics (28.90%) were reported to induce maximum number of ADRs. Most of the adverse drug reactions were possible (194, 75.78%) and mild (208, 81.25%) in nature.Conclusions: The antibiotics, ART drugs were most common drugs to reported ADRs. The commonly reported reactions were rash and itching

Web Service Based News Portal

Providing web services for smart phones is the currently recent booming topic, this happened because the smart phones are used in almost every area, where today’s user uses it for mobile banking, emailing, searching location and data. Smart phones are advanced in terms of processing power, memory, an embedded camera, sensors and same time parallel advancement in wireless network and software web technologies. This project will direct our work in the current generation platform technologies and standards such as Android OS and REST for News Portal. It is a complete news portal showing all the news around the nation in an interactive fashion at one place. It aims in bringing more simplicity for obtaining news about any issue round the nation. Every newspaper and news channel publishes the news on their website. So a person has to visit various websites if the user needs information about any current news in which ever language the user wants. So this portal aims to bring all the news of all different languages grouped together under one banner by provisioning web services. All sorts of news ranging from breaking news to cricket news are covered over here. Information regarding daily horoscope as well as latest stock prices are also obtained in this single portal. Mobile devices (Smart phones, PDA, Tablets), Mobile web services and wireless communications, by the year 2020 will be expected to play a central role in all aspects of our lives. The Mobile web service provisioning is substantially expanding on the concept of ‘Anywhere, Anytime and on Any Device’ to a new paradigm ubiquitous mobile computing. It is used to improve access to meaningful, quickly and required information and content through mobile web services. Many of the problems of mobile web services can be solved by targeting the distributed nature and isolated deployment of mobile applications. One of the most promising way to create viable web services for mobile devices is to add extra intelligence to the web services, both on the web service provider and the web service consumer

DRUG UTILIZATION STUDY IN GERIATRIC PATIENTS AT RURAL TERTIARY CARE HOSPITAL

AbstractObjective: To study the drug utilization pattern in geriatric patients at rural tertiary care hospital.Materials and Methods:  This was a cross-sectional observational study involving 600 geriatric outpatients. The study was carried out from May 2014 to July 2014. The data was collected using predesigned pro forma specially designed for this purpose. Relevant information was obtained by analyzing the prescriptions for WHO core drug indicators.Results: - The total numbers of prescriptions studied were 600. The total number of drugs prescribed is a product of actual drugs and number of patient prescriptions. The majority of the patients were in the age group 65-70 years (69.33%). There was male preponderance (58.66%). Musculoskeletal diseases were the most common (26.33%), followed by cardiovascular diseases (26%). The average number of drugs per prescription was 2.79. Out of total number of drugs prescribed, 380 drugs (22.64%)  were prescribed by their generic name and 1298 drugs (77.35%) were prescribed by their brand name. 1308 drugs (77.94%)  prescribed were from World Health Organization's Essential Medicines List 2011 (WHO-EML). Drugs acting on the cardiovascular system (23.36%) were the most frequently prescribed, followed by vitamins, minerals (18.23%) and drugs acting on the gastrointestinal system (15.73%).Conclusion:  The study has shown the pattern of diseases prevalent in geriatric patients and drug use among them. Thus drug utilization study can help in assessment and promotion of rational use of drugsKeywords: Drug utilization, geriatric, polypharmacy, rational use