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Pandian V, Hopkins BS, Yang CJ, Ward E, Sperry ED, Khalil O, Gregson P, Bonakdar L, Messer J, Messer S, Chessels G, Bosworth B, Randall DM, Freeman-Sanderson A, McGrath BA, Brenner MJ. Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection. Am J Otolaryngol 2022; 43:103525. [PMID: 35717856 PMCID: PMC9172276 DOI: 10.1016/j.amjoto.2022.103525] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.
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Affiliation(s)
- Vinciya Pandian
- Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, United States of America; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States of America.
| | - Brandon S Hopkins
- Department of Otolaryngology, Head and Neck Surgery, The Cleveland Clinic, Cleveland, OH, United States of America.
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, NY, United States of America.
| | - Erin Ward
- Global Tracheostomy Collaborative, Raleigh, NC, United States of America; Family Liaison, Multidisciplinary Tracheostomy Team, Boston Children's Hospital, Boston, MA, United States of America; MTM-CNM Family Connection, Inc., Methuen, MA, United States of America(1)
| | - Ethan D Sperry
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Ovais Khalil
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America.
| | - Prue Gregson
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Lucy Bonakdar
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Jenny Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Sally Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Gabby Chessels
- Austin Health Tracheostomy Patient & Family Forum, Tracheostomy Review and Management Services, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia.
| | | | - Diane M Randall
- Memorial Regional Health System, Fort Lauderdale, FL, United States of America.
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| | - Brendan A McGrath
- Anaesthesia & Intensive Care Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, United States of America; Global Tracheostomy Collaborative, Raleigh, NC, United States of America.
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Young JC, Dasgupta N, Chidgey BA, Stürmer T, Pate V, Hudgens M, Funk MJ. Impacts of Initial Prescription Length and Prescribing Limits on Risk of Prolonged Postsurgical Opioid Use. Med Care 2022; 60:75-82. [PMID: 34812786 PMCID: PMC8900903 DOI: 10.1097/mlr.0000000000001663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In response to concerns about opioid addiction following surgery, many states have implemented laws capping the days supplied for initial postoperative prescriptions. However, few studies have examined changes in the risk of prolonged opioid use associated with the initial amount prescribed. OBJECTIVE The objective of this study was to estimate the risk of prolonged opioid use associated with the length of initial opioid prescribed and the potential impact of prescribing limits. RESEARCH DESIGN Using Medicare insurance claims (2007-2017), we identified opioid-naive adults undergoing surgery. Using G-computation methods with logistic regression models, we estimated the risk of prolonged opioid use (≥1 opioid prescription dispensed in 3 consecutive 30-d windows following surgery) associated with the varying initial number of days supplied. We then estimate the potential reduction in cases of prolonged opioid use associated with varying prescribing limits. RESULTS We identified 1,060,596 opioid-naive surgical patients. Among the 70.0% who received an opioid for postoperative pain, 1.9% had prolonged opioid use. The risk of prolonged use increased from 0.7% (1 d supply) to 4.4% (15+ d). We estimated that a prescribing limit of 4 days would be associated with a risk reduction of 4.84 (3.59, 6.09)/1000 patients and would be associated with 2255 cases of prolonged use potentially avoided. The commonly used day supply limit of 7 would be associated with a smaller reduction in risk [absolute risk difference=2.04 (-0.17, 4.25)/1000]. CONCLUSIONS The risk of prolonged opioid use following surgery increased monotonically with increasing prescription duration. Common prescribing maximums based on days supplied may impact many patients but are associated with relatively low numbers of reduced cases of prolonged use. Any prescribing limits need to be weighed against the need for adequate pain management.
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Affiliation(s)
- Jessica C. Young
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599
| | - Nabarun Dasgupta
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC 27599
| | - Brooke A. Chidgey
- Department of Anesthesiology and Pain Management, University of North Carolina School of Medicine, Chapel Hill, NC 27599
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
| | - Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, U.S.A
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Sukhina OM, Simbirova AS, Sukhin VS. DEVIATION BETWEEN THE PLANNED DOSE AND THE IN VIVO DOSIMETRY RESULTS DURING POSTOPERATIVE IRRADIATION IN PATIENTS WITH UTERINE CANCER DEPENDING ON ANTHROPOMETRIC DATA. Probl Radiac Med Radiobiol 2021; 26:573-586. [PMID: 34965575 DOI: 10.33145/2304-8336-2021-26-573-586] [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: 07/20/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED Topometry is an integral part of irradiation whose task is to repeat the position of the patient set by the simulator to repeat the PTV and the spatial relationship between the radiation field and the risk organs that were identified during planning. The dose distribution formulated in the plan is only an ideal model. There is some gap between the actual and planned dose distribution, especially in overweight patients. OBJECTIVE evaluate the effect of anthropometric data on the deviation between the planned dose and the results of dosimetry in vivo in patients with uterine cancer during postoperative irradiation. MATERIALS AND METHODS The authors analyzed the results of treatment of 110 patients with stage IB-II uterine can- cer who were treated at the Department of Radiation Therapy of the Institute of Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine from 2016 to 2019. The technique of classical fractionation was used with a single focal dose of 2.0 Gy 5 times a week, the total focal dose was 42.0-50.0 Gy. To assess the effect of the patient's anthropometric data on the difference between the actual and calculated dose, the authors per- formed in vivo dosimetry after the first session and in the middle of the postoperative course of external beam radi- ation therapy. RESULTS Рatients with BSA < 1.92 m2, had the median relative deviation at the first session -4.12 %, after 20.0 Gy - 3.61 %, patients with BSA > 1.92 m2: -2.06 % and -1.55 % respectively. After 20 Gy 34.8 % of patients with BSA < 1.92 m2 there was an increase in deviation from the planned dose, 65.2 % a decrease, while in 56.1 % of patients with BSA > 1.92 m2 there was an increase, and in 43.9 % - its reduction. With increasing BMI, the actual dose received on the rectal mucosa in the tenth session of irradiation is approaching the calculated one. CONCLUSIONS When irradiated on the ROKUS-AM device, we did not find a probable dependence of the influence of the constitutional features of patients between the received and planned radiation dose. When treated with a Clinac 600 C, only body weight and body mass index at the tenth irradiation session have a likely effect on the dose differ- ence. Therefore, issues related to the individual approach to the treatment of uterine cancer, depending on anthro- pometric data is an urgent problem of modern radiotherapy.
