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Loomba RS, Dyamenahalli U, Savorgnan F, Acosta S, Elhoff JJ, Farias JS, Villarreal E, Flores S. The effect of clinical and haemodynamic variables on post-operative length of stay immediately upon admission after biventricular repair with Yasui operation following an earlier Norwood operation. Cardiol Young 2023; 33:2066-2071. [PMID: 36537282 DOI: 10.1017/s1047951122003948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are a variety of approaches to biventricular repair in neonates and infants with adequately sized ventricles and left-sided obstruction in the presence of a ventricular septal defect. Those who undergo this in a staged manner initially undergo a Norwood procedure followed by a ventricular septal defect closure such that the neo-aorta is entirely committed to the left ventricle and placement of a right ventricular to pulmonary artery conduit (Yasui operation). This study aimed to determine clinical and haemodynamic factors upon paediatric cardiac ICU admission immediately after the two-stage Yasui operation that was associated with post-operative length of stay. METHODS This was a retrospective review of patients who underwent the Yasui procedure after the initial Norwood operation between 1 January 2011 and 31 December 2020. Patients with complete data on admission were identified and analysed using Bayesian regression analysis. RESULTS A total of 15 patients were included. The median age was 9.0 months and post-operative length of stay was 6days. Bayesian regression analysis demonstrated that age, weight, heart rate, mean arterial blood pressure, central venous pressure, pulse oximetry, cerebral near infrared spectroscopy, renal near infrared spectroscopy, pH, pCO2, ionised calcium, and serum lactate were all associated with post-operative length of stay. CONCLUSION Discrete clinical and haemodynamic factors upon paediatric cardiac ICU admission after staged Yasui completion are associated with post-operative length of stay. Clinical target ranges can be developed and seem consistent with the notion that greater systemic oxygen delivery is associated with lower post-operative length of stay.
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Affiliation(s)
- Rohit S Loomba
- Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Umesh Dyamenahalli
- Division of Pediatric Cardiology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Fabio Savorgnan
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sebastian Acosta
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Justin J Elhoff
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Saul Flores
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Fawi HMT, Papastergiou P, Khan F, Hart A, Coleman NP. Use of monofilament sutures and triclosan coating to protect against surgical site infections in spinal surgery: a laboratory-based study. Eur J Orthop Surg Traumatol 2023; 33:3051-3058. [PMID: 37000241 PMCID: PMC10504140 DOI: 10.1007/s00590-023-03534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE We investigated bacterial propagation through multifilament, monofilament sutures and whether sutures coated with triclosan would exhibit a different phenomenon. METHODS One centimetre (cm) wide trenches were cut in the middle of Columbia blood Agar plates. We tested a 6 cm length of two Triclosan-coated (PDS plus®, Vicryl plus®) and two uncoated (PDS ®, Vicryl ®) sutures. Each suture was inoculated with a bacterial suspension containing methicillin-sensitive Staphylococcus aureus (MSSA), Escherichia coli (E. coli), Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA) at one end of each suture. The plates were incubated at 36C for 48 h, followed by room temperature for a further 5 days. We established bacterial propagation by observing for any bacterial growth on the Agar on the opposite side of the trench. RESULTS Bacterial propagation was observed on the opposite side of the trench with both suture types, monofilament PDS and multifilament Vicryl, when tested with the motile bacterium (E. coli). Propagation was not observed on the other side of the trench with the monofilament PDS suture following incubation with MSSA and S. epidermidis, and in 66% of MRSA. With multifilament suture Vicryl, propagation was observed on the other side of the trench in 90% (MSSA), 80% (S. epidermidis), and 100% (MRSA) of plates tested. No bacterial propagation was observed in any of the triclosan-coated sutures (monofilament or multifilament). CONCLUSIONS Monofilament sutures are associated in vitro with less bacterial propagation along their course when compared to multifilament sutures. Inhibition in both sutures can be further enhanced with a triclosan coating.
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Affiliation(s)
- H M T Fawi
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital NHS Trust, Kings Lynn, UK.
- School of Public Health, Imperial College London, London, UK.
| | - P Papastergiou
- Microbiology Department, Limassol General Hospital, Kato Polemidia, Cyprus
- Microbiology Department, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - F Khan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - A Hart
- Microbiology Department, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
| | - N P Coleman
- Trauma and Orthopaedics Department, Queen Elizabeth Hospital NHS Trust, Kings Lynn, UK
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Schlauch AM, Shah I, Caicedo M, Raji OR, Farrell B. Missing the first post-operative visit is an independent risk factor for 90-day complication and re-admission following hip fracture surgery. J Orthop 2023; 36:7-10. [PMID: 36578975 PMCID: PMC9791690 DOI: 10.1016/j.jor.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Knowing the risk factors for poor outcomes following hip fracture surgery is necessary for appropriate patient care. The objective of this study was to determine if the first post-operative visit (POV) following hip fracture surgery is a risk factor for increased mortality, complications, and re-admissions. Methods This was a retrospective review of 285 patients who underwent operative fixation of a hip fracture at an academic acute care hospital. Outcome measurements were 90-day and one year mortality, 90-day complications, and 90-day re-admission rates in patients who missed or attended their first post-operative visit following hip fracture surgery. Results 279 patients met inclusion criteria and had sufficient data for analysis, of which 213 (76.3%) made their first post-operative visit. 90-day and one-year mortality were significantly higher in the patients who missed their first POV (31.8% vs. 4.2%; 51.5% vs. 12.7%). Independent risk factors for 90-day complications were missing the first POV, coronary artery disease, and lower pre-injury status (ORs = 10.65, 2.80, 7.89, respectively). Independent risk factors for 90-day re-admission were missing the first POV, chronic obstructive pulmonary disease on home oxygen, and lower re-injury status (ORs = 8.04, 5.44, 5.47, respectively). Conclusion Missing the first POV was the strongest independent risk factor for 90-day complications and 90-day readmission. Patients who miss their first POV have significantly higher 90-day and one year mortality rates.
