The preoperative cardiology consultation: Indications and risk modification

Background The cardiologist is regularly consulted preop-eratively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear. Methods This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for elective non-cardiac surgery, which resulted in 273 (1%) referrals to the cardiologist for further preoperative evaluation. Medical charts were reviewed for patient characteristics, main reason for referring, requested diagnostic tests, interventions, adjustment in medical therapy, 30-day mortality and major adverse cardiac events. Results The most common reason for consultation was the evaluation of a cardiac murmur (95 patients, 35%). In 167 (61%) patients, no change in therapy was initiated by the cardiologist. Six consultations (2%) led to invasive interventions (electrical cardioversion, percutaneous coronary intervention or coronary artery bypass surgery). On average, consultation delayed clearance for surgery by two weeks. Conclusion In most patients referred to the cardiologist after being screened at an outpatient anaesthesiology clinic, echocardiography is performed for ruling out specific conditions and to be sure that no further improvement can be made in the patient’s health. In the majority, no change in therapy was initiated by the cardiologist. A more careful consideration about the potential benefits of consulting must be made for every patient

Immediate postoperative high-sensitivity troponin T concentrations and long-term patient-reported

BACKGROUND: Myocardial injury after noncardiac surgery is associated with mortality and major adverse postoperative cardiovascular events. The effect of postoperative troponin concentrations on patient-reported health-related quality of life (HRQoL) is unknown. OBJECTIVE: The study examined the association between immediate postoperative troponin concentrations and self-reported HRQoL 1 year after surgery. DESIGN: Prospective cohort study. SETTING: Single-centre tertiary care hospital in the Netherlands between July 2012 and 2015. PATIENTS: Patients aged at least 60 years undergoing moderate and major noncardiac surgery.None. MAIN OUTCOME MEASURES: HRQoL total score was assessed with the EuroQol five-dimensional questionnaire. Tobit regression analysis was used to determine the association between postoperative troponin concentrations and 1-year HRQoL. Peak high-sensitivity troponin T values were divided into four categories: less than 14, 14 to 49, 50 to 149 and at least 150 ng l. RESULTS: A total of 3085 patients with troponin measurements were included. 2634 (85.4%) patients were alive at 1-year follow-up of whom 1297 (49.2%) returned a completed questionnaire. The median score for HRQoL was 0.82 (0.85, 0.81, 0.77 and 0.71 per increasing troponin category). Multivariable analysis revealed betas of -0.06 [95% confidence interval (CI) -0.09 to -0.02], -0.11 (95% CI -0.18 to -0.04) and -0.18 (95% CI -0.29 to -0.07) for troponin levels of 14 to 49, 50 to 149 and at least 150 ng l when compared with values less than 14 ng l. Other independent predictors for lower HRQoL were chronic obstructive pulmonary disease, female sex, peripheral arterial disease and increasing age. CONCLUSION: Higher levels of postoperative troponin measured immediately after surgery were independently associated with lower self-reported HRQoL total score at 1-year follow-up

Postoperative troponin release is associated with major adverse cardiovascular events in the first year after noncardiac surgery

_Introduction:_ Troponin elevations after intermediate-to-high risk noncardiac surgery are common and can predict mortality. However, the prognostic value for early and late major adverse cardiovascular events (MACE) is less well investigated. The authors evaluated the relationship between postoperative troponin release and MACE in the first year after noncardiac surgery. _Methods:_ This observational cohort registry comprised data of patients aged ≥60 years undergoing intermediateto-high risk noncardiac surgery between July 2012 and 2015, at the Erasmus University Medical Center, Rotter

Type D Personality and Health-Related Quality of Life in Vascular Surgery Patients

Background: This study evaluated the association of type D personality and health-related quality of life (HRQoL) and assessed the stability of type D personality in vascular surgery patients during the year after surgery. Method: In a prospective cohort study between 2008 and 2014, 294 patients were assessed with validated questionnaires preoperatively and at 1, 6, and 12 months after surgery. Associations between type D personality, depression, and HRQoL were analyzed by generalized estimating equation models. Type D personality was analyzed in its standard dichotomous form as well as continuous (z) scores of its two components, negative affectivity (NA) and social inhibition (SI), and their interaction term. Results: Prevalence of type D personality varied between 18% and 25%. However, only 9% of the complete responders were classified as type D personality at all four assessments, whereas one third changed between type D classifications. Continuous scores showed greater stability over time. Dichotomized type D personality measured over time was significantly associated with impaired HRQoL, but this was not the case if measured once at baseline, like in general use. The continuous NA score and depression were also significantly associated with impaired HRQoL over time. Conclusion: Type D personality was not a stable trait over time. Preoperative assessment of type D personality did not predict improvement in HRQoL after vascular surgery. However, the study revealed associations between the NA component of type D personality, depression, and lower HRQoL. This indicates that measures of overall negative affect should be taken into account when assessing HRQoL patient-reported outcomes in vascular surgery patients

A double neon colour illusion

Contains fulltext : 62841.pdf (publisher's version ) (Open Access)A new visual illusion is presented. When two neon-coloured illusory bands overlap each other, the filling-in at the region of overlap is perceived as different from those of the overlapping bands, resulting in an additional illusory shape at the region of overlap. An experiment with ten naÔve participants was performed to measure the illusory percept. The results show that illusory surfaces may interact with each other, and, to a certain extent, create new illusory percepts

The effect of figural manipulations on brightness differences in the Benary cross

Contains fulltext : 99797.pdf (publisher's version ) (Open Access)The Benary cross is a classical demonstration showing that the perceived brightness of an area is not solely determined by its luminance, but also by the context in which it is embedded. Despite the fact that two identical grey triangles are flanked by an equal amount of black and white, one of the triangles is perceived as being lighter than the other. It has been argued that the junctions surrounding a test area are crucial in determining brightness. Here, we explored how different aspects influencing perceptual organisation influence perceived figure–background relations in the Benary cross and, with that, the perceived brightness of the triangular patches in our stimuli. The results of a cancellation task confirm that the alignment of contours at junctions indeed has a strong influence on an area’s brightness. At the same time, however, the Benary effect is also influenced by the overall symmetry of the cross and its orientation.17 p

Dancing shapes: a comparison between luminance induced distortions

Contains fulltext : 56740.pdf (publisher's version ) (Open Access)We present an illusory display in which a grid of outlined squares is positioned in front of a moving luminance gradient. Observers perceive a strong, illusory, `wavelike' motion of the superimposed squares. We compared luminance effects on dynamic and static aspects of this illusion. The dynamic aspect was investigated by means of a temporal gradient, which induced an illusory pulsing of the outlined squares. The static aspect was investigated in two different ways. In one experiment, the outlined squares were positioned on a spatial gradient, which caused the squares to look like trapezoid shapes. In another experiment, the squares were positioned on different luminance fields, which affected their apparent size. In all experiments, luminance settings were the same, and observers were asked to indicate the direction and strength of the induced distortions. The overall results show large agreements between the dynamic distortion and the first-mentioned static distortion, whereas different tendencies emerged for the second static distortion. In a second series of experiments, we examined these distortions for various ranges of the luminance gradient and for border gradients as well. On the basis of these data, we explored how the directions of the perceived distortions of the single-gradient displays examined in this paper could be related to each other.24 p

Global cues affect the apparent misalignment in the Poggendorf illusion

Contains fulltext : 62957.pdf (publisher's version ) (Open Access)1 p