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Affiliation(s)
- O M Sukhina
- State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska Str., Kharkiv 61024, Ukraine
| | - A S Simbirova
- State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska Str., Kharkiv 61024, Ukraine
| | - V S Sukhin
- State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», 82 Pushkinska Str., Kharkiv 61024, Ukraine
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Cambria V, Beccuti G, Prencipe N, Penner F, Gasco V, Gatti F, Romanisio M, Caputo M, Ghigo E, Zenga F, Grottoli S. First but not second postoperative day growth hormone assessments as early predictive tests for long-term acromegaly persistence. J Endocrinol Invest 2021; 44:2427-2433. [PMID: 33837920 PMCID: PMC8502138 DOI: 10.1007/s40618-021-01553-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/10/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Postoperative assessment of acromegaly activity is typically performed at least 3 months after neurosurgery (NS). Few studies have evaluated the use of early postoperative growth hormone (GH) levels as a test to predict short- and long-term remission of acromegaly. Our objective was to evaluate the diagnostic performance of serum random GH on a postoperative day one (D1-rGH) and two (D2-rGH), particularly in predicting long-term disease persistence. MATERIALS AND METHODS Forty-one subjects with acromegaly who were undergoing NS were enrolled (mean age ± SD 47.4 ± 13.1 years at diagnosis; women 54%; macroadenomas 71%). The final assessment of disease activity was performed one year after NS. ROC curves were used to evaluate the diagnostic performance of D1-rGH and D2-rGH. RESULTS After a 1-year follow-up, the overall remission rate was 55%. ROC analysis identified an optimal D1-rGH cut-off value of 2.1 ng/mL for diagnosing long-term disease persistence (55.6% SE; 90.9% SP). The cut-off point became 2.5 ng/mL after maximizing specificity for disease persistence (yielding a 100% positive predictive value) and 0.3 ng/mL after maximizing sensitivity for disease remission. The optimal D2-rGH cut-off value was 0.6 ng/mL (81.8% SE; 50% SP); the cut-off point became 2.9 ng/mL after maximizing specificity and 0.1 ng/mL after maximizing sensitivity, with no clinical utility. CONCLUSIONS D1-rGH could be a highly specific test for the early diagnosis of long-term acromegaly persistence, which is predicted by a value > 2.5 ng/mL with a great degree of certainty. The diagnostic performance of D2-rGH was insufficient. Further research is required to validate these preliminary results prior to modifying the postoperative management of acromegaly.
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Affiliation(s)
- V. Cambria
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - G. Beccuti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - N. Prencipe
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Penner
- Division of Neurosurgery, Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - V. Gasco
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Gatti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - M. Romanisio
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - M. Caputo
- Division of Endocrinology, Department of Translational Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy
| | - E. Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
| | - F. Zenga
- Division of Endocrinology, Department of Translational Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy
| | - S. Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126 Turin, Italy
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Felbaum DR, Dowlati E, Jacobs M, Tom LK. Manuka Honey: Feasibility and Safety in Postoperative Neurosurgical Wound Care. Adv Skin Wound Care 2021; 34:249-253. [PMID: 33852461 DOI: 10.1097/01.asw.0000741508.83558.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To date, no reports have been published on active Leptospermum manuka honey (ALH) feasibility as a postoperative topical wound supplement in neurosurgical patients. The objective of the study is to present the authors' initial experience with using ALH in postoperative neurosurgical patients. METHODS A single-surgeon retrospective case series review of cranial and spinal operations between 2018 and 2020 was performed in patients with nonhealing wounds or wounds deemed "at risk" as defined by grade 1 Sandy surgical wound dehiscence grading classification. An ALH gel or ointment was applied to these incisions once a day for 2 to 4 weeks. Patients were followed up in the clinic every 2 weeks until incisions had healed. RESULTS Twenty-five postoperative patients (12 cranial, 13 spinal) were identified to be at high risk of operative debridement. All 25 patients were prescribed a topical application of ALH, which was easily adopted without patient-related adverse events. Seven (four cranial, three spinal) patients required operative debridement and treatment with long-term antibiotic therapy. CONCLUSIONS In this small case series of neurosurgical patients who were at risk of poor wound healing, the application of medical-grade ALH was well tolerated without patient-reported adverse events. The ALH may have prevented the need for operative debridement in the majority of patients. Further prospective studies are necessary to establish its efficacy in wound healing in the neurosurgical population.