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Affiliation(s)
- Adam Michael Schlauch
- San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA
| | - Ishan Shah
- San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA
| | - Maria Caicedo
- The Taylor Collaboration, 2255 Hayes St, San Francisco, CA, 94117, USA
| | | | - Brian Farrell
- Kaiser Permanente, 3600 Broadway, Oakland, CA, 94611, USA
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Lopezosa-Reca E, Martínez-Nova A, Sánchez-Rodríguez R, Gijon-Nogueron G, Marchena-Rodriguez A, Martinez-Rico M, Alabau-Dasi R. Effectiveness of hyaluronic acid in post-surgical cures following partial matricectomies with the phenol/alcohol technique: A randomized clinical trial. J Tissue Viability 2023; 32:59-62. [PMID: 36725463 DOI: 10.1016/j.jtv.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-operative cures with hyaluronic acid (HA) could potentially shorten the period recovery involved in the phenol technique for ingrown toenail. The aim of this study was therefore to compare a standard healing protocol with the experimental one based on hyaluronic acid cream. MATERIAL AND METHODS 70 patients who had undergone phenol technique surgery for ingrown toenail were divided into two groups - control (n = 35) who received post-operative cures following the standard protocol with povidone iodine gel, and experimental (n = 35) who received cures with HA in the first 3 visits. Bleeding, total healing time, and perceived pain were assessed. RESULTS Patients in the control group recovered from the intervention in a total of 26.17 ± 7.75 days, while those in the HA group recovered in a significantly shorter time - 22.42 ± 2.41 days (p = 0.007, effect size 0.653). However, there were no between-group statistical differences in bleeding or perceived pain over the course of the post-surgery visits. CONCLUSIONS The use of low molecular weight hyaluronic acid is effective in reducing the phenol-technique healing time by 4 days compared with the standard cure. However, no extra effects such as reductions in bleeding or perceived pain can be expected in choosing this healing protocol.
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Affiliation(s)
| | | | | | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Universidad de Málaga, Spain; Instituto de Investigación Biomédica de Málaga IBIMA, Spain
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Gross K, Georgeades C, Farazi M, Calaway L, Gourlay D, Van Arendonk KJ. Utilization and Adequacy of Telemedicine for Outpatient Pediatric Surgical Care. J Surg Res 2022; 278:179-189. [PMID: 35605570 PMCID: PMC9121887 DOI: 10.1016/j.jss.2022.04.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/25/2022] [Accepted: 04/08/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Telemedicine (TM) use accelerated out of necessity during the COVID-19 pandemic, but the utility of TM within the pediatric surgery population is unclear. This study measured utilization, adequacy, and disparities in uptake of TM in pediatric surgery during the COVID-19 pandemic. METHODS Scheduled outpatient pediatric surgery clinic encounters at a large academic children's hospital from January 2020 through March 2021 were reviewed. Sub-group analysis examined post-operative (PO) visits after appendectomy and umbilical, epigastric, and inguinal hernia repairs. RESULTS Of 9149 scheduled visits, 87.9% were in-person and 12.1% were TM. TM visits were scheduled for PO care (76.9%), new consultations (7.1%), and established patients (16.0%). Although TM visits were more frequently canceled or no shows (P < 0.001), most canceled TM visits were PO visits, of which 41.7% were canceled via electronic communication reporting the absence of any PO concerns. TM visits were adequate for accomplishing visit goals in 98.2%, 95.5%, and 96.2% of PO, new, and established patient visits, respectively. Patients utilizing TM visits were more frequently of white race, privately-insured, from less disadvantaged neighborhoods, and living a greater distance from clinic (P < 0.001 for all comparisons). CONCLUSIONS TM was adequate for the majority of visits in which it was utilized, including the basic PO visits that occurred via TM. TM was used more by patients with greater travel and less by those of minority race, with public insurance, and from more disadvantaged neighborhoods. Future work is necessary to ensure broad access to this useful tool for all children requiring surgical care.
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Affiliation(s)
- Kendall Gross
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Manzur Farazi
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lynn Calaway
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David Gourlay
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyle J Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin.
