Beierebbesen7209

Drug-induced QT prolongation is a potentially preventable cause of morbidity and mortality, however there are no widespread clinical tools utilized to predict which individuals are at greatest risk. Machine learning (ML) algorithms may provide a method for identifying these individuals, and could be automated to directly alert providers in real time.

This study applies ML techniques to electronic health record (EHR) data to identify an integrated risk-prediction model that can be deployed to predict risk of drug-induced QT prolongation.

We examined harmonized data from the UCHealth EHR and identified inpatients who had received a medication known to prolong the QT interval. Using a binary outcome of the development of a QTc interval >500 ms within 24 hours of medication initiation or no ECG with a QTc interval >500 ms, we compared multiple machine learning methods by classification accuracy and performed calibration and rescaling of the final model.

We identified 35,639 inpatients who received an novel EHRs and within the physician order entry system to assess the ability to improve patient safety.This case report discusses a cervical psammomatous melanotic schwannoma - a rare form of peripheral nerve sheath tumour - which may be highly vascular and is often associated with the Carney complex. Significant intraneural bleeding, which was encountered intraoperatively, was controlled successfully with a gelatine-based thrombin haemostatic agent (Floseal®, Baxter International, Deerfield, IL, USA) without complication.

Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees.

Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used.

The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Bardoxolone Accuracy within 1mm was achieved in one of seven cases.

Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.

Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.

Necrotising otitis externa (NOE) is a severe infection of the temporal bone. The traditional severity based staging system does not fully prognosticate all patients with NOE. We hypothesise that a patient response staging system would more accurately capture the disease process and guide prognosis.

We carried out a retrospective notes review of patients diagnosed with NOE from January 2017 to December 2018 in a regional tertiary referral centre. Patient outcomes from our proposed patient response staging system were compared to a modified previously published severity based Gleeson staging system with patients requiring prolonged treatment classified as having a poor outcome.

A total of 34 patients were treated for NOE. The majority were male (

=24) and had diabetes (

=25). Patients with the most severe Gleeson staging did not have the worst outcome. Daily delay in resolution of otorrhoea was associated with an increased need for more than six weeks of treatment. Rapid responders are patients who had uration of treatment and early diagnosis of potential fungal NOE.

Diagnostic reference levels are radiation dose levels in medical radiodiagnostic practices for typical examinations for groups of standard-sized individuals for broadly defined types of equipment. This study aimed to contribute to national diagnostic reference levels for common hand and wrist procedures using mini C-arm fluoroscopy. Small joint and digital fracture procedure diagnostic reference levels have not been reported in significant numbers previously with procedure-level stratification.

Data were collected from fluoroscopy logbooks and were cross-referenced against the audit log kept on fluoroscopy machines. A total of 603 procedures were included.

The median radiation dose for wrist fracture open fixation was 2.73 cGycm

, Kirschner wiring (K-wiring) procedures was 2.36 cGycm

, small joint arthrodesis was 1.20 cGycm

, small joint injections was 0.58 cGycm

, and phalangeal fracture fixation was 1.05 cGycm

.

Wrist fracture fixation used higher radiation doses than phalangeal fracture fixati. This study helps to define standards for this activity by adding to the data available for wrist fracture diagnostic reference levels and defining standards for digital and injection procedures.

Superior vena cava (SVC) syndrome (SVCS) is a life-threatening occurrence that necessitates prompt treatment. At present, endovascular stenting is proposed as a first-line treatment to relieve symptoms. We assessed the effectiveness, safety and outcome of SVC stent positioning in patients affected with advanced cancer.

Forty-two patients undergoing stent positioning in the SVC for neoplasms from January 2002 to December 2018 form the basis of this retrospective study. Demographic data, risk factors, associated diseases, symptoms at presentation according to the score proposed by Kishi and the type of SVCS according to Sanford and Doty were collected. Minor and major complications were recorded. Suspected stent occlusion was confirmed by means of recurrence of symptoms followed by a confirmatory computed tomography (CT).

Thirty-four (81%) patients had a nonresectable lung tumour invading or compressing the SVC. Five (12%) patients had a non-Hodgkin's lymphoma, and three (7%) had metastatic lymphadenopathies.