Among older patients, frailty and cognitive impairment before surgery are associated with developing complications after surgery, but age is not, a new study suggests.
In addition to frailty, depressive symptoms and smoking were also associated with developing postoperative complications following elective surgery, according to the systematic review.
Researchers at St. Michael’s Hospital also found that a patient’s American Society of Anesthesiologists status, which evaluates the physical health of a patient before surgery and is traditionally assessed as a risk factor for postoperative complications, was not associated with postoperative complications in older patients.
“The fact that age and ASA status were not risk factors for postoperative complications is somewhat surprising, because these are the factors a clinician would typically look at when assessing a patient’s risk of developing complications after surgery,” said Dr. Jennifer Watt, lead author of the study.
The review examined 44 existing studies including more than 12,000 patients 60 years and older and reporting on postoperative outcomes including complications, postoperative mortality, length of hospitalization, functional decline and whether patients were discharged home or to another hospital or long-term care facility.
Due to significant differences in the design and reporting methods of the included studies, the authors were unable to report on the level of risk for specific postoperative complications, or their severity.
The researchers found that across all studies, 25 per cent of older patients experienced some complications following elective surgery.
“Older adults are a diverse group of patients whose risk of postoperative complications is not solely defined by their age, comorbidities or the type of surgical procedure they receive,” said Dr. Watt. “This study highlights how common postoperative complications are among older adults undergoing elective surgery, and the importance of geriatric syndromes, including frailty, in identifying older adults who may be at risk.”
The review did not examine why frailty was associated with negative outcomes following surgery, but the authors hypothesize that frailty and not older age was associated with postoperative complications because frailty represents a patient’s biological age as opposed to their chronological age.
The authors also noted that there are proven interventions for a number of the risk factors identified in the review. Interventions aimed at improving a patient’s nutrition, physical fitness and cognition have been found to improve frailty in older patients, and smoking cessation interventions before surgery have been associated with a lower risk of postoperative complications, according to the review.
St. Michael’s Hospitalwww.stmichaelshospital.com/media/detail.php?source=hospital_news/2018/0112

Partnership will allow hospitals easier access to integrated suites of diagnostic imaging modalities, advanced informatics and services for comprehensive breast screening and diagnosis

Royal Philips and Hologic, Inc. announced on March 2^nd a global partnership agreement to offer care professionals integrated solutions comprising diagnostic imaging modalities, advanced informatics and services for screening, diagnosis and treatment of women across the world. The collaboration combines Hologic’s innovative mammography technologies and Philips’ leading portfolio of ultrasound, MRI, CT, and X-ray systems, advanced informatics and broad range of services, including maintenance, upgrade, training and operational performance management services.

“No two women are alike, and we are teaming up with care providers and leading industry partners to support the delivery of a tailored, seamless breast care experience for women,” said said Rob Cascella, CEO Diagnosis & Treatment businesses for Royal Philips. “That is why I am very pleased to announce our new partnership with Hologic for mammography. This partnership allows us to offer a complete set of innovative diagnostic imaging systems, software and services to our customers, including Hologic’s market-leading mammography solutions for breast screening and diagnosis of women in need of care.”

“Hologic believes in enabling doctors with superior technology that improves women’s health through early detection and treatment,” said Pete Valenti, Hologic’s Division President, Breast and Skeletal Health Solutions. “Our market-leading mammography solutions perfectly complement Philips’ portfolio, making Hologic the right industry partner for this first-of-its-kind collaboration. Now, through the partnership, Hologic can join Philips when engaging with customers on projects that were not previously possible for the two companies alone. It’s a win for everyone involved, including the customers and patients we serve.”

In breast care, Philips offers advanced imaging for ultrasound (e.g. Philips Affinity with Anatomical Intelligence for Breast), MRI (e.g. Philips Ingenia digital MRI with Compressed SENSE to speed up exam times), and PET/CT (e.g. Philips Vereos fully digital PET/CT), supported by intelligent image analysis, quantification, information management and workflow tools. Under the agreement, Philips will be able to offer select products from Hologic’s breast health portfolio as part of multi-modality deals for hospitals and health systems. This will include Hologic’s new 3DimensionsÔ mammography system, the fastest, highest resolution breast tomosynthesis system in the industry, as well as other technologies for breast screening and interventional radiology [1,2].

The multi-year, non-exclusive global partnership agreement allows for customized regional implementation to best meet the individual needs of each customer. The financial details of the agreement were not disclosed.

To learn more about the 3Dimensions system and its comprehensive range of features, which are compatible with all Hologic 3D Mammography^TM systems, visit 3DimensionsSystem.com. Hologic featured its full breast health portfolio, including the new 3Dimensions system, at the 2018 European Congress of Radiology (ECR) in Vienna.