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Affiliation(s)
- Daniel R Felbaum
- At the MedStar Washington Hospital Center, in Washington, DC, Daniel R. Felbaum, MD, is Assistant Professor, Department of Neurosurgery; Ehsan Dowlati, MD, is Resident Physician, Department of Neurosurgery; Matthew Jacobs, PA-C, is Physician Assistant, Department of Neurosurgery; and Laura K. Tom, MD, is Assistant Professor, Department of Plastic and Reconstructive Surgery. The authors have disclosed no financial relationships related to this article. Submitted May 22, 2020; accepted in revised form July 7, 2020
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Li Y, Ying M, Cai X, Thirukumaran CP. Association of Mandatory Bundled Payments for Joint Replacement With Postacute Care Outcomes Among Medicare and Medicaid Dual Eligible Patients. Med Care 2021; 59:101-110. [PMID: 33273296 PMCID: PMC7855778 DOI: 10.1097/mlr.0000000000001473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/23/2022]
Abstract
IMPORTANCE The Medicare comprehensive care for joint replacement (CJR) model, a mandatory bundled payment program started in April 2016 for hospitals in randomly selected metropolitan statistical areas (MSAs), may help reduce postacute care (PAC) use and episode costs, but its impact on disparities between Medicaid and non-Medicaid beneficiaries is unknown. OBJECTIVE To determine effects of the CJR program on differences (or disparities) in PAC use and outcomes by Medicare-Medicaid dual eligibility status. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 2013-2017, based on difference-in-differences (DID) analyses on Medicare data for 1,239,452 Medicare-only patients, 57,452 dual eligibles with full Medicaid benefits, and 50,189 dual eligibles with partial Medicaid benefits who underwent hip or knee surgery in hospitals of 75 CJR MSAs and 121 control MSAs. MAIN OUTCOME MEASURES Risk-adjusted differences in rates of institutional PAC [skilled nursing facility (SNF), inpatient rehabilitation, or long-term hospital care] use and readmissions; and for the subgroup of patients discharged to SNF, risk-adjusted differences in SNF length of stay, payments, and quality measured by star ratings, rate of successful discharge to community, and rate of transition to long-stay nursing home resident. RESULTS The CJR program was associated with reduced institutional PAC use and readmissions for patients in all 3 groups. For example, it was associated with reductions in 90-day readmission rate by 1.8 percentage point [DID estimate=-1.8; 95% confidence interval (CI), -2.6 to -0.9; P<0.001] for Medicare-only patients, by 1.6 percentage points (DID estimate=-1.6; 95% CI, -3.1 to -0.1; P=0.04) for full-benefit dual eligibles, and by 2.0 percentage points (DID estimate=-2.0; 95% CI, -3.6 to -0.4; P=0.01) for partial-benefit dual eligibles. These CJR-associated effects did not differ between dual eligibles (differences in above DID estimates=0.2; 95% CI, -1.4 to 1.7; P=0.81 for full-benefit patients; and -0.3; 95% CI, -1.9 to 1.3; P=0.74 for partial-benefit patients) and Medicare-only patients. Among patients discharged to SNF, the CJR program showed no effect on successful community discharge, transition to long-term care, or their persistent disparities. CONCLUSIONS The CJR program did not help reduce persistent disparities in readmissions or SNF-specific outcomes related to Medicare-Medicaid dual eligibility, likely due to its lack of financial incentives for reduced disparities and improved SNF outcomes.
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Affiliation(s)
- Yue Li
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
| | - Meiling Ying
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center
| | - Caroline Pinto Thirukumaran
- Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center
- Department of Orthopaedics, University of Rochester Medical Center
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Wainwright TW. Enhanced Recovery after Surgery (ERAS) for Hip and Knee Replacement-Why and How It Should Be Implemented Following the COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 57:medicina57010081. [PMID: 33477852 PMCID: PMC7832821 DOI: 10.3390/medicina57010081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 01/02/2023]
Abstract
The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.