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Belete KG, Ashagrie HE, Workie MM, Ahmed SA. Prevalence and factors associated with thirst among postsurgical patients at University of Gondar comprehensive specialized hospital. Institution-based cross-sectional study. J Patient Rep Outcomes 2022; 6:69. [PMID: 35716262 PMCID: PMC9206692 DOI: 10.1186/s41687-022-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Thirst is a powerfully distressing sensation that occurs most frequently in the immediate postoperative period. Postoperative thirst is prevalent, the moderate-to-severe type is estimated to affect 53.2-69.8% of patients and causes significant patient discomfort. OBJECTIVE The objective of this study was to assess the prevalence, and factors associated with postoperative thirst among surgical patients in PACU at the University of Gondar Comprehensive Specialized Hospital from April 20 to June 27, 2021. METHODS An institution-based cross-sectional study was conducted at the University of Gondar Comprehensive Specialized Hospital. A total of 424 participants were included in the study. Statistical analysis had performed using SPSS 26.00 version statistical software. Binary logistic regression analysis was performed to identify the association between the prevalence of postoperative thirst and independent variables and only variables with p-value < 0.2 were entered into the multivariable analysis. The strength of the association was presented by odds ratio and 95% Confidence interval. P-value < 0.05 was considered statistically significant. RESULT The prevalence of postoperative thirst among postsurgical patients was 59% (95% CI = 54.74-64.13). Inadequate preloading (Adjusted odes ratio (AOR) = 2.137 95% CI 1.260-3.624), prolonged Nil Per Os (NPO) time (AOR = 13.80 95% CI 2.93-65.37), general anesthesia (AOR = 3.90 95% CI 3.56-11.25), and axillary body temperature ≥ 37.5 °C (AOR = 8.07 95% CI 3.63-17.96) were significantly associated with postoperative thirst. Low room temperature (< 20 °C) was protective for the occurrence of postoperative thirst (AOR = 0.162 95% CI 0.37-0.707). CONCLUSION AND RECOMMENDATIONS The prevalence of postoperative thirst remains high and need commitment in close monitoring of PACU patients and immediate intervention. We also urge that high-level, ongoing research be conducted in this area, as postoperative thirst is a very common problem with a lot to discover.
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Affiliation(s)
- Kumlachew Geta Belete
- Department of Anesthesia, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henos Enyew Ashagrie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Mengie Workie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Seid Adem Ahmed
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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James P, Bekiroglu F, Broderick D, Khattak O, Lowe D, Schache A, Shaw RJ, Rogers SN. Immediate postoperative care on high dependency unit or ward following microvascular free tissue transfer: lessons learnt from a change in practice imposed during the COVID-19 pandemic. Br J Oral Maxillofac Surg 2021; 60:343-349. [PMID: 34852938 PMCID: PMC8388193 DOI: 10.1016/j.bjoms.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Abstract
The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic, and to reflect on the implications of ward-based rather than HDU care. A total of 235 patients had free tissue transfer between 3 January 2019 and 25 February 2021: 125 before (lockdown 23 March 2020), and 110 during the pandemic (52 ward-managed and 58 HDU-managed). There were subtle case-mix differences during the pandemic, with 92% of ward-treated patients having oral cancers compared with 64% of HDU patients, and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU vs 0% ward) and inotropes (12% HDU vs 2% ward). There were fewer returns to theatre for evacuation of a haematoma or re-anastomosis during the pandemic than there were before it. Other than fewer haematoma complications during the pandemic, the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown that the ward is a safe place for patients to be cared for immediately postoperatively, and it alleviates the bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients who need the HDU.
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Affiliation(s)
- P James
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - F Bekiroglu
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Broderick
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - O Khattak
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - A Schache
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK.
| | - R J Shaw
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK
| | - S N Rogers
- Regional Maxillofacial Unit, Liverpool Head and Neck Centre, Liverpool University Hospital NHS Foundation Trust, Lower Lane, Liverpool, UK; Faculty of Health and Social Care, Edge Hill University, Ormskirk L39 4QP, UK.
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Ter Laan M, Roelofs S, Adang EMM, Bartels RHMA. Reducing the burden of brain tumor surgery. Acta Neurochir (Wien) 2021; 163:1879-82. [PMID: 32870422 DOI: 10.1007/s00701-020-04543-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022]
Abstract
Background Even though the need has been challenged, admitting patients to an intensive care or medium care unit (ICU/MCU) after adult supratentorial tumor craniotomy remains common practice. We have introduced a “no ICU, unless” policy for tumor craniotomy patients and evaluate costs, complications, and length of stay. Methods A prospective cohort study was performed comparing patients that underwent tumor craniotomy for supratentorial tumors during 2 years after introduction of the new policy with the year before. Results A reduction in ICU/MCU admittance from 88 to 23% of patients was found resulting in 13% cost reduction. Also, the new policy resulted in a 1.4-day shorter post-operative length of stay. Minor complications were reduced, while major complications remained the same. All major complications are reviewed. Conclusions We show that routine post-operative ICU/MCU admittance after tumor craniotomy does not reduce complications, but actually interferes with recovery of our patients. Changing the paradigm results in earlier discharge and cost reduction. Electronic supplementary material The online version of this article (10.1007/s00701-020-04543-y) contains supplementary material, which is available to authorized users.
