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Annually, 15% of patients who receive oral anticoagulation require interruption for surgery or an invasive procedure. This study evaluates the adherence of patients with atrial fibrillation with a history of stroke or transient ischemic attack to the Thrombosis Canada Perioperative guidelines for the discontinuation and reinitiation of anticoagulation treatment.
We collected data from a prospective patient survey at the Stroke Prevention Clinic in the University of Alberta hospital. Patients' charts were reviewed from the electronic medical records, and adherence was looked at according to the Thrombosis Canada Perioperative guidelines for the interruption of anticoagulants.
During the study period (2016-2019), there were 509 patients surveyed. Anticoagulation treatment was interrupted in 150 patients with 98 interrupted for surgical or invasive procedures. The interruption was adherent to guidelines in only 29 (29.6%) of patients and inappropriate or nonadherent in 69 (70.4%) patients. There were seven ischemic strokes recorded during the period of interruption. The proportion of strokes was higher in patients whose anticoagulation interruption was longer than what the guidelines recommended (6/61 or 9.8%) when compared to those who adhered to recommended perioperative anticoagulation guidelines (1/29 or 3.4%).
Our results indicate that significant discrepancy with following the recommended perioperative anticoagulation guidelines is common in real-life practice. Delay in re-anticoagulation may increase the risk of complications.
Our results indicate that significant discrepancy with following the recommended perioperative anticoagulation guidelines is common in real-life practice. Delay in re-anticoagulation may increase the risk of complications.
Many capital cities around the world have been subjected to terrorist attacks on their transport systems with devastating consequences. Large crowds in small enclosed spaces, disruption to people movement, and the psychosocial and financial repercussions of attacks are some of the many soft target vulnerabilities of mass-transit systems.This study is an epidemiological examination of all terrorism-related events targeting air, sea, and ground transport modalities sustained from 1970-2019, comparing the rates of fatal injuries (FI) and non-fatal injuries (NFI).
The Global Terrorism Database (GTD) was downloaded and searched using the internal database search functions for all events that occurred from January 1, 1970 - December 31, 2019. Years 2020 and 2021 were not yet available at the time of the study. "Transportation," "Airport and Aircraft," and "Maritime" as primary target types were selected for the purpose of this study, and events were further sub-classified by region, weapon type used, and by suicide attacks on subways represent a unique and significantly higher casualty risk than other transport modalities. Risk mitigation strategies should be regularly revisited by Counter-Terrorism Medicine (CTM) specialists.
Transport modalities are vulnerable terrorist soft targets. The repercussions of attacks on public transport modalities represent a significant and unique psychosocial and economical risk to the affected communities. Suicide attacks on subways represent a unique and significantly higher casualty risk than other transport modalities. Risk mitigation strategies should be regularly revisited by Counter-Terrorism Medicine (CTM) specialists.
Anxiety before an invasive intervention is associated in children with persistent psychological disorders. We studied the effect of the transfer to the catheterisation room by an electric toy car on the anxiety of children and their parents before a cardiac catheterisation.
Forty-eight children with a median age of 5.6 years [4.2-7.0] were randomised to either riding on an electric car to go to the catheterisation laboratory or being transported lying supine on a gurney. Anxiety assessments were performed by a physician blinded to group allocation on the day before the procedure (T0) and at anaesthesia induction (T1). The modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) and visual analogue scale for anxiety (VAS-A) were used in the children and the VAS-A in the parents.
The mYPAS-SF, VAS-A-child, and the VAS-A-parent scores were significantly higher at T1 than at T0 (p < 0.001, p < 0.001, and p = 0.005, respectively). The primary outcome (the median mYPAS-SF score at T1) was not significantly different in the two groups when males and females were combined. At T1, the VAS-A-child score, however, was significantly lower in the intervention than the control group (22 versus 55, p < 0.001). In the boys, the median mYPAS-SF score at T1 was significantly lower in the intervention group (25.0 versus 51.0, p = 0.024). No difference was observed in girls. The VAS-A parent score was lower at T1 in the intervention group (60 versus 87, p = 0.05).
Riding to the catheterisation laboratory on an electric toy car decreased anxiety in boys and decreased parental anxiety.
Riding to the catheterisation laboratory on an electric toy car decreased anxiety in boys and decreased parental anxiety.
To determine the 180-day cumulative incidence of culture-confirmed Staphylococcus aureus infections after elective pediatric surgeries.
Retrospective cohort study utilizing the Premier Healthcare database (PHD).
Inpatient and hospital-based outpatient elective surgical discharges.
Pediatric patients <18 years who underwent surgery during elective admissions between July 1, 2010, and June 30, 2015, at any of 181 PHD hospitals reporting microbiology results.
In total, 74 surgical categories were defined using ICD-9-CM and CPT procedure codes. Microbiology results and ICD-9-CM diagnosis codes defined S. aureus infection types bloodstream infection (BSI), surgical site infection (SSI), and other types (urinary tract, respiratory, and all other). Cumulative postsurgical infection incidence was calculated as the number of infections divided by the number of discharges with qualifying elective surgeries.
Among 11,874 inpatient surgical discharges, 180-day S. aureus infection incidence was 1.79% overalildren. These results underscore the need for continued infection prevention efforts and longer-term surveillance after surgery.Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent-child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Triparanol concentration Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided.
To document perfluoroalkyl acids (PFAAs) and bisphenol-A (BPA) exposure in four First Nation communities in northern Quebec compared to the Canadian Health Measures Survey (CHMS Cycle 5 2016-2017) and examine the associations between dietary consumption and chemical exposure.
We used cross-sectional data from the JES-YEH! project conducted in collaboration with four First Nation communities in 2015. A food frequency questionnaire collected information on diet, and PFAAs and BPA were measured in biological samples. We used generalized linear models to test the associations between food intake and chemical biomarkers.
Northern Quebec.
Youth aged 3-19years (n=198).
Mean PFNA levels were significantly higher in JES-YEH! than CHMS and BPA levels were higher among those aged 12-19years compared to CHMS. Dairy products were associated with PFNA among Anishinabe and Innu participants [geometric mean ratio (GMR) 95% confidence intervals (95% CI) 1.53 (1.03-2.29) and 1.52 (1.05-2.20), respectively]. PFNA was ood environments for youth in Indigenous communities and beyond.Serenity Integrated Monitoring (SIM) involved the police and mental health crisis services working in a single team, developing case management plans that allowed a seamless move from offers of therapeutic engagement (by the mental health team) to use of coercive measures (by the police) with those who persisted with frequent crisis presentations. Withdrawn after widespread criticism, the scheme raises important questions - about the practice of mental health professionals who are involved in decisions about using criminal sanctions for people presenting in crisis, about the ethical and legal status of the sharing of confidential clinical information with the police, and about the processes that professional bodies use in promoting, monitoring and responding to controversial service developments.
To investigate clustering of risk behaviours in adolescents with excess weight.
Cross-sectional analysis of baseline data from the PRALIMAP- INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and week-end days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographical data were collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression.
French PRALIMAP-INÈS trial.
Adolescents with excess weight.
A total of 1391 participants (13-18 years old, 58.2% female) were included in the analysis, which resulted in the identification of four groups of participants, including respectively 543 (39.0%), 373 (26.8%), 246 (17.7%) and 229 (16.5%) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership.
Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.
Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.