Philips also showcased its full suite of solutions for diagnosis and treatment at ECR 2018. For more information about Philips’ presence at ECR 2018, including its virtual reality MR experience, visit www.philips.com/ecr.
^{[1]           Hologic Data on file
[2]           Pending FDA approval and/or commercial availability}

Entry submissions for the 2019 International Hospital Federation Awards is now open. Hospitals and health service providers can nominate their outstanding and innovative projects and programs for a chance to be recognized internationally in one of the four awards.
The IHF/Dr Kwang Tae Kim Grand Award is open only to IHF Full and Associate Members and their members. This recognizes excellence and achievements at health system or facility level in multiple areas including quality and patient safety, corporate social responsibility, innovations in service delivery at affordable costs, and healthcare leadership and management practices.
The Excellence Awards are open to both IHF Member and non-member public and private healthcare providers.
The IHF/Bionexo Excellence Award for Corporate Social Responsibility is for excellent projects that provide quality healthcare services at affordable costs, promote volunteer contribution to community care, uphold sustainable environment, energy and green initiatives, reduce inequalities in healthcare service delivery to the community and advance healthcare for emerging and developing nations.
The IHF/EOH Excellence Award for Leadership and Management in Healthcare recognizes outstanding projects that enhance governance, leadership, management policies and practices, foster new culture of service, effectively manage finance and resources, and for major breakthroughs in productivity improvements or innovations in healthcare delivery or process management.
The IHF/Austco Excellence Award for Quality & Safety and Patient-centered Care recognizes exceptional programs that promote quality and safety, enhances patient education, engagement and empowerment, and promote ethical approaches and evidence-based practices.
Winning an IHF Award is a prestigious accolade in the industry and all public and private healthcare service providers are encouraged to join. Submitting an entry is the first step in an extensive process to determine this year’s award winners, who will be announced at the Awards Ceremony during the 43rd World Hospital Congress in Muscat, Oman on 6-9 November.
Entries can be submitted online through the IHF Awards submission website: https://congress.ihf-fih.org/ihf_awardsDeadline of entries is on 17 May 2019.
 https://worldhospitalcongress.org/

Researchers at Okayama University report in The Journal of Vascular Access a supporting device for accurately placing hemodialysis catheters on kidney patients.  The device was successfully used on a group of 10 patients and is expected to become an essential tool in situations where other, catheter-free hemodialysis approaches are not possible.
Patients with improperly functioning kidneys often need to undergo hemodialysis — the procedure of purifying blood in an artificial kidney outside the body — on a regular basis.  Hemodialysis requires access to blood vessels, for the collection of blood and its re-introduction after purification.  In this context, vascular access is commonly achieved with a so-called tunneled cuffed catheter (TCC).  Accurate TCC placement is important; incorrect positioning can lead to blood clots and induce central vein thrombosis.  Assistant Professor Toshiaki Ohara from Okayama University and colleagues have now developed a device enabling accurate TCC placement.  The researchers’ insertion support device accommodates for individual body shape differences and is expected to decrease the rate of TCC replacements — typically ranging between 8.9% and 56%.
The device was made from a material called expanded polytetrafluoroethylene (ePTFE), having the property of maintained plasticity.  It can be described as a bendable ribbon with holes (eyelets) spaced 1 cm apart; the holes allow making markings on the patient’s body with a felt-tip pen.
The insertion support device was tested on 10 Japanese adult hemodialysis patients (6 men and 4 women with a mean age of 71.3 years) treated at Shigei Medical Research Hospital.  Placement of the device on the body took place with the help of X-ray imaging: the tip of the device, for marking the TCC entry site, was laid so that it overlaps with the right heart border.  With the help of the markings made on the patient’s body, the physician could insert the TCC within an error of about 1 cm.  The patients were observed for 2 months, during which there was no catheter replacement needed.
The device of Dr.Ohara and colleagues helps to reduce catheter waste and the overall cost of hemodialysis.  In addition, as the attachment of a catheter requires exposure to X-rays, it reduces accumulated radiation doses for both patients and physicians.  Although the study was only carried out for 10 patients in a short observation period, the scientists “anticipate that this new device … can be used for catheter intervention in many fields”.

Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. A team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional X-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analysed the locomotory system of a velvet worm.
During a CT analysis, the object under investigation is X-rayed and a detector measures the respective amount of radiation absorbed from various angles. Three-dimensional images of the inside of the object can be constructed based on several such measurements. Up until now, however, the technology reached its limits when it came to objects as small as the tiny, 0.4 millimeter long legs of the velvet worm (Onychophora).
High-resolution images of this magnitude required radiation from particle accelerators, yet there are only a few dozen such facilities in Europe. Approaches suitable for the typical laboratory still had to struggle with low resolutions, or the samples investigated had to be made of certain materials and could not exceed a certain size. The reason was often the use of X-ray optics. Put simply, X-ray optics focus X-ray radiation similar to the way optical lenses focus light – but they also have several limitations.
The TUM Nano-CT system is based on a newly developed X-ray source, which generates a particularly focused beam, without relying on X-ray optics. In combination with an extremely low-noise detector, the device produces images that approach the resolution possible with a scanning electron microscope, while also capturing structures under the surface of the object under investigation.
“Our system has decisive advantages compared to CTs using X-ray optics,” says TUM scientist Mark Müller, lead author of the PNAS article. “We can make tomographies of significantly larger samples and we are more flexible in terms of the materials that can be investigated.”
Like so many other imaging instruments, the Nano-CT system was developed and installed at the Munich School of BioEngineering (MSB). This TUM interdisciplinary research centre is Europe’s thematically most comprehensive university facility for the intersection of medicine, engineering sciences and natural sciences. “Our goal in the development of the Nano-CT system is not only to be able to investigate biological samples, such as the leg of the velvet worm,” says Franz Pfeiffer, TUM Professor for Biomedical Physics, Director of the MSB, and a Fellow at the TUM Institute for Advanced Study (TUM-IAS).
“In the future, this technology will also make biomedical investigations possible. Thus, for example, we will be able to examine tissue samples to clarify whether or not a tumour is malignant. A non-destructive and three-dimensional image of the tissue with a resolution like that of the Nano-CT can also provide new insights into the microscopic development of widespread illnesses such as cancer.”

TUMhttps://tinyurl.com/y9x4jycu