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Laviano A, Koverech A, Prado CM. Letter to the Editor: Post-operative nutritional care of patients with gastrointestinal cancer: are long-term clinical outcomes achievable? Clin Nutr 2021; 40:2504-2505. [PMID: 33932794 DOI: 10.1016/j.clnu.2021.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandro Laviano
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
| | - Angela Koverech
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University, Rome, Italy
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Canada
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Dev S, Gonzalez AA, Ghaferi AA, Nallamothu BK, Kocher KE. Emergency Department Utilization and Readmissions Following Major Surgery: A Retrospective Study of Medicare Data. J Surg Res 2021; 265:187-94. [PMID: 33945926 DOI: 10.1016/j.jss.2021.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/22/2021] [Accepted: 02/27/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Reliable strategies for reducing postoperative readmissions remain elusive. As the emergency department (ED) is a frequent source of post-operative admissions, we investigated whether hospitals with high readmission rates also have high rates of post-discharge ED visits and high rates of readmission once an ED visit occurs. METHODS We conducted a retrospective analysis of 1,947,621 Medicare beneficiaries undergoing 1 of 5 common procedures in 2,894 hospitals between 2008 and 2011. We stratified hospitals into quintiles based on risk-standardized, 30-day post-discharge readmission rates (RSRR) and then compared rates of post-discharge ED visits, proportion readmitted from the ED, and readmissions within 7 days of ED discharge across these quintiles. RESULTS RSRR varied widely across extremes of hospital quintiles (3.9% to 17.5%). Hospitals with either very low or very high RSRR had modest differences in rates of ED visits (12.4% versus 14.6%). In contrast, the proportion readmitted from the ED was nearly 3 times greater in Hospitals with very high RSRR compared with those with very low RSRR (12% versus 32.2%). These findings were consistent across all procedures. Importantly, hospitals with a low proportion readmitted from the ED did not exhibit an increased rate of readmission within 7 days of ED discharge. CONCLUSIONS Although hospitals experience similar rates of ED visits following major surgery, some EDs and their affiliated surgeons and health system may deliver care preventing readmissions without an increased short-term risk of readmission following ED discharge. Reducing 30-day readmissions requires greater attention to the coordination of care delivered in the ED.
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Silva JM, Katayama HT, Lopes FMV, Toledo DO, Amendola CP, Oliveira FDS, Andraus LMR, Carmona MJC, Lobo SM, Malbouisson LMS. Referral to immediate postoperative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire. Braz J Anesthesiol 2021; 71:265-270. [PMID: 33930339 PMCID: PMC9373420 DOI: 10.1016/j.bjane.2021.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 03/01/2021] [Accepted: 03/13/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction and objective Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for postoperative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to postoperative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians. Methods A questionnaire on referrals to postoperative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU. Results 360 physicians participated in the study, with median time of 10 (5–18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care. Conclusion Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on postoperative referral to the ICU.
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Affiliation(s)
- João Manoel Silva
- Hospital Servidor Público Estadual de São Paulo, Departamento de Anestesiologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Departamento de Pacientes Graves, São Paulo, SP, Brazil; Hospital de Câncer de Barretos, Departamento de Anestesiologia e Terapia Intesiva, Barretos, SP, Brazil.
| | - Henrique Tadashi Katayama
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
| | | | - Diogo Oliveira Toledo
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Departamento de Pacientes Graves, São Paulo, SP, Brazil
| | - Cristina Prata Amendola
- Hospital de Câncer de Barretos, Departamento de Anestesiologia e Terapia Intesiva, Barretos, SP, Brazil
| | | | | | - Maria José C Carmona
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
| | - Suzana Margareth Lobo
- Faculdade de Medicina de São José do Rio Preto (FAMERP), Hospital de Base de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas, Divisão de Anestesiologia, São Paulo, SP, Brazil
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Van Zyl N, Andrews L, Williamson H, Meyrick J. The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence. Obes Res Clin Pract 2020; 14:404-420. [PMID: 32631804 DOI: 10.1016/j.orcp.2020.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/12/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. METHODS The review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. RESULTS Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. CONCLUSION Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.
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Affiliation(s)
- Natascha Van Zyl
- Institute for Optimum Nutrition, Paradise Road, Richmond, TW9 1SQ, UK.
| | - Lee Andrews
- Abertillery Group Practice, The Bridge Centre, Foundry Bridge, Abertillery, NP13 1BQ.
| | - Heidi Williamson
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY, UK.
