These guidelines are intended to assist physicians and patients in the decision-making process regarding the management of LUTS/BPH, and support the process of continuous improvement of the quality of care and services to patients.
Objectives
To determine whether the Flemish version of the Triage Risk Screening Tool (fTRST) can be used to accurately assess frailty in an emergency setting.
Design
Prospective observational study.
Setting
of a tertiary referral hospital.
Patients
All individuals aged 70 and older consecutively admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 who met inclusion criteria (N=110).
Measurements
Individuals were screened with the fTRST and additional metrics such as the age‐adjusted Charlson Comorbidity Index and American Society of Anesthesiology score. Thirty‐ and 90‐day postoperative complications where recorded. Regression analyses were performed to identify possible preoperative predictors of adverse outcomes.
Results
Thirty‐day major complications (Clavien‐Dindo Classification 3–5) occurred in 28.2% of participants (n=31). fTRST had the highest correlation with major complications (odds ratio (OR) = 7.42). All participants who died within 30 days of surgery has a fTRST score of 2 or greater (area under the receiver operating curve (AUC)=71.3). When risk factors for overall 90‐day mortality were analyzed, a fTRST score of 2 or greater had sensitivity of 96% (95% confidence interval CI=79.6–99.9%), specificity of 43.5% (95% CI=32.8–54.7%) (AUC=69.8%; OR=18.50, 95% CI=2.39–143.11, p = .005). The average length of hospital stay was more than twice as long in the group with a fTRST score of 2 or greater (15.2 days) than in those with a score less than 2 (6.6 days) (p = .005).
Conclusion
The fTRST is an effective tool to predict mortality, morbidity, and length of stay after emergency surgery and can therefore be used to anticipate postoperative course, determine care goals, and plan for involvement of a dedicated geriatric care team. J Am Geriatr Soc 67:309–316, 2019.
The aim was to look at the effect of sulodexide in diabetic and non-diabetic patients with peripheral occlusive arterial disease (POAD), by verifying, through meta-analysis of Italian data, if the drug affects the clinical course of claudication or the main risk factors for POAD. Sulodexide increases the pain-free walking distance (benefit 36% vs controls, P < 0.001). The meta-analysis confirmed the effectiveness of sulodexide in improving claudication (lower limit of the 95% CI for overall odds ratio always > 1). There was a marked effect in lowering triglycerides (overall -28%, P = 0.0015), fibrinogen (-13%, P < 0.0001) and plasma and serum viscosities, and in increasing high-density-lipoprotein cholesterol (24.4%, P = 0.0007). The medium-term administration of sulodexide has a therapeutic effect on claudication of diabetic and/or hyperlipidaemic patients suffering from POAD stages- and also counteracts several POAD risk factors. Long-term use of sulodexide appears to be well tolerated. The treatment has a low daily cost; therefore, it has a favourable cost-benefit ratio, in view of the high general costs associated with global POAD care, particularly in diabetic patients.
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