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- 저자 : Vignesh Narasimhan (검색결과 2 건)
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Blood Transfusions for Emergency Laparotomies in General Surgery
Vignesh Narasimhan,Robert Spychal,Charles Pilgrim 대한외상중환자외과학회 2017 Journal of Acute Care Surgery Vol.7 No.1
Purpose: Decisions regarding perioperative blood transfusions are subject to clinical and laboratory factors. Blood transfusions are associated with increased risk of infection, sepsis, organ failure, and length of stay. Current guidelines on transfusions are based on elective settings. There is a paucity of data on blood transfusion use in emergency surgery. This study reviews the appropriateness of blood transfusions in patients undergoing emergency general surgical laparotomies.Methods: Patients undergoing emergency general surgical laparotomies at Peninsula Health from January 2013 to May 2015 were reviewed. Hemoglobin (Hb) levels triggering transfusion and overall blood utilization were obtained. Transfusions were classified based on whether they were given pre-, intra- or postoperatively. Transfusions with Hb >80 g/L in the absence of bleeding or preoperative anemia were deemed ‘inappropriate’ as per Australian Blood Authority guidelines.Results: Over the 29-month period, 368 patients underwent 398 emergency laparotomies. Blood transfusions were given to 102 patients (27.7%). These patients required 240 transfusion episodes. Patients were given a median of three units of blood. One hundred and sixty-six transfusions (69.2%) were postoperative. Forty-six transfusions (19.2%) were given with Hb >80 g/L in the absence of other indications, and were deemed inappropriate. Inappropriate trans-fusions occurred more frequently on the ward compared to ICU (p<0.05). Almost two thirds of inappropriate transfusions were given for Hb 80∼85 g/L.Conclusion: Nearly one in five patients received an inappropriate transfusion. More judicious use of blood products in emergency patients is required, especially on surgical wards. (J Acute Care Surg 2017;7:15-22)
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Kim Kyongsong,Siddharth Narasimhan Aiyer,Vignesh Gunasekaran,Latha Mani,Sri Vijay Anand K. S.,Shanmuganathan Rajasekaran,Ajoy Prasad Shetty 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.3
Study Design: Prospective case series. Purpose: This study aimed to investigate the impact of education, financial income, occupation, and patient counseling on the timing of enrolment in a spinal cord injury (SCI) rehabilitation program. Overview of Literature: A rehabilitation program following SCI is essential to improve functional outcomes. Socioeconomic factors can affect the timing of enrolment to a rehabilitation program. Literature on the effects of socioeconomic factors among patients with SCI in the Indian scenario is limited. Methods: A prospective, consecutive analysis of patients with SCI was performed with 1-year follow-up. Assessment of the timing of enrolment to a rehabilitation program was performed using the modified Kuppuswamy socioeconomic scores (MKSS). Patients admitted to the SCI unit (group A), underwent intensive individual, group, and family counseling sessions to encourage early enrolment into a rehabilitation program. Patients presenting directly for rehabilitation (group B) were analyzed for comparison. Results: A total of 153 patients were recruited. Group A was composed of 122 patients who started the rehabilitation program after a mean of 28 days, compared with a mean of 149 days for 31 patients in group B. In group A, 104 patients (85%; mean MKSS, 14.02) and 18 patients (15%; mean MKSS, 15.61) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. In group B, 12 patients (39%; mean MKSS, 13.69) and 19 patients (61%; mean MKSS, 12.10) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. The total MKSS and scores for education, income, and occupation did not show a significant difference between the two both groups (p>0.05). Conclusions: Early patient counseling in the acute care unit helps in the early enrolment of patients with poor socioeconomic demographic profile to a rehabilitation program.
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