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Affiliation(s)
- Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, 6th Floor, Executive Business Centre, 89, Holdenhurst Road, Bournemouth BH8 8EB, UK; ; Tel.: +44-01202-961656
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
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Shahid SM, Anguita R, daCruz L. Telemedicine for postoperative consultations following vitrectomy for retinal detachment repair during the COVID-19 crisis: a patient satisfaction survey. Can J Ophthalmol 2020; 56:e46-e48. [PMID: 33358626 PMCID: PMC7721350 DOI: 10.1016/j.jcjo.2020.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/15/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S M Shahid
- Moorfields Eye Hospital, London, United Kingdom.
| | - R Anguita
- Moorfields Eye Hospital, London, United Kingdom
| | - L daCruz
- Moorfields Eye Hospital, London, United Kingdom
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Chan Y, Banglawala SM, Chin CJ, Côté DWJ, Dalgorf D, de Almeida JR, Desrosiers M, Gall RM, Gevorgyan A, Hassan Hassan A, Janjua A, Lee JM, Leung RM, Mechor BD, Mertz D, Monteiro E, Nayan S, Rotenberg B, Scott J, Smith KA, Sommer DD, Sowerby L, Tewfik MA, Thamboo A, Vescan A, Witterick IJ. CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:81. [PMID: 33272328 PMCID: PMC7714255 DOI: 10.1186/s40463-020-00476-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/25/2020] [Indexed: 01/19/2023] Open
Abstract
Healthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists - Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.
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Affiliation(s)
- Yvonne Chan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.
| | - Sarfaraz M Banglawala
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Christopher J Chin
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Saint John, NB, Canada
| | - David W J Côté
- University of Montreal Hospital Center (CHUM) and Research Center (CRCHUM), Montreal, QC, Canada
| | - Dustin Dalgorf
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Richard M Gall
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Artur Gevorgyan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - A Hassan Hassan
- Department of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Arif Janjua
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John M Lee
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Randy M Leung
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Smriti Nayan
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John Scott
- Department of Otolaryngology - Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Kristine A Smith
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Doron D Sommer
- Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Leigh Sowerby
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Andrew Thamboo
- Division of Otolaryngology - Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Allan Vescan
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
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10
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Zemni I, Meriem K, Khelil M, Safer M, Zoghlami C, Ben Abdelaziz A. Quality indicators of hip fracture management. A systematic review. Tunis Med 2020; 98:913-925. [PMID: 33479993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To identify standards and quality indicators of hip fracture management from the medical literature. METHODS We conducted a "systematic review" on the topic of quality indicators of hip fracture management using PubMed database, during 15 years from 2001 to 2015. The collected publications were studied by two readers to extract the different quality indicators of hip fracture management. These indicators were stratified according to their type (process or outcome) and to the time of health care (pre, per or post-operative). RESULTS A total of 41 articles were included in the study: The analysis of these articles highlighted a predominance of Anglo-Saxon papers, an increasing rate of publication over time, a dominance of evaluative studies and a multiplicity of guidelines. A total of 46 quality indicators were identified through these articles. Two third were classified as procedural items and 60% were about post-operative hip fracture management. The most assessed indicators and standards, among those related to the preoperative care, were time to surgery (34%) and patient clinical condition assessment (11%). During the operation time, the most assessed indicator was the proportion of patients who have had spinal anesthesia (73%). For the postoperative care, the most common indicators and standards were length of hospital stay (12%), osteoporosis treatment prescription (8%), mattresses use to prevent pressure ulcer (7%), pressure sores occurring (7%) and in hospital mortality (7%). CONCLUSION This systematic review allowed to identify the main indicators recommended to evaluate the management of hip fracture. The continuous monitoring of these indicators should be generalized in maghrebian countries using strategic dashboards in all hospitals and clinics treating this pathology.
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11
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Khan S, Siow VS, Lewis A, Butler G, Narr M, Srinivasan S, Michaels M, Mollen K. An Evidence-Based Care Protocol Improves Outcomes and Decreases Cost in Pediatric Appendicitis. J Surg Res 2020; 256:390-396. [PMID: 32771703 PMCID: PMC7864993 DOI: 10.1016/j.jss.2020.05.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/09/2019] [Revised: 04/20/2020] [Accepted: 05/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Appendicitis is a common indication for urgent abdominal surgery in the pediatric population. The postoperative management varies significantly in time to discharge and cost of care. The objective of this study was to investigate whether implementation of an evidence-based protocol after an appendectomy would lead to decreased length of stay and cost of care. METHODS In 2014 at the Children's Hospital of Pittsburgh, an initiative to develop an evidenced-based protocol to treat appendicitis was undertaken. A work group was formed of pediatric surgeons and other important personnel to determine best practices. Treatment pathways were created. Pathways differed with recommendation on postoperative antibiotic choice and duration, diet initiation, and discharge criteria. Data were prospectively gathered from all patients (ages 0-18 y) with acute appendicitis from January 2015 to December 2016. Primary outcomes were length of stay and cost of care. Secondary outcomes were surgical site infection, readmission rate, and duration of postoperative antibiotics. RESULTS Among the 1289 patients, 481 patients were in the preprotocol cohort and 808 patients were in the postprotocol cohort. 27% of patients had an intraoperative diagnosis of complicated appendicitis. There was a significantly shorter length of stay in the postprotocol cohort (P < 0.001). Median costs for the whole cohort decreased 0.6% and 24.6% for patients with complicated appendicitis after protocol initiation (P < 0.01). CONCLUSIONS This study has demonstrated that introduction of an evidence-based clinical care protocol for pediatric patients with appendicitis leads to shorter hospital stay and decreased hospital costs.
