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Jean Neemeh - One of the best experts on this subject based on the ideXlab platform.

  • prevention of deep vein thrombosis after elective Hip Surgery
    Annals of Internal Medicine, 2020
    Co-Authors: Mark Levine, Jack Hirsh, Alexander G G Turpie, Richard M Jay, Peter Powers, Michael Gent, Jacques R Leclerc, Jean Neemeh
    Abstract:

    Objective: To determine the relative efficacy and safety of low molecular weight (LMW) heparin (Enoxaparin) compared with standard calcium heparin for the prevention of postoperative deep vein thro...

  • prevention of deep vein thrombosis after elective Hip Surgery a randomized trial comparing low molecular weight heparin with standard unfractionated heparin
    Annals of Internal Medicine, 1991
    Co-Authors: Mark Levine, Jack Hirsh, Alexander G G Turpie, Richard M Jay, Peter Powers, Michael Gent, Jacques R Leclerc, Jean Neemeh
    Abstract:

    OBJECTIVE To determine the relative efficacy and safety of low molecular weight (LMW) heparin (Enoxaparin) compared with standard calcium heparin for the prevention of postoperative deep vein thrombosis in patients undergoing elective Hip Surgery. DESIGN A double-blind, randomized, controlled trial. PATIENTS Six hundred sixty-five consecutive patients undergoing Hip replacement at five participating hospitals. INTERVENTIONS Patients received either fixed-dose LMW heparin, 30 mg subcutaneously twice daily, or fixed-dose standard calcium heparin, 7500 units subcutaneously twice daily; both regimens were started 12 to 24 hours after Surgery and continued for 14 days or until discharge if sooner. MEASUREMENTS All patients had postoperative I-125-fibrinogen leg scanning and impedance plethysmography. If results of one or both tests were positive, then venography was done. Otherwise, venography was done between day 10 and day 14, or sooner if the patient was ready for discharge. RESULTS Evaluable venograms were obtained in 258 of the 333 patients randomly assigned to receive LMW heparin and in 263 of the 332 patients assigned to receive calcium heparin. For patients with evaluable venograms, thrombosis was detected in 50 patients (19.4%) who received LMW heparin compared with 61 patients (23.2%) who received standard heparin (difference, -3.8%; 95% CI, -11.1% to 3.6%) (P greater than 0.2). Proximal deep vein thrombosis was detected in 5.4% of the patients receiving LMW heparin and in 6.5% of the patients receiving standard heparin (difference, -1.1%; CI, - 5.2% to 3.3%) (P greater than 0.2). For the entire group of 665 patients, venous thrombosis occurred in 17.1% given LMW heparin and in 19.0% given standard heparin. Hemorrhagic complications occurred in 31 patients (9.3%) given standard heparin and in 17 patients (5.1%) given LMW heparin (difference, 4.2%; CI, 0.3% to 8.2%) (P = 0.035). The relative risk reduction was 45%. The rate of major bleeding in the standard heparin group was 5.7% compared with 3.3% in the LMW heparin group (difference, 2.4%; CI, -1.0% to 5.4%) (P = 0.13). The relative risk reduction was 42%. CONCLUSION Low molecular weight heparin is significantly less hemorrhagic than standard unfractionated heparin; the difference in the rate of deep vein thrombosis, although not statistically significant (P greater than 0.2), favors the use of LMW heparin.

Kees J. Kalisvaart - One of the best experts on this subject based on the ideXlab platform.

  • Anesthesia and Postoperative Delirium in Older Adults Undergoing Hip Surgery
    Journal of the American Geriatrics Society, 2011
    Co-Authors: Chantal J. Slor, Jos F. M. De Jonghe, Ralph Vreeswijk, Erwin R. Groot, Tjeerd Van Der Ploeg, Willem A. Van Gool, Marc Snoeck, Piet Eikelenboom, Ben Schmand, Kees J. Kalisvaart
    Abstract:

    OBJECTIVES: To examine the effects of general anesthesia on the risk of incident postoperative delirium in older adults undergoing Hip Surgery. DESIGN: Secondary analysis of haloperidol prophylaxis for delirium clinical trial data. Predefined risk factors for delirium were assessed prior to Surgery. Primary outcome was postoperative delirium. Study outcome was compared across patient groups who received either general or regional anesthesia, and for individuals receiving various perioperative medications (benzodiazepines, anti-cholinergics, and opioids), using multivariable logistic regression after controlling for potential confounders. Subgroup analyses based on baseline cognitive impairment and delirium risk were also undertaken. SETTING: Large medical school-affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: Five hundred twenty-six adults aged 70 and older undergoing Hip Surgery. MEASUREMENTS: The primary outcome was the incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). RESULTS: Sixty participants (11.4%) had incident postoperative delirium. One hundred eighty-nine (35.9%) received general anesthesia, 18 (9.5%) of whom developed postoperative delirium, and 337 (64.1%) received regional anesthesia, 42 (12.5%) of whom developed postoperative delirium (adjusted odds ratio = 0.81, 95% confidence interval = 0.43-1.52, P=.51). Results were stratified for baseline cognitive impairment, age, acute admission, perioperative medication and other delirium risk factors. Delirium was not independently associated with specific drugs or the medication classes opioids, benzodiazepines, and anticholinergics. CONCLUSION: General anesthesia has no distinct effect on incident postoperative delirium in older adults undergoing Hip Surgery. This also holds for individuals suffering from cognitive impairment or who are otherwise at risk for postoperative delirium. Perioperative use of narcotics, benzodiazepines, and anticholinergic agents was not associated with incident delirium in this cohort of older adults undergoing Hip Surgery.

  • risk factors and prediction of postoperative delirium in elderly Hip Surgery patients implementation and validation of a medical risk factor model
    Journal of the American Geriatrics Society, 2006
    Co-Authors: Kees J. Kalisvaart, Jos F. M. De Jonghe, Ralph Vreeswijk, Tjeerd Van Der Ploeg, Willem A. Van Gool, Piet Eikelenboom
    Abstract:

    OBJECTIVES: To evaluate risk factors for postoperative delirium in a cohort of elderly Hip-Surgery patients and to validate a medical risk stratification model. DESIGN: Prospective cohort study. SETTING: Medical school‐affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: Six hundred three Hip-Surgery patients aged 70 and older screened forrisk factors forpostoperative delirium. MEASUREMENTS: Predefined risk factors for delirium were assessed on admission. One point was assigned for each of four risk factors present, resulting in three groups: low, intermediate, and high risk. Baseline screening and assessment included the Mini-Mental State Examination, the standardized Snellen test for visual impairment, chart review to determine Acute Physiological and Chronic Health Evaluation II score, and blood urea nitrogen to creatinine ratio. The primary outcome was postoperative delirium, as defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria. All patients were screened daily fordelirium. RESULTS: Incidence of delirium was 3.8% in the low-risk group (Po.001), 11.1% in the intermediate-risk group (P 5.27, relative risk (RR) 53.0), and 37.1% in the highrisk group (Po.001, RR 59.8). Cognitive impairment at admission hadthe highestpredictive valueforpostoperative delirium (coefficient of determination 50.15). Contrary to previous findings, age was an independent predictive factor for delirium. Moreover, postoperative delirium was four times as frequent in acute patients as in elective Hipreplacement patients. CONCLUSION: The medical risk factor model is valid for elderly Hip-Surgery patients. Cognitive impairment, age, and type of admission are important risk factors for delirium in this surgical population. J Am Geriatr Soc 54:817–822, 2006.

  • haloperidol prophylaxis for elderly Hip Surgery patients at risk for delirium a randomized placebo controlled study
    Journal of the American Geriatrics Society, 2005
    Co-Authors: Kees J. Kalisvaart, Jos F. M. De Jonghe, Ralph Vreeswijk, Marja J Bogaards, Bart J. Burger, Toine C.g. Egberts, Piet Eikelenboom, Willem A. Van Gool
    Abstract:

    OBJECTIVES: To study the effectiveness of haloperidol prophylaxis on incidence, severity, and duration of postoperative delirium in elderly Hip-Surgery patients at risk for delirium. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Large medical school–affiliated general hospital in Alkmaar, the Netherlands. PARTICIPANTS: A total of 430 Hip-Surgery patients aged 70 and older at risk for postoperative delirium. INTERVENTION: Haloperidol 1.5 mg/d or placebo was started preoperatively and continued for up to 3 days postoperatively. Proactive geriatric consultation was provided for all randomized patients. MEASUREMENTS: The primary outcome was the incidence of postoperative delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Confusion Assessment Method criteria). Secondary outcomes were the severity of delirium (Delirium Rating Scale, revised version-98 (DRS-R-98)), the duration of delirium, and the length of hospital stay. RESULTS: The overall incidence of postoperative delirium was 15.8%. The percentage of patients with postoperative delirium in the haloperidol and placebo treatment condition was 15.1% and 16.5%, respectively (relative risk 5 0.91, 95% confidence interval (CI) 5 0.6–1.3); the

Mine Solak - One of the best experts on this subject based on the ideXlab platform.