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Perdue TO, Schreier A, Swanson M, Neil J, Carels R. Majority of female bariatric patients retain an obese identity 18-30 months after surgery. Eat Weight Disord 2020; 25:357-64. [PMID: 30382542 DOI: 10.1007/s40519-018-0601-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/19/2018] [Indexed: 01/25/2023] Open
Abstract
PURPOSE When bariatric surgery is performed, a successful outcome is usually described as % total weight lost (EWL) or a change in BMI. These definitions fail to address the importance of post-operative psychosocial adjustment. Previous research has alluded to a 'mind-body lag' where the patient's experienced body feels larger than their physically smaller post-operative body, perhaps as a result of amygdalae conditioning. The purpose of this study is to further investigate this psychological issue and assess its relationship to health locus of control, alexithymia, health quality of life and weight regain in bariatric surgery patients. METHODS Forty female bariatric surgery patients between 18 and 30 months post-op completed demographic data, survey instruments and anthropometric testing. Their evolving self-view, health locus of control, tendency toward alexithymic thought, and health quality of life were measured to identify significant relationships. Hermans' Dialogical Self Theory was used to understand the conflicted self-view of the participants. RESULTS The majority of participants retained an obese view of self despite weight loss. Those who retained an 'I-obese' viewpoint were significantly more likely to see external situations and powerful others as controlling their weight, have difficulty identifying their feelings and score significantly lower in vitality, social functioning and mental health. CONCLUSION Despite losing weight, the majority of participants retained an obese view of self that was significantly associated with a lessened health quality of life. Use of the Evolving Self-View (ESV) exploratory tool may allow early identification of post-operative patients with a prolonged 'I-obese' self-view and provide an opportunity for intervention. LEVEL OF EVIDENCE Level III, cross-sectional case-control study.
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Miller RJH, Gregory AJ, Kent W, Banerjee D, Hiesinger W, Clarke B. Predicting Transfusions During Left Ventricular Assist Device Implant. Semin Thorac Cardiovasc Surg 2019; 32:747-755. [PMID: 31128255 DOI: 10.1053/j.semtcvs.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/17/2019] [Indexed: 01/28/2023]
Abstract
Perioperative bleeding and transfusion cause morbidity and mortality in patients receiving left ventricular assist devices (LVADs). We assessed factors associated with transfusions within 30 days of durable LVAD implantation and the clinical outcomes associated with transfusions. A retrospective cohort study of patients undergoing initial durable LVAD implantation between 2014 and 2016 was performed. Rates of packed red blood cell (PRBC) or other blood product transfusions (platelets or fresh frozen plasma) were assessed. Ordinal multivariable regression analysis was performed to determine factors independently associated with transfusion. Analysis included 156 patients, mean age 54.6 years and 74.4% male, who received a mean of 11.7 units of PRBC and 10.0 units of other products within 30 days. Preimplant mechanical ventilation, dialysis, higher INR, previous sternotomy, higher model for end-stage liver disease score, and lower hemoglobin were associated with increased PRBC transfusion rates. Higher preoperative central venous pressure, mechanical ventilation, concomitant surgical procedures, previous sternotomy, and lower hemoglobin were associated with increased PRBC transfusion rates within 48 hours of implant (adjusted odds ratio [OR] 1.46, P = 0.013 per 5 mm Hg). There were no significant associations with ferritin (adjusted OR 1.00, P = 0.236) or transferrin saturation (adjusted OR 1.17, P = 0.068). Transfusions were associated with an increase in ventilation duration, intensive care unit length of stay, reoperation for bleeding, and all-cause mortality. In patients undergoing LVAD implantation, perioperative blood product exposure is common and associated with increased morbidity and mortality. Elevated central venous pressure and anemia are potentially modifiable factors associated with increased early PRBC transfusion rates.
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Affiliation(s)
- Robert J H Miller
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada; Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, Stanford, California
| | - Alexander J Gregory
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - William Kent
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Dipanjan Banerjee
- Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, Stanford, California
| | - William Hiesinger
- Section of Heart Failure, Cardiac Transplant, and Mechanical Circulatory Support, and Department of Medicine, Stanford University, Stanford, California
| | - Brian Clarke
- Division of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
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Clark BC, Berger JT, Berul CI, Jonas RA, Kaltman JR, Lapsa J, Nath DS, Sherwin ED, Sinha P, Zurakowski D, Moak JP. Risk Factors for Development of Ectopic Atrial Tachycardia in Post-operative Congenital Heart Disease. Pediatr Cardiol 2018; 39:459-65. [PMID: 29147786 DOI: 10.1007/s00246-017-1773-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
Ectopic atrial tachycardia (EAT) is common in surgically repaired congenital heart disease (CHD) and carries the potential for significant hemodynamic compromise. Our objective was to determine the incidence, and risk factors of EAT after CHD surgery. Prospective study of patients that underwent surgery for CHD from February to October 2016 was performed. Demographic, perioperative and electrophysiologic data were collected. Sustained EAT (> 30 s) was documented by telemetry or electrocardiogram and confirmed by a pediatric electrophysiologist. All patients were followed through index hospitalization. During the study period, 17/204 (8%) of patients developed EAT with median time-to-event of 14 days. 15/17 (88%) received anti-arrhythmic therapy for sustained EAT. By univariate analysis, younger age (5 vs. 284 days, P < .001), lower weight (3.2 vs. 7.5 kg, P < .001), single ventricle physiology (P = .05), longer cardiopulmonary bypass time (176 vs. 94 min, P < .001), need for delayed sternal closure (P < .001), and higher STAT category (P < .001) were associated with EAT. Incidence among single ventricle patients was 7/44 (16%), and of those 7/13 (54%) were < 30 days of age. Multivariable Cox regression analysis confirmed age at surgery < 30 days (hazard ratio = 11.7, P = .002) and use of milrinone (hazard ratio = 4.4, P = .007) as independent predictors of EAT. Post-operative EAT is frequent following surgery for CHD especially in neonates. Further study is warranted, specifically in the single ventricle population, given the high potential risk for arrhythmia-induced hemodynamic compromise in this vulnerable population.