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Affiliation(s)
- Sidrah Khan
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vei Shaun Siow
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anthony Lewis
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gabriella Butler
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marissa Narr
- Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suresh Srinivasan
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Marian Michaels
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin Mollen
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Pediatric Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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12
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Bernal-Sprekelsen M, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Martín Delgado MC. [Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. Acta Otorrinolaringol Esp (Engl Ed) 2020; 71:386-392. [PMID: 32513456 PMCID: PMC7211599 DOI: 10.1016/j.otorri.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- Manuel Bernal-Sprekelsen
- Vicepresidente de la SEORL-CCC; Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España.
| | | | - Julián Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - César Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - Candelaria de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - Pedro Díaz de Cerio Canduela
- Presidente de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - Eduardo Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO); Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - Carlos Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - Ricard Ferrer Roca
- Presidente de SEMICYUC; Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - Alberto Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - Fernando López Álvarez
- Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Pablo Monedero Rodríguez
- Vicepresidente de la Sección de Cuidados Intensivos, SEDAR; Departamento de Anestesia y Cuidados Intensivos; Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Andrea Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España; Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - Pablo Parente Arias
- Presidente de Relaciones Internacionales de la SEORL-CCC; Hospital Universitario Locus Augusti, Lugo, España
| | - Antonio Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - Guillermo Plaza Mayor
- Presidente de Congresos de la SEORL-CCC; Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - Pedro Rascado Sedes
- Presidente de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC); Vocal JD SEMICYUC; Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - Jon Alexander Sistiaga Suárez
- Vocal de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Claudia Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC; Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Rosa Villalonga Vadell
- Vicepresidenta de la Comisión Nacional de Anestesiologia, Reanimación y Terapéutica del Dolor; Presidenta de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - María Cruz Martín Delgado
- Servicio Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
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13
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Villalonga Vadell R, Martín Delgado MC, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Martín Delgado MC, Bernal-Sprekelsen M. Consensus Document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on Tracheotomy in Patients with COVID-19 Infection. Rev Esp Anestesiol Reanim 2020; 67:504-510. [PMID: 32532430 PMCID: PMC7283053 DOI: 10.1016/j.redar.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/20/2022]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- R Villalonga Vadell
- Vicepresidencia de la Comisión Nacional de Anestesiología, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD).
| | - M C Martín Delgado
- Vicepresidencia de la Comisión Nacional de Anestesiología, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - F X Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
| | - J Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - C Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - C de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - P Díaz de Cerio Canduela
- Presidencia de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - E Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO), Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - C Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Ferrer Roca
- Presidencia de SEMICYUC, Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - A Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - F López Álvarez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Monedero Rodríguez
- Vicepresidencia de la Sección de Cuidados Intensivos, SEDAR, Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España, Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - P Parente Arias
- Presidencia de Relaciones Internacionales de la SEORL-CCC, Hospital Universitario Locus Augusti, Lugo, España
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - G Plaza Mayor
- Presidencia de Congresos de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - P Rascado Sedes
- Presidencia de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC), Vocalía JD SEMICYUC, Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - J A Sistiaga Suárez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - C Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC, Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - R Villalonga Vadell
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España
| | - M Bernal-Sprekelsen
- Vicepresidencia de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
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14
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Martín Delgado MC, Avilés-Jurado FX, Álvarez Escudero J, Aldecoa Álvarez-Santuyano C, de Haro López C, Díaz de Cerio Canduela P, Ferrandis Perepérez E, Ferrando Ortolá C, Ferrer Roca R, Hernández Tejedor A, López Álvarez F, Monedero Rodríguez P, Ortiz Suñer A, Parente Arias P, Planas Roca A, Plaza Mayor G, Rascado Sedes P, Sistiaga Suárez JA, Vera Ching C, Villalonga Vadell R, Bernal-Sprekelsen M. [Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection]. Med Intensiva 2020; 44:493-499. [PMID: 32466990 PMCID: PMC7205735 DOI: 10.1016/j.medin.2020.05.002] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.
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Affiliation(s)
- M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Universidad Francisco de Vitoria, Torrejón de Ardoz, Madrid, España.
