Moving Beyond Reflexive and Prophylactic Gynecologic Surgery.
Ontology highlight
ABSTRACT:
SUBMITTER: Stewart EA
PROVIDER: S-EPMC8088594 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Publications
Moving Beyond Reflexive and Prophylactic Gynecologic Surgery.
Stewart Elizabeth A EA Missmer Stacey A SA Rocca Walter A WA
Mayo Clinic proceedings 20210201 2
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Project description:ObjectiveTo estimate the effectiveness of prophylactic negative pressure wound therapy in patients undergoing laparotomy for gynecologic surgery.MethodsWe conducted a randomized controlled trial. Eligible, consenting patients, regardless of body mass index (BMI), who were undergoing laparotomy for presumed gynecologic malignancy were randomly allocated to standard gauze or negative pressure wound therapy. Patients with BMIs of 40 or greater and benign disease also were eligible. Randomization, stratified by BMI, occurred after skin closure. The primary outcome was wound complication within 30 (±5) days of surgery. A sample size of 343 per group (N=686) was planned.ResultsFrom March 1, 2016, to August 20, 2019, we identified 663 potential patients; 289 were randomized to negative pressure wound therapy (254 evaluable participants) and 294 to standard gauze (251 evaluable participants), for a total of 505 evaluable patients. The median age of the entire cohort was 61 years (range 20-87). Four hundred ninety-five patients (98%) underwent laparotomy for malignancy. The trial was eventually stopped for futility after an interim analysis of 444 patients. The rate of wound complications was 17.3% in the negative pressure wound therapy (NPWT) group and 16.3% in the gauze group, absolute risk difference 1% (90% CI -4.5 to 6.5%; P=.77). Adjusted odds ratio controlling for estimated blood loss and diabetes was 0.99 (90% CI 0.62-1.60). Skin blistering occurred in 33 patients (13%) in the NPWT group and in three patients (1.2%) in the gauze group (P<.001).ConclusionNegative pressure wound therapy after laparotomy for gynecologic surgery did not lower the wound complication rate but did increase skin blistering.Clinical trial registrationClinicalTrials.gov, NCT02682316.Funding sourceThe protocol was supported in part by KCI/Acelity.
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Project description:The use of imaging systems in protein crystallisation means that the experimental setups no longer require manual inspection to determine the outcome of the trials. However, it leads to the problem of how best to find images which contain useful information about the crystallisation experiments. The adoption of a deeplearning approach in 2018 enabled a four-class machine classification system of the images to exceed human accuracy for the first time. Underpinning this was the creation of a labelled training set which came from a consortium of several different laboratories. The MARCO classification model does not have the same accuracy on local data as it does on images from the original test set; this can be somewhat mitigated by retraining the ML model and including local images. We have characterized the image data used in the original MARCO model, and performed extensive experiments to identify training settings most likely to enhance the local performance of a MARCO-dataset based ML classification model.
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Project description:BackgroundClinical experience teaches us that patients are willing to accept postoperative pain, despite high pain intensity scores. Nevertheless, relationships between pain scores and other methods of pain assessment, e.g. acceptability of pain or its interference with physical functioning, are not fully established. Our aims were to examine these relationships.MethodsA cross-sectional study was conducted on patients who underwent major surgery between January 2008 and August 2013. Using logistic regression, we quantified the relationships between movement-evoked pain scores on the numerical rating scale (NRS-MEP) and three dichotomous dependent variables: patient's opinion on acceptability of pain (PO: acceptable or unacceptable pain); nurses' observation of patient's performance of necessary activities to expedite recovery (NO: good or bad performance); a compound measure judging the presence of the clinically desirable situation of acceptable pain associated with good patients' performance (PONO: present or not). Using Receiver Operating Characteristics (ROC) analysis, NRS cut-off points were determined such that they best discriminate between patients having one versus the other outcome for PO, NO and PONO.Results15,394 assessments were obtained in 9,082 patients in the first three postoperative days. Nine percent of the patients had unacceptable pain while having an NRS-MEP of 0-4. An estimated 47% (95%CI = 45%-49%) of patients with an NRS-MEP of 7 described their pain as acceptable on day one. Moreover, 33% (31%-35%) performed all required physical activities, and 22% (21%-24%) combined acceptable pain with appropriate movement. NRS cut-off points for PO, NO and PONO were five, four and four, respectively, but had insufficient discriminatory power.ConclusionsOur results suggest pain management should be guided by the many dimensions of the patient's pain experience, not solely by NRS cut-off points. Future research should evaluate the impact of such multidimensional pain assessment on patients' functional outcome.
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Project description:Livestock predation is a global problem and constitutes the main source of conflict between large carnivores and human interests. In Latin America, both jaguar and puma are known to prey on livestock, yet studies in Mesoamerica have been scattered and few have been carried out in Honduras. We interviewed ranchers in a biosphere reserve where jaguars and pumas are present. Local indigenous communities reported livestock predation (average annual loss of 7% from 2010-2019), with preventive and retaliatory killing as their main actions against predation by the jaguar and puma. Other sources of cattle loss included diseases and theft. The extensive management system (free grazing) lets cattle access forests where predators are more common. We found that livestock predation is not random, but rather, related to landscape variables and human influence. Sites farther from human influence and closer to forest cover were more susceptible to predation. Jaguar and puma persistence in the biosphere reserve will require measures that facilitate human-carnivore coexistence and comply with Sustainable Development Goals (SDG) 2 and 15 (zero hunger and biodiversity conservation). We propose management practices to mitigate livestock predation in the presence of large carnivores based on examples of proven human-carnivore coexistence in Venezuela, Brazil, Paraguay, and Nicaragua, such as improving the spatial arrangement of livestock (maintaining a distance from forest areas) and the incorporation of confinement pens for young calves (at least the first three months of life) and their mothers. If the pens are built close to the property's house and have constant surveillance and/or dogs, the results are likely to be more effective. Deploying these proven tools may help change the current negative perception of ranchers towards large carnivores that is essential to conservation under the aims of SDG 15. We recommend government policies and support aimed to strengthen livestock health to increase productivity and to reduce their vulnerability to predation. Finally, this study represents a baseline to understand the magnitude of the human-carnivore conflict over cattle in one of the largest biosphere reserves in Mesoamerica.
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2022-08-18 | GSE208053 | GEO