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Florez-García M, García-Pérez F, Curbelo R, Pérez-Porta I, Nishishinya B, Rosario Lozano MP, Carmona L. Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2017; 25:3340-3353. [PMID: 27401004 DOI: 10.1007/s00167-016-4231-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/28/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the efficacy and safety of non-supervised home-based exercise versus individualized and supervised programs delivered in clinic-based settings for the functional recovery immediately after discharge from a primary TKA. METHODS Medline, Embase, Cochrane, and PEDro databases were screened, from inception to April 2015, in search for randomized clinical trials (RCT) of home-based exercise interventions versus individualized and supervised outpatient physical therapy after primary TKA. Target outcomes were: knee range of motion (ROM), patient-reported pain and function, functional performance, and safety. Risk of bias was assessed with the PEDro scale. After assessing homogeneity, data were combined using random effects meta-analysis and reported as standardized mean differences or mean differences. We set a non-inferiority margin of four points in mean differences. RESULTS The search and selection process identified 11 RCT of moderate quality and small sample sizes. ROM active extension data suitable for meta-analysis was available from seven studies with 707 patients, and ROM active flexion from nine studies with 983 patients. Most studies showed no difference between groups. Pooled differences were within the non-inferiority margin. Most meta-analyses showed significant statistical heterogeneity. CONCLUSION Short-term improvements in physical function and knee ROM do not clearly differ between outpatient physiotherapy and home-based exercise regimes in patients after primary TKA; however, this conclusion is based on a meta-analysis with high heterogeneity. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Mariano Florez-García
- Rehabilitación, Hospital Universitario Fundación Alcorcón, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Rafael Curbelo
- Instituto de Salud Musculoesquelética, Calle Conde de la Cimera, 6, 28040, Madrid, Spain
| | - Irene Pérez-Porta
- Rehabilitación, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Betina Nishishinya
- Programa de doctorado en Ciencias de la Educación y el Deporte de la Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Barcelona, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética, Calle Conde de la Cimera, 6, 28040, Madrid, Spain.
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Bell T, Stokes S, Jenkins PC, Hatcher L, Fecher AM. Prevalence of cardiovascular and respiratory complications following trauma in patients with obesity. Heart Lung 2017; 46:347-350. [PMID: 28648466 PMCID: PMC5590371 DOI: 10.1016/j.hrtlng.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND It is generally accepted that obesity puts patients at an increased risk for cardiovascular and respiratory complications after surgical procedures. However, in the setting of trauma, there have been mixed findings in regards to whether obesity increases the risk for additional complications. OBJECTIVE The aim of this study was to identify whether obese patients suffer an increased risk of cardiac and respiratory complications following traumatic injury. METHODS A retrospective analysis of 275,393 patients was conducted using the 2012 National Trauma Data Bank. Hierarchical regression modeling was performed to determine the probability of experiencing a cardiac or respiratory complication. RESULTS Patients with obesity were at a significantly higher risk of cardiac and respiratory complications compared to patients without obesity [OR: 1.81; CI: 1.72-1.91]. Prevalence of cardiovascular and respiratory complications for patients with obesity was 12.6% compared to 5.2% for non-obese patients. CONCLUSIONS Obesity is predictive of an increased risk for cardiovascular and respiratory complications following trauma.
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Affiliation(s)
- Teresa Bell
- Indiana University School of Medicine, Department of Surgery, Indianapolis, IN 46204, USA.
| | - Samantha Stokes
- Indiana University School of Medicine, Department of Surgery, Indianapolis, IN 46204, USA
| | - Peter C Jenkins
- Indiana University School of Medicine, Department of Surgery, Indianapolis, IN 46204, USA
| | - LeRanna Hatcher
- Indiana University School of Medicine, Department of Surgery, Indianapolis, IN 46204, USA
| | - Alison M Fecher
- Indiana University School of Medicine, Department of Surgery, Indianapolis, IN 46204, USA
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Abstract
Tracheotomy refers to a surgical incision made into a trachea. Tracheostomy, on the other hand, refers to a surgical procedure whereby the tracheal lumen is positioned in close proximity to the skin surface. Tracheostomy is an uncommon procedure in the pediatric population. When required tracheostomy is typically performed as an open surgical procedure under general anesthesia with the patient intubated. However, it may need to be performed under local anesthesia or over a rigid bronchoscope in the patient with a precarious airway. Over the past half century, the primary indication for pediatric tracheostomy has shifted from acute infectious airway compromise to the need for prolonged ventilatory support in neurologically compromised children. The surgical technique, choice of tracheostomy tube, and post-operative care requires a nuanced approach in infants and young children. This article will review these topics in a comprehensive fashion.