| | - F X Avilés-Jurado
- Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
| | - J Álvarez Escudero
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - C Aldecoa Álvarez-Santuyano
- Servicio de Anestesiología y Reanimación, Hospital Universitario del Río Hortega, Departamento de Cirugía, Universidad de Valladolid, Valladolid, España
| | - C de Haro López
- Àrea de Crítics, Hospital Universitari Parc Taulí, Sabadell, Barcelona, CIBERES Enfermedades Respiratorias, ISCIII, y Grupo de trabajo de Insuficiencia Respiratoria Aguda, SEMICYUC, Madrid, España
| | - P Díaz de Cerio Canduela
- Presidencia de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Área de Otorrinolaringología, Hospital San Pedro, Logroño, España
| | - E Ferrandis Perepérez
- Instituto Valenciano de Oncología (IVO), Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Valencia, España
| | - C Ferrando Ortolá
- Servicio de Anestesiología y Reanimación, Instituto de Investigación Pi i Suñer, Hospital Clínic i Provincial de Barcelona, Barcelona, CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
| | - R Ferrer Roca
- Presidencia de SEMICYUC, Servicio de Medicina Intensiva, Grupo de Investigación SODIR-VHIR, Hospital Vall d'Hebron, Barcelona, España
| | - A Hernández Tejedor
- Departamento de Operaciones, SAMUR-Protección Civil. Unidad de Cuidados Intensivos, Hospital COVID-19 IFEMA, Madrid, España
| | - F López Álvarez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - P Monedero Rodríguez
- Vicepresidencia de la Sección de Cuidados Intensivos, SEDAR, Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - A Ortiz Suñer
- Servicio de Medicina Intensiva, Hospital Comarcal, Vinaroz, Castellón, España, Grupo de Trabajo de Insuficiencia Respiratoria Aguda de la SEMICYUC
| | - P Parente Arias
- Presidencia de Relaciones Internacionales de la SEORL-CCC, Hospital Universitario Locus Augusti, Lugo, España
| | - A Planas Roca
- Servicio de Anestesiología y Reanimación, Hospital Universitario de la Princesa, Madrid, España
| | - G Plaza Mayor
- Presidencia de Congresos de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
| | - P Rascado Sedes
- Presidencia de la Sociedad Gallega de Medicina Intensiva y Unidades Coronarias (SOGAMIUC), Vocalía JD SEMICYUC, Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | - J A Sistiaga Suárez
- Vocalía de la Comisión de Cirugía de Cabeza y Cuello de la SEORL-CCC; Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - C Vera Ching
- Grupo de Trabajo de Insuficiencia Respiratoria Aguda de SEMICYUC, Servicio de Medicina Intensiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - R Villalonga Vadell
- Vicepresidencia de la Comisión Nacional de Anestesiologia, Reanimación y Terapéutica del Dolor; Presidencia de la Sociedad Catalana de Anestesiología, Reanimación y Terapéutica del Dolor (SCARTD)
| | - M Bernal-Sprekelsen
- Vicepresidencia de la SEORL-CCC, Servicio de Otorrinolaringología, Hospital Clínic i Provincial, Barcelona, España
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Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, Haft J, Bermudez CA, Shah AS, D'Alessandro DA. 2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-Cardiotomy Extracorporeal Life Support in Adult Patients. Ann Thorac Surg 2020; 111:327-369. [PMID: 33036737 DOI: 10.1016/j.athoracsur.2020.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Center, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland
| | - Milan Milojevic
- Department of Anesthesiology and Critical Care Medicine, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - David M McMullan
- Department of Cardiac Surgery, Seattle Children Hospital, Seattle, Washington
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christian A Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashish S Shah
- Department of Cardio-Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A D'Alessandro
- Department of Cardio-Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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16
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Gatta G. [Linee guida di pratica clinica sulla cura peri- e post-operatoria delle fistole e delle protesi arterovenose per emodialisi negli adulti. Sintesi delle raccomandazioni delle "European Renal Best Practice (ERBP)"]. G Ital Nefrol 2020; 37:37-S75-2020-3. [PMID: 32749083] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Questo documento è stato tradotto dall'inglese a nome dell'ERBP (European Renal Best Practice), un organo ufficiale dell'ERA-EDTA (European Renal Association - European Dialysis and Transplant Association), e si basa su una pubblicazione ufficiale edita su Nephrology, Dialysis and Transplantation (NDT). ERBP si assume la piena responsabilità solo per la versione completa delle linee guida in originale e in lingua inglese pubblicate su NDT: Gallieni M, Hollenbeck M, Inston N, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34(S_2):ii1-ii42. https://doi.org/10.1093/ndt/gfz072.
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Affiliation(s)
- Giuseppe Gatta
- S.C. di Nefrologia e Dialisi, Ospedale "Casa Sollievo della Sofferenza" IRCCS, San Giovanni Rotondo, Italy
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Guasch E, Brogly N, Manrique S. Practical recommendations in the obstetrical patient with a COVID-19 infection. ACTA ACUST UNITED AC 2020; 67:438-445. [PMID: 32814634 PMCID: PMC7351396 DOI: 10.1016/j.redar.2020.06.009] [Citation(s) in RCA: 2] [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: 04/30/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
La infección por COVID-19 afecta también a las pacientes obstétricas. La atención obstétrica habitual ha continuado a pesar de la pandemia. Existen series de casos de pacientes obstétricas. Parece que las técnicas neuroaxiales son seguras y es importante asegurarse que los bloqueos funcionen correctamente antes de una cesárea. Es por esto que se recomienda que los bloqueos sean realizados por anestesiólogos expertos. La protección y seguridad de los profesionales es un punto fundamental y, en caso de anestesia general, también se recomienda acudir al anestesiólogo más experto. Las pacientes gravemente enfermas deben reconocerse rápida y precozmente, para poder suministrarles el tratamiento adecuado lo antes posible. La susceptibilidad a las trombosis hace que la anticoagulación profiláctica sea prioritaria.
