Documentation of individualized preoperative risk assessment: a multi-center study

Background: Individual surgical risk assessment (ISRA) enhances patient care experience and outcomes by informing shared decision-making, strengthening the consent process, and supporting clinical management. Neither the use of individual pre-surgical risk assessment tools nor the rate of individual risk assessment documentation is known. The primary endpoint of this study was to determine the rate of physician documented ISRAs, with or without a named ISRA tool, within the records of patients with poor outcomes. Secondary endpoints of this work included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk. / Methods: The records of non-obstetric surgical patients within 22 community-based private hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017, were evaluated. A two-sample proportion test was used to identify the difference between surgical documentation and anesthesiology documentation of risk. Logistic regression was used to analyze both individual and group effects associated with secondary endpoints. / Results: Seven hundred fifty-six of 140,756 inpatient charts met inclusion criteria (0.54%, 95% CI 0.50 to 0.58%). ISRAs were documented by 16.08% of surgeons and 4.76% of anesthesiologists (p < 0.0001, 95% CI −0.002 to 0.228). Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p = 0.0086, R-squared = 0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented (p = 0.023, R-squared = 0.730%). Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p = 0.043, R-squared = 0.580%]. Only 10 of 756 (1.3%) records included documentation of a named ISRA tool. / Conclusions: The observed rate of documented ISRA in our sample was extremely low. Surgeons were more likely than anesthesiologists to document ISRA. As these individualized risk assessment discussions form the bedrock of perioperative informed consent, the rate and quality of risk documentation must be improved

Assessing palaeobathymetry and sedimentation rates using palynomaceral analysis: a study of modern sediments from the Gulf of Papua, offshore Papua New Guinea

© 2015 © 2015 AASP - The Palynological Society. Palynologists interested in better understanding the sedimentation and energy of depositional environments have often included studies of palynomaceral fragments, particularly when performing palynofacies analyses. Due to the difficult nature of classifying these fragments, researchers have developed numerous, often overlapping, classification schemes. These different schemes make it difficult to compare and contrast between research projects. Determining the appropriate scheme to apply when counting these fragments can be confusing, and application of these schemes can yield inconclusive results, especially when sedimentation and energy are in constant flux. A scheme of five categories, including brown wood (palynomaceral 1-2), leaf cuticle (palynomaceral 3), black debris (palynomaceral 4), structureless organic matter (SOM) and resin, is utilised here. It is applied to the analysis of 64 modern samples from the top 0-4 cm of sediment collected throughout the Gulf of Papua, Papua New Guinea. These samples span a suite of common marine depositional environments: river mouths and deltas, the proximal portion of the continental shelf dominated by a large clinoform, and turbidite and hemipelagic/pelagic deposits on the slope and in the deep ocean basin. Principal component analysis (PCA) confirms this simplified classification scheme provides an indirect means of assessing distance from shore and shelf-slope break, overall water depth and sediment accumulation rate, but other factors, such as processing technique, marine productivity, sediment source, time in transport and residence and bioturbation, are taken into account to fully explain distribution

Fine sediment mineralogy as a tracer of latest Quaternary sediment delivery to a dynamic continental margin: Pandora Trough, Gulf of Papua, Papua New Guinea

Sediment cores and geophysical data from the shelf and slope in the Pandora Trough and Gulf of Papua (GoP; Papua New Guinea, northern Coral Sea) have been studied to evaluate timing, pathways, and sources of sediment delivery to a muddy shelf-slope depositional system that developed during the late Quaternary marine transgression. Cores were analyzed for 14C geochronology, clay and bulk mineralogy, grain size, sedimentary fabric, and physical properties. Observations reveal a shelf-edge depocenter and adjacent middle-to-upper slope sediment wedge that each developed at different times from different sedimentary sources, despite close proximity along a down-slope gradient. Clay mineralogy of modern shelf sediments reveals strong longitudinal gradients that appear related to fluvial source composition. Similar gradients in source composition reveal heterogeneous and shifting sediment sources to the shelf and slope through time. From the Bølling-Allerød interstadial (14.5-12.5kyr BP), and the Younger Dryas (12.5-11.5kyr BP), fluvial sediments accumulated in a muddy inner shelf, forming a shelf-edge depocenter (core MV-41) with high kaolinite/chlorite values that are indicative of a local volcanic source, consistent with the geology of the nearby Lakekamu and Vailala river catchments. Shelf-edge sediment accumulation decreased from the time of Meltwater Pulse 1B (MWP-1B) to the present due to shelf flooding and inshore trapping of sediment. During MWP-1B, and possibly earlier, sediment transport west of MV-41 was steered obliquely offshore to the northern Pandora Trough continental margin upper/middle slope (MV-46 and MV-49). This transport has persisted nearly to the present, and has allowed for the development of a Holocene upper/middle slope sediment wedge (cores MV-46 and MV-49) that differs strongly in clay composition (and so source) from the adjacent up-slope shelf-edge depocenter (MV-41). Slope deposits have intermediate illite/smectite values similar to the central GoP, which differ from the very low illite/smectite values at MV-41. Such heterogeneous dispersal patterns oblique to seabed gradient are likely due to complex interactions of shelf processes with dynamic shelf morphology along the flooding GoP shelf, rather than a response solely due to rising sea-level and down-slope transport. © 2014 Elsevier B.V