Articles: outcome.
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Interact Cardiovasc Thorac Surg · Aug 2013
ReviewWhat is the utility of preoperative frailty assessment for risk stratification in cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether frailty scoring can be used either separately or combined with conventional risk scores to predict survival and complications. Five hundred and thirty-five papers were found using the reported search, of which nine cohort studies represented the best evidence to answer the clinical question. ⋯ However, risk models incorporating frailty parameters require further validation and have not been widely adopted. Routine collection of objective frailty measures such as 5-metre walk time and ADL assessment will help to provide data to develop new risk-assessment models to facilitate risk stratification and clinical decision-making in elderly patients. Based on the best evidence currently available, we conclude that frailty is an independent predictor of adverse outcome following cardiac surgery or transcatheter aortic valve implantation, increasing the risk of mortality 2- to 4-fold compared with non-frail patients.
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Little is known about recovery of female sexual function following an acute myocardial infarction (MI). Interventions to improve sexual outcomes in women are limited. ⋯ Partnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post-MI outcomes for women and their partners.
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Aust J Rural Health · Aug 2013
Recombinant tissue plasminogen activator (rt-PA) utilisation by rural clinicians in acute ischaemic stroke: an audit of current practice and clinical outcomes.
This audit of activity reports on current rates of recombinant tissue plasminogen activator (rt-PA) use within specialised stroke care units in rural New South Wales (NSW). It measures stroke onset-to-treatment time and morbidity outcomes for patients treated with rt-PA and aims to establish the safety and effectiveness of rt-PA use in rural NSW. ⋯ Recombinant tissue plasminogen activator can be delivered in rural Australian hospitals in a timely manner within recommended implementation guidelines. Acute stroke thrombolytic services in rural Australian facilities had comparable outcomes to metropolitan facilities. Small numbers of thrombolysed patients prevented a validation study of the well-defined outcome benefits from rt-PA. The need for ongoing data collection in regional settings is supported.
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Severe lower limb trauma with significant soft tissue injury can be managed with reconstruction or, if this is impossible, amputation. If amputation is considered, below-knee amputation preserving limb length is optimal for long-term functional outcome. ⋯ The procedure was technically challenging and required follow-up debulking operations. However, the technique provided the significant advantage of immediate sensation of robust glabrous distal stump cover and optimising leg length to enhance functional outcome.
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Clin Neurol Neurosurg · Aug 2013
Observational StudyA population based study of outcomes after evacuation of primary supratentorial intracerebral hemorrhage.
The role of surgery after primary intracerebral hemorrhage (ICH) is controversial. To explore whether hematoma evacuation after ICH had improved short-term survival or functional outcome we conducted a retrospective observational population-based study. ⋯ Improved 3-month survival was observed in patients who had undergone hematoma evacuation relative to patients not undergoing evacuation particularly in the subgroup of patients aged≤70 years with ≥30 ml supratentorial hematomas. Surgery might improve outcome if cases could be selected more precisely and if performed before deterioration.