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MESH Headings
- Analgesia, Epidural/methods
- Analgesia, Epidural/standards
- Analgesia, Obstetrical/standards
- Anesthesia, General
- Anesthesia, Obstetrical/standards
- Anesthesiologists
- Betacoronavirus
- COVID-19
- Cesarean Section/methods
- Cesarean Section/standards
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Cross Infection/prevention & control
- Female
- Humans
- Infectious Disease Transmission, Patient-to-Professional/prevention & control
- Monitoring, Physiologic/methods
- Monitoring, Physiologic/standards
- Pandemics/prevention & control
- Patient Isolation/standards
- Personal Protective Equipment
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Postoperative Care/methods
- Postoperative Care/standards
- Pregnancy
- Pregnancy Complications, Infectious
- SARS-CoV-2
- Severity of Illness Index
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Affiliation(s)
- E Guasch
- Hospital Universitario La Paz, Madrid, España.
| | - N Brogly
- Hospital Universitario La Paz, Madrid, España
| | - S Manrique
- Hospital Universitario Vall d'Hebron, Barcelona, España
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18
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Jette DU, Hunter SJ, Burkett L, Langham B, Logerstedt DS, Piuzzi NS, Poirier NM, Radach LJL, Ritter JE, Scalzitti DA, Stevens-Lapsley JE, Tompkins J, Zeni Jr J. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther 2020; 100:1603-1631. [PMID: 32542403 PMCID: PMC7462050 DOI: 10.1093/ptj/pzaa099] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.
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Affiliation(s)
- Diane U Jette
- FAPTA, MGH, Institute of Health Professions, Boston, Massachusetts
| | | | - Lynn Burkett
- ONC, National Association of Orthopaedic Nurses (NAON), Wyomissing, Pennsylvania
| | - Bud Langham
- Home Health and Hospice Services, Encompass Health, Birmingham, Alabama
| | - David S Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, Pennsylvania
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Noreen M Poirier
- Department of Orthopedics and Rehabilitation, University of Wisconsin (UW) Health, Madison, Wisconsin
| | - Linda J L Radach
- Consumers United for Evidence Based Healthcare, Lake Forest Park, Washington
| | - Jennifer E Ritter
- Department of Rehabilitation Services/Physical Therapy, University of Pittsburgh Medical Center (UPMC) St Margaret Hospital/Catholic Relief Services, Pittsburgh, Pennsylvania
| | - David A Scalzitti
- OCS, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver & Health Sciences Center, Denver, Colorado
| | - James Tompkins
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona
| | - Joseph Zeni Jr
- Department of Physical Therapy, University of Delaware, Newark, Delaware
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19
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Vilallonga R, Pereira-Cunill JL, Morales-Conde S, Alarcón I, Breton I, Domínguez-Adame E, Ferrer JV, Ruiz-de-Gordejuela AG, Goday A, Lecube A, García-Almenta EM, Rubio MÁ, Tinahones FJ, García-Luna PP. A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity. Obes Surg 2020; 29:3842-3853. [PMID: 31342249 DOI: 10.1007/s11695-019-04043-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 12/11/2022]
Abstract
PURPOSE Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO). METHOD The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies. RESULTS Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76). CONCLUSION In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.
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Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J L Pereira-Cunill
- Clinical Nutritión Unit, Endocrinology and Nutrition Service, University Hospital "Virgen del Rocío", Seville, Spain
| | - S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
| | - I Breton
- Unidad de Nutrición Clínica y Dietética del Servicio de Endocrinología y Nutrición del Hospital Gregorio Marañón, Madrid, Spain
| | - E Domínguez-Adame
- UGC Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
| | | | - A Garcia Ruiz-de-Gordejuela
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Goday
- Servicio de Endocrinología, Hospital del Mar de Barcelona, Departament de Medicina, CIBERobn, ISCIII, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Lecube
- Servicio deEndocrinología y Nutrición, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Avda. Rovira Roure, 80 25198, Lleida, Spain
| | - E Martín García-Almenta
- Unidad Cirugía Esófago-Gástrica, Metabólica y Bariátrica, Hospital Clínico San Carlos, Madrid, Spain
| | - M Á Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Idissc, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - F J Tinahones
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Málaga, Spain
| | - P P García-Luna
- Unidad de Nutrición Clínica y de la Unidad de Obesidad Mórbida (Unidad de Gestión de Endocrinología y Nutrición, UGEN), Hospital Universitario Virgen del Rocío, Seville, Spain
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20
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Schultz P, Morvan JB, Fakhry N, Morinière S, Vergez S, Lacroix C, Bartier S, Barry B, Babin E, Couloigner V, Atallah I. French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:167-169. [PMID: 32307265 PMCID: PMC7144608 DOI: 10.1016/j.anorl.2020.04.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.
