The impact of comorbidity on patient outcomes following an intervention has been largely ignored. No studies have been reported in the UK or Japan. The aim of this thesis was to assess the impact of comorbidity on the outcome of a common major surgical operation - total hip replacement. Comorbidity was measured using the Index of Co-Existent Disease developed in the USA, which reliability was assessed. Two retrospective cohorts, one in Japan and one in the UK were studied. Data were collected from patients' case notes extraction and by postal questionnaire to patients one year after surgery. After THR, patient's health status was improved in both countries and satisfaction for care was high. Significant differences in in-hospital complications were observed between Japan and the UK in terms of complication rate. type and severity, and their association with independent variables. Comorbidity was significantly associated with serious complications and with change in health status in the UK and with minor complications in Japan. A logistic regression model using the ICED and independent confounding factors suggested a significant relationship between comorbidity and complications. However, the model did not fit the data well. A multiple regression model for change in health status showed that much of the variance was explained by the preoperative health status but not by comorbidity. The low number of serious complications in Japan and the high complication rate in patients in the lowest comorbidity severity level in the UK made the predictive power weak. Finally, through the experience of this study, some recommendations for clinical practice and further research are discussed.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand , in partial fulfillment of the requirements for the degree of Master of Medicine, Johannesburg, 2013 / Postoperative nausea and vomiting (PONV) is a multifactorial, complex phenomenon that has been widely studied. Little work has been done in assessing the risk of PONV in South African population groups. The aim of the study was to compare the effect of racial background on the incidence of PONV in moderate to high-risk black versus non-black South African patients undergoing general anaesthesia. Methods A prospective, controlled observational study was carried out. After an initial power calculation, 82 patients in each group (164 in total) were required for the study. However, due to researcher availability, time constraints and a readjustment of the power calculation, 95 patients at moderate to high risk for PONV were enrolled onto the study over an extended study period of 20 months (initially the study period was planned to be 6 months). 89 patients fulfilling the inclusion criteria were divided according to race into two cohorts. Ondansetron and dexamethasone were used as PONV prophylaxis after induction of general anaesthesia. Propofol was used as the induction hypnotic with isoflurane to maintain anaesthesia. Nitrous oxide, ketamine and droperidol were avoided. Use of analgesics was unrestricted, but neuraxial and nerve plexus regional anaesthesia were avoided. If a non-depolarising neuromuscular blocking agent was used, a maximum of 2.5mg of neostigmine was given to reverse neuromuscular blockade. Nausea and vomiting were assessed by means of a visual analogue scale in the recovery room and ward. Time intervals to assess degree of PONV were 0 hours (defined by first assessment of a modified Aldrete recovery score of at least 9 out of 10 and Glasgow Coma Scale of at least 14/15), 15 minutes, 90 minutes, 180 minutes, and 24 hours. Reports of incidents of vomiting and complaints of nausea between interviews were obtained from patients through questioning. Results There were 59 black participants and 30 non-black participants. There were 17 males and 72 females. There were no differences in the black and non-black groups with regard to gender, past history of motion sickness, past history of post operative nausea and vomiting, ASA status, smoking and anaesthetic time (p>0.05). There was a significant difference in the distribution of surgical procedures in the black and non-black participants (Mann Whitney U test, p= 0.02), although this did not affect the final result. On univariate analysis there were significant correlations between black South African ethnicity and nausea at all time intervals and also vomiting. Using multivariate regression analysis, non-black South African ethnicity was identified as a risk factor for PONV. It was found that black South African patients were protected against postoperative nausea, with a RR of 0.41 (95% CI, 0.28-0.60). Conclusion In this study we found that black South African ethnicity reduced the risk of PONV as compared with non-black South African ethnicity. We found that non-black South Africans had a similar risk of PONV to that published in international literature and predicted by the Apfel score, whereas the risk of PONV in similar Apfel scored black South African patients was much lower.

Submitted in partial fulfilment of the requirements tor the degree of Master of Medicine (Anaesthesia) in the Department of Anaesthesla University of the Witwatersrand / This study investigated the postoperative management of hypothermia of intraoperative origin using a forced-air convective warming device. Hypothermia develops during the intraoperative period partly as a result of disordered thermoregulation induced by anaesthesia and partly because of the nature of the operational injury and the surgical environment. Both the hypothermic state and the consequences of physiological attempts to return the core temperature to normal, which take place during the postoperative period, are associated with non-beneficial effects. Attempts to prevent intraoperative decline in core temperature are a part of anaesthesia management. However, most of the traditional options available are inefficient or ineffective, particularly in adults. This study evaluated the performance of a new device, the forced-air convective warmer, in the management of the postoperative hypothermic state. Results showed that when compared to a hypothermic control group the device made a significant difference to the thermal state of a group of hypothermic postoperative patients but only if it was used for at least two hours postoperation. / Andrew Chakane 2018

Thesis (doctor of medicine)--Universitetet i Lund.

Thesis (doctor of medicine)--Universitetet i Lund.

by Li Wen. / "April 2000." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2000. / Includes bibliographical references (p. 200-236). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (M.Sc.). / Written for the Dept. of Epidemiology and Biostatistics. Title from title page of PDF (viewed 2008/05/14). Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1989.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 110-126).