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Affiliation(s)
- Paolo Campisi
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, Canada M5G 1×8.
| | - Vito Forte
- Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, Canada M5G 1×8
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Gopalakrishanan S, Babu MR, Thangarajan R, Punja D, Jaganath VD, Kanth AB, Rao M, Rai KS. Impact of Seasonal Variant Temperatures and Laboratory Room Ambient Temperature on Mortality of Rats with Ischemic Brain Injury. J Clin Diagn Res 2016; 10:CF01-5. [PMID: 27190796 DOI: 10.7860/jcdr/2016/17372.7597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION A popular rat model for hypoperfusion ischemic brain injury is bilateral common carotid artery occlusion (BCCAO). BCCAO surgery when performed in varying geographical locations and during different seasons of the year is reported to have variable mortality rates. Studies have also documented the diminishing influence of Ketamine-Xylazine (KT-XY) on thermoregulatory functions in rodents. AIM To explore the impact of seasonal variant temperatures and laboratory room ambient temperatures on mortality of rats following BCCAO surgery. MATERIALS AND METHODS The study has two parts: 1 The first part is an analysis of a three year retrospective data to explore the association between the geographical season (hot summer and cold winter) induced laboratory room ambient temperature variations and the mortality rate in KT-XY anaesthetized BCCAO rats. 2. The second part investigated the effect of conditioned laboratory room ambient temperature (CAT) (23-25(0)C) in KT-XY anaesthetized BCCAO group of rats. Rats were divided into 4 groups(n =8/group) as-Normal control, BCCAO and Sham BCCAO where they were all exposed to unconditioned ambient temperature (UCAT) during their surgery and postoperative care. And finally fourth group rats exposed to CAT during the BCCAO surgery and postoperative care. RESULTS Pearson's chi-square test indicates a significantly high association (p<0.006) between post-BCCAO mortality and hot season of the year. CAT during the hot season reduced the mortality rate (24% less) in post- BCCAO rats compared to the rats of UCAT. CONCLUSION Despite seasonal variations in temperature, conditioning the laboratory room ambient temperatures to 23-25(0)C, induces hypothermia in KT-XY anaesthetized ischemic brain injured rodents and improves their survival rate.
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Affiliation(s)
- Sivakumar Gopalakrishanan
- Senior Grade Lecturer, Department of Physiology, Kasturba Medical College, Manipal University , India
| | - Mg Ramesh Babu
- Senior Grade Lecturer, Department of Physiology, Melaka Manipal Medical College, Manipal University , India
| | - Rajesh Thangarajan
- Lecturer, Department of Anatomy, Melaka Manipal Medical College, Manipal University , India
| | - Dhiren Punja
- Associate Professor, Department of Physiology, Kasturba Medical College, Manipal University , India
| | | | - Akriti B Kanth
- Student, Department of Biotechnology, School of Life Sciences, Manipal University , Manipal, India
| | - Mohandas Rao
- Professor, Department of Anatomy, Melaka Manipal Medical College, Manipal University , India
| | - Kiranmai S Rai
- Professor, Department of Physiology, Melaka Manipal Medical College, Manipal University , India
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Chatchumni M, Namvongprom A, Eriksson H, Mazaheri M. Thai Nurses' experiences of post-operative pain assessment and its' influence on pain management decisions. BMC Nurs 2016; 15:12. [PMID: 26933384 PMCID: PMC4772523 DOI: 10.1186/s12912-016-0136-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/24/2016] [Indexed: 01/11/2023] Open
Abstract
Background While many studies have addressed various issues with regards to pain management, there is limited knowledge about how nurses assess pain in surgical wards. This study aimed to describe Thai nurses’ experiences of pain assessment in a surgical ward. Methods A cross-sectional explorative study was conducted. Participants were selected through theoretical sampling. Data was collected through interviews with twelve registered nurses working in surgical wards. Qualitative content analysis guided the analysis of the data. Results Nurses use a double/triple check system, communicated to the healthcare team via records and protocols, and they used their skills and experiences in pain assessment. The results showed that nurses missed the opportunity to include the patients’ self-reported pain in their accounts. Though much evidence of pain was collected, this did not seem to benefit the patients. Furthermore, the nurses were not using instruments to measure pain, which illustrates the potential unreliability of professionals who have differing opinions concerning the patients’ pain. Conclusions Thai nurses worked based on a ‘patient-evidence’ paradigm when assessing patients in pain; this should be shifted to an evidence-based paradigm. Furthermore, by including the patients’ self-reported pain in their assessment, nurses would both improve the quality of the pain assessment and empower patients in their pain management. Pain management practices in Thailand should be improved through education, training, supportive innovation, and collegial competence development in order to improve the quality of care in the post-operative field.
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Affiliation(s)
- Manaporn Chatchumni
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | | | - Henrik Eriksson
- Department of Nursing and Care, The Red Cross University College, Stockholm, Sweden
| | - Monir Mazaheri
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden ; Department of Nursing and Care, The Red Cross University College, Stockholm, Sweden
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Abstract
The goal of flexor tendon repair is to achieve normal range of motion of the finger or thumb. The surgical approach depends on the level of injury. Multistrand core suture repairs are recommended for primary flexor tendon repair. It is evident that at least 4 strands are required to an initiate and active range of motion protocol. The epitendinous suture can also increase the strength of the repair. Careful attention to the post-operative therapy regiment is critical to a successful repair.
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Affiliation(s)
- Isabella M Mehling
- Department of Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, Frankfurt am Main 60389, Germany
| | - Annika Arsalan-Werner
- Department of Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, Frankfurt am Main 60389, Germany
| | - Michael Sauerbier
- Department of Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, Frankfurt am Main 60389, Germany.
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Yaman Aktaş Y, Karabulut N. The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. Nurs Crit Care 2015; 21:44-52. [PMID: 25721305 DOI: 10.1111/nicc.12159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endotracheal suctioning has been identified as a painful procedure for critically ill patients. AIM To determine the effect of music therapy on pain intensity, sedation level and physiological parameters during endotracheal suctioning of mechanically ventilated patients in cardiovascular surgery intensive care unit (ICU). DESIGN Experimental survey. METHODS The study was conducted between May 2010 and June 2013 in Ordu Medical Park Hospital Cardiovascular Surgery Intensive Care Unit. The study sample consisted of 66 patients (33 experimental and 33 control) who complied with the criteria of inclusion for the study. Data was collected using the 'Patient Information Form', 'Critical-Care Pain Observation Tool', 'Ramsay Sedation Scale' and 'Form of Physiological Parameters'. RESULTS The mean scores of the Ramsay Sedation Scale during endotracheal aspiration were respectively 1·88 and 1·55 in the experimental and control group and the difference between the groups was statistically significant (p = 0·003). The mean score of Critical-Care Pain Observation Tool during endotracheal suctioning in the experimental group was found to be lower statistically than those of the control group (p < 0·001). There were no significant differences before, during and 20 min after suctioning between the two groups with regard to systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation (p > 0·05). CONCLUSIONS The results of this study implies that music therapy can be effective practice for nurses attempting to reduce patients' pain and control sedation level in patients on mechanical ventilators during endotracheal suctioning. RELEVANCE TO CLINICAL PRACTICE It is recommended that music therapy should be added to the routine nursing care for mechanically ventilated patients.
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Affiliation(s)
- Yeşim Yaman Aktaş
- Department of Surgical Nursing, The Faculty of Health Science, Giresun University, Giresun, Turkey
| | - Neziha Karabulut
- Department of Surgical Nursing, The Faculty oh Health Science, Atatürk University, Erzurum, Turkey
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Branch-Elliman W, Strymish J, Itani KMF, Gupta K. Using clinical variables to guide surgical site infection detection: a novel surveillance strategy. Am J Infect Control 2014; 42:1291-5. [PMID: 25465259 DOI: 10.1016/j.ajic.2014.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/14/2014] [Accepted: 08/14/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are a common and expensive health care-associated infection, and are used as a health care quality benchmark. As such, SSI detection is a major focus of infection prevention programs. In an effort to improve on conventional surveillance methods, a simple algorithm for SSI detection was developed using clinical variables not traditionally included in National Healthcare Safety Network definitions. METHODS A case-control study was conducted among surgeries performed at the Veterans Affairs Boston Healthcare System between January 2008 and December 2009. SSI cases were matched to controls without SSI. Clinical variables (administrative, microbiological, pharmacy, radiology) were compared between the groups to determine those that best identified SSI. RESULTS A total of 70 SSIs were matched to 70 controls. On multivariable analysis, variables significantly associated with SSI identification were wound culture order, computed tomography scan/magnetic resonance imaging order, antibiotic order within 30 days after surgery, and application of a relevant International Classification of Disease, Ninth Revision code. Among patients with no SSI identifiers, 98% were correctly classified as having no SSI. Among patients with multiple SSI identifiers, 97.1% were correctly identified as having SSI. The area under the curve for this model was 0.87. CONCLUSION We have derived a novel surveillance algorithm for SSI detection with excellent operating characteristics. This algorithm could be automated to streamline infection control efforts.
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Affiliation(s)
- Westyn Branch-Elliman
- Department of Medicine, Boston VA Healthcare System, Boston, MA; Department of Healthcare Quality, Division of Infection Control, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Harvard University Medical School, Boston, MA.
| | - Judith Strymish
- Department of Medicine, Boston VA Healthcare System, Boston, MA; Department of Medicine, Harvard University Medical School, Boston, MA
| | - Kamal M F Itani
- Department of Medicine, Harvard University Medical School, Boston, MA; Department of Surgery, Boston VA Healthcare System, Boston, MA; Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Kalpana Gupta
- Department of Medicine, Boston VA Healthcare System, Boston, MA; Department of Medicine, Boston University School of Medicine, Boston, MA
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24
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Estupiñán-Jiménez JC, Castro-Rincón JM, González O, Lora D, López E, Pérez-Cerdà F. Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques. ACTA ACUST UNITED AC 2014; 62:184-90. [PMID: 25048994 DOI: 10.1016/j.redar.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/08/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). MATERIALS AND METHODS A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. RESULTS In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). CONCLUSION Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies.
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Affiliation(s)
- J C Estupiñán-Jiménez
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J M Castro-Rincón
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - O González
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Lora
- Estadístico i+12, Instituto de Investigación del Hospital 12 de Octubre, Madrid, España
| | - E López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Pérez-Cerdà
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
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