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Affiliation(s)
- P Schultz
- Service d'ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France.
| | - J-B Morvan
- Service d'ORL et de chirurgie cervico-faciale, hôpital d'instruction des armées Saint-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - N Fakhry
- Service d'ORL et de chirurgie cervico-faciale, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - S Morinière
- Service d'ORL et de chirurgie cervico-faciale, CHRU Bretonneau-Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - S Vergez
- Service d'ORL et de chirurgie cervico-faciale, CHU Rangueil-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France; Service de chirurgie, Institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France
| | - C Lacroix
- Service d'ORL et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - S Bartier
- Service d'ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France
| | - B Barry
- Service d'ORL et de chirurgie cervico-faciale, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France
| | - E Babin
- Service d'ORL et de chirurgie cervico-faciale, CHU Caen Normandie, avenue Côte de Nacre, 14000 Caen, France
| | - V Couloigner
- Service d'ORL et de chirurgie cervico-faciale pédiatriques, hôpital Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France
| | - I Atallah
- Service d'ORL et de chirurgie cervico-faciale, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
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Abstract
Approximately half of all pediatric tracheostomies are performed in infants younger than 1 year. Most tracheostomies in patients in the NICU are performed in cases of chronic respiratory failure requiring prolonged mechanical ventilation or upper airway obstruction. With improvements in ventilation and management of long-term intubation, indications for tracheostomy and perioperative management in this population continue to evolve. Evidence-based protocols to guide routine postoperative care, prevent and manage tracheostomy emergencies including accidental decannulation and tube obstruction, and attempt elective decannulation are sparse. Clinician awareness of safe tracheostomy practices and larger, prospective studies in infants are needed to improve clinical care of this vulnerable population.
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Affiliation(s)
- Julia Chang
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
| | - Douglas R Sidell
- Department of Otolaryngology, Head and Neck Surgery. Stanford University School of Medicine, Stanford, CA
- Stanford Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford, CA
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Abstract
As metabolic and bariatric surgery (MBS) increasingly becomes a treatment of choice for adolescents with severe obesity, there is a need to understand how to deliver pre- and postoperative care in ways that maximize long-term safety and efficacy. This article describes major pre- and postoperative goals, lifestyle modification targets, and, when necessary, pharmacologic management strategies for adolescents undergoing MBS. Three categories of evidence were used-studies of pre- and postoperative interventions and factors influencing MBS outcomes in adolescents, studies of pre- and postoperative associations and interventions in adults, and studies of non-surgical weight management applicable to adolescents pursuing MBS. Finally, priority areas for future research within this topic are identified.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States.
| | - Matthew A Haemer
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN 55455, United States
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23
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Abstract
UNLABELLED This study investigates if the day of the week a person is admitted with a hip fracture influences the quality of care they receive. We found those admitted Thursday and Friday were likely to obtain poorer postoperative care, indicating a need to optimize services ensuring equality for all. PURPOSE We sought to investigate how the day of admission affects the quality of care provided to hip fracture patients according to national standards (The Scottish Standards of Care for Hip Fracture Patients [SSCHFP]). METHODS Retrospective analysis of national cohort data. Data were collected by the Scottish Hip Fracture Audit (SHFA) local audit co-ordinators (LACs) at participating Scottish hospitals on behalf of NHS Scotland and the Scottish Government. Adherence to the SSCHFP included assessment of both individual and cumulative standard attainment as a marker for quality of patient care. RESULTS From January 2014 to April 2018, 15,351 admissions for hip fracture were recorded. Compared with Monday admission (reference day), patients admitted on a Thursday or Friday had a significantly lower likelihood of achieving the postoperative standards of prompt mobilization (OR 1.77; p < 0.001 & OR 1.48; p < 0.001, respectively); prompt physiotherapy assessment (OR 8.61; p < 0.001 & OR 3.47; p < 0.001, respectively); and prompt comprehensive geriatric assessment (OR 1.88; p < 0.001 & OR 1.41; p < 0.001, respectively). Patients admitted on a Friday or Saturday were less likely to receive the preoperative standards of no delay prior to theatre (OR 1.24; p = 0.001 & OR 1.23; p = 0.002, respectively) and avoidance of repeat fasting (OR 1.22; p = 0.009 & OR 1.22; p = 0.01, respectively). CONCLUSION Patients admitted on Thursday or Friday were significantly more likely to not receive postoperative care standards than patients admitted on the reference day (Monday). This appears to be related to inequalities in service provision for Saturday and Sunday compared with the rest of the week.
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Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | | | - Lorna Aucott
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme Holt
- University Hospital Crosshouse, Kilmarnock, UK
| | - Phyo K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Kay AH, Venn M, Urban R, Gray HJ, Goff B. Postoperative narcotic use in patients with ovarian cancer on an Enhanced Recovery After Surgery (ERAS) pathway. Gynecol Oncol 2019; 156:624-628. [PMID: 31882241 DOI: 10.1016/j.ygyno.2019.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the impact of an ERAS pathway on post-discharge narcotic use for patients with ovarian cancer undergoing open surgery. METHODS This was a retrospective cohort study of women who underwent open ovarian cancer surgeries in 2014 prior to ERAS ("pre-ERAS") and in 2016/2018 after ERAS was instituted ("ERAS"). Patients taking chronic narcotics were excluded. A statewide prescription monitoring program was used to identify narcotic prescriptions filled in the three months after surgery. Quantity of narcotic medication is referenced in morphine milligram equivalents (MME). RESULTS 42 pre-ERAS and 94 ERAS patients were included