  • one operator s experience of ultrasound guided lumbar plexus block for paediatric Hip Surgery
    Journal of Clinical Monitoring and Computing, 2017
    Co-Authors: Yavuz Gürkan, Can Aksu, Alparslan Kuş, Kamil Toker, Mine Solak
    Abstract:

    Lumbar plexus block has been shown to be effective for providing postoperative analgesia after major Hip surgeries in children. The goal of the study was to evaluate the feasibility of ultrasound guidance during lumbar plexus block in children undergoing Hip Surgery for congenital Hip dislocation. After obtaining local institutional ethical committee approval and parental informed consent, ASA I or II, 1–6 years old children undergoing Hip Surgery were included into the study. Lumbar plexus block was performed after general anaesthesia using ultrasound guided Shamrock Method. Bupivacaine 0.25 % was used during block performance. Dose of the local anaesthetic was 1 ml/kg and the maximum dose was limited to 20 ml. In the postoperative period pain was assessed using modified CHEOPS (Children’s Hospital Eastern Ontario Pain Scale) pain score. If pain score in the postoperative period exceeded 3, patients received IV paracetamol 15 mg/kg−1. Morphine 0.1 mg/kg−1 IV was planned to administer if pain scores were still higher than 3 despite paracetamol treatment. 75 patients whose mean age was 47 months were enrolled into the study. All blocks were performed successfully and without complications. Mean time for the first analgesic is found as 10 h after Surgery. Only one patient required morphine in the recovery unit and 23 patients received paracetamol. US guided lumbar plexus block using Shamrock Method is an effective technique for providing postoperative analgesia after Hip surgeries in children and it’s effect lasts for 8–12 h after Surgery.

Mark Levine - One of the best experts on this subject based on the ideXlab platform.

  • prevention of deep vein thrombosis after elective Hip Surgery
    Annals of Internal Medicine, 2020
    Co-Authors: Mark Levine, Jack Hirsh, Alexander G G Turpie, Richard M Jay, Peter Powers, Michael Gent, Jacques R Leclerc, Jean Neemeh
    Abstract:

    Objective: To determine the relative efficacy and safety of low molecular weight (LMW) heparin (Enoxaparin) compared with standard calcium heparin for the prevention of postoperative deep vein thro...

  • prevention of deep vein thrombosis after elective Hip Surgery a randomized trial comparing low molecular weight heparin with standard unfractionated heparin
    Annals of Internal Medicine, 1991
    Co-Authors: Mark Levine, Jack Hirsh, Alexander G G Turpie, Richard M Jay, Peter Powers, Michael Gent, Jacques R Leclerc, Jean Neemeh
    Abstract:

    OBJECTIVE To determine the relative efficacy and safety of low molecular weight (LMW) heparin (Enoxaparin) compared with standard calcium heparin for the prevention of postoperative deep vein thrombosis in patients undergoing elective Hip Surgery. DESIGN A double-blind, randomized, controlled trial. PATIENTS Six hundred sixty-five consecutive patients undergoing Hip replacement at five participating hospitals. INTERVENTIONS Patients received either fixed-dose LMW heparin, 30 mg subcutaneously twice daily, or fixed-dose standard calcium heparin, 7500 units subcutaneously twice daily; both regimens were started 12 to 24 hours after Surgery and continued for 14 days or until discharge if sooner. MEASUREMENTS All patients had postoperative I-125-fibrinogen leg scanning and impedance plethysmography. If results of one or both tests were positive, then venography was done. Otherwise, venography was done between day 10 and day 14, or sooner if the patient was ready for discharge. RESULTS Evaluable venograms were obtained in 258 of the 333 patients randomly assigned to receive LMW heparin and in 263 of the 332 patients assigned to receive calcium heparin. For patients with evaluable venograms, thrombosis was detected in 50 patients (19.4%) who received LMW heparin compared with 61 patients (23.2%) who received standard heparin (difference, -3.8%; 95% CI, -11.1% to 3.6%) (P greater than 0.2). Proximal deep vein thrombosis was detected in 5.4% of the patients receiving LMW heparin and in 6.5% of the patients receiving standard heparin (difference, -1.1%; CI, - 5.2% to 3.3%) (P greater than 0.2). For the entire group of 665 patients, venous thrombosis occurred in 17.1% given LMW heparin and in 19.0% given standard heparin. Hemorrhagic complications occurred in 31 patients (9.3%) given standard heparin and in 17 patients (5.1%) given LMW heparin (difference, 4.2%; CI, 0.3% to 8.2%) (P = 0.035). The relative risk reduction was 45%. The rate of major bleeding in the standard heparin group was 5.7% compared with 3.3% in the LMW heparin group (difference, 2.4%; CI, -1.0% to 5.4%) (P = 0.13). The relative risk reduction was 42%. CONCLUSION Low molecular weight heparin is significantly less hemorrhagic than standard unfractionated heparin; the difference in the rate of deep vein thrombosis, although not statistically significant (P greater than 0.2), favors the use of LMW heparin.

Zdravko Gamulin - One of the best experts on this subject based on the ideXlab platform.