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- Feigin, VL, et al.
(författare)
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Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study
- 2015
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Ingår i: Neuroepidemiology. - : S. Karger AG. - 1423-0208 .- 0251-5350. ; 45:3, s. 161-176
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> Global stroke epidemiology is changing rapidly. Although age-standardized rates of stroke mortality have decreased worldwide in the past 2 decades, the absolute numbers of people who have a stroke every year, and live with the consequences of stroke or die from their stroke, are increasing. Regular updates on the current level of stroke burden are important for advancing our knowledge on stroke epidemiology and facilitate organization and planning of evidence-based stroke care. <b><i>Objectives:</i></b> This study aims to estimate incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke (IS) and hemorrhagic stroke (HS) for 188 countries from 1990 to 2013. <b><i>Methodology:</i></b> Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated using all available data on mortality and stroke incidence, prevalence and excess mortality. Statistical models and country-level covariate data were employed, and all rates were age-standardized to a global population. All estimates were produced with 95% uncertainty intervals (UIs). <b><i>Results:</i></b> In 2013, there were globally almost 25.7 million stroke survivors (71% with IS), 6.5 million deaths from stroke (51% died from IS), 113 million DALYs due to stroke (58% due to IS) and 10.3 million new strokes (67% IS). Over the 1990-2013 period, there was a significant increase in the absolute number of DALYs due to IS, and of deaths from IS and HS, survivors and incident events for both IS and HS. The preponderance of the burden of stroke continued to reside in developing countries, comprising 75.2% of deaths from stroke and 81.0% of stroke-related DALYs. Globally, the proportional contribution of stroke-related DALYs and deaths due to stroke compared to all diseases increased from 1990 (3.54% (95% UI 3.11-4.00) and 9.66% (95% UI 8.47-10.70), respectively) to 2013 (4.62% (95% UI 4.01-5.30) and 11.75% (95% UI 10.45-13.31), respectively), but there was a diverging trend in developed and developing countries with a significant increase in DALYs and deaths in developing countries, and no measurable change in the proportional contribution of DALYs and deaths from stroke in developed countries. <b><i>Conclusion:</i></b> Global stroke burden continues to increase globally. More efficient stroke prevention and management strategies are urgently needed to halt and eventually reverse the stroke pandemic, while universal access to organized stroke services should be a priority.
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- Abbott, T. E. F., et al.
(författare)
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The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis
- 2018
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Ingår i: British Journal of Anaesthesia. - : ELSEVIER SCI LTD. - 0007-0912 .- 1471-6771. ; 120:1, s. 146-155
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Forskningsöversikt (refereegranskat)abstract
- Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained amp;gt;= 1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32-0.77); Pamp;lt;0.01], but no difference in complication rates [OR 1.02 (0.88-1.19); P = 0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62-0.92); Pamp;lt;0.01; I-2 = 87%] and reduced complication rates [OR 0.73 (0.61-0.88); Pamp;lt;0.01; I-2 = 89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.
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- Prowle, John R., et al.
(författare)
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Postoperative acute kidney injury in adult non-cardiac surgery : joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative
- 2021
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Ingår i: Nature Reviews Nephrology. - : Springer Nature. - 1759-5061 .- 1759-507X. ; 17:9, s. 605-618
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Forskningsöversikt (refereegranskat)abstract
- The development of acute kidney injury (AKI) after major non-cardiac surgery is associated with substantial long-term morbidity and mortality. This joint Consensus Statement from the Acute Disease Quality Initiative and the PeriOperative Quality Initiative provides recommendations for the definition, prevention and management of postoperative AKI. Postoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.
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- Rice, A. M., et al.
(författare)
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Development and characterization of nine polymorphic microsatellite markers for Mexican spadefoot toads (Spea multiplicata) with cross-amplification in Plains spadefoot toads (S-bombifrons)
- 2008
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Ingår i: Molecular Ecology Resources. - : Wiley. - 1755-098X .- 1755-0998. ; 8:6, s. 1386-1389
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Tidskriftsartikel (refereegranskat)abstract
- We developed nine polymorphic microsatellite markers for the Mexican spadefoot toad, Spea multiplicata. Allele numbers range from five to 12, with observed heterozygosities from 0.48 to 0.87. Because two loci are in linkage disequilibrium, these nine loci provide eight independent markers. Three loci exhibit departure from Hardy-Weinberg equilibrium, possibly resulting from null alleles or population admixture. These markers will be useful for assessing population structure and relatedness in S. multiplicata. Based on our success at cross-amplification in the Plains spadefoot toad (Spea bombifrons), these loci also may be useful in this species with additional optimization.
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- Stafford, Joshua D., et al.
(författare)
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Spring migration of waterfowl in the northern hemisphere : a conservation perspective
- 2014
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Ingår i: Wildfowl. - 0954-6324 .- 2052-6458. ; :Special Issue 4, s. 70-85
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Tidskriftsartikel (refereegranskat)abstract
- Spring migration is a key part of the annual cycle for waterfowl populations in the northern hemisphere, due to its temporal proximity to the breeding season and because resources may be limited at one or more staging sites. Research based on field observations during spring lags behind other periods of the year, despite the potential for fitness consequences through diminished survival or cross-seasonal effects of conditions experienced during migration. Consequently, conservation strategies for waterfowl on spring migration are often only refined versions of practices used during autumn and winter. Here we discuss the current state of knowledge of habitat requirements for waterfowl at their spring migratory sites and the intrinsic and extrinsic factors that lead to variability in those requirements. The provision of plant foods has become the main conservation strategy during spring because of the birds’ energy requirements at this time, not only to fuel migration but to facilitate early clutch formation on arrival at the breeding grounds. Although energy sources are important to migrants, there is little evidence on the extent to which the availability of carbohydrate-based food is limiting for many migratory waterfowl populations. Such limitation is relatively unlikely among populations that exploit agricultural grain during migration (e.g. arctic-nesting geese), suggesting that conservation strategies for these populations may be misplaced. In general, however, we found few cases in which an ecological understanding of spring-migrating waterfowl was sufficient to indicate true resource limitation during migration, and still fewer cases where conservation efforts ameliorated these limitations. We propose a framework that aims to address knowledge gaps and apply empirical research results to conservation strategies based on documented limitations and associated fitness impacts on migrating waterfowl. Such a strategy would improve allocation of scarce conservation resources during spring migration and greatly improve ecological understanding of migratory waterfowl and their habitats in the northern hemisphere.
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- Stafford, Joshua D., et al.
(författare)
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Spring migration of waterfowl in the northern hemisphere : a conservation perspective
- 2014
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Ingår i: Wildfowl. - : Wildfowl and Wetlands Trust. - 0954-6324. ; :Special Issue 4, s. 70-85
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Tidskriftsartikel (refereegranskat)abstract
- Spring migration is a key part of the annual cycle for waterfowl populations in the northern hemisphere, due to its temporal proximity to the breeding season and because resources may be limited at one or more staging sites. Research based on field observations during spring lags behind other periods of the year, despite the potential for fitness consequences through diminished survival or cross-seasonal effects of conditions experienced during migration. Consequently, conservation strategies for waterfowl on spring migration are often only refined versions of practices used during autumn and winter. Here we discuss the current state of knowledge of habitat requirements for waterfowl at their spring migratory sites and the intrinsic and extrinsic factors that lead to variability in those requirements. The provision of plant foods has become the main conservation strategy during spring because of the birds’ energy requirements at this time, not only to fuel migration but to facilitate early clutch formation on arrival at the breeding grounds. Although energy sources are important to migrants, there is little evidence on the extent to which the availability of carbohydrate-based food is limiting for many migratory waterfowl populations. Such limitation is relatively unlikely among populations that exploit agricultural grain during migration (e.g. arctic-nesting geese), suggesting that conservation strategies for these populations may be misplaced. In general, however, we found few cases in which an ecological understanding of spring-migrating waterfowl was sufficient to indicate true resource limitation during migration, and still fewer cases where conservation efforts ameliorated these limitations. We propose a framework that aims to address knowledge gaps and apply empirical research results to conservation strategies based on documented limitations and associated fitness impacts on migrating waterfowl. Such a strategy would improve allocation of scarce conservation resources during spring migration and greatly improve ecological understanding of migratory waterfowl and their habitats in the northern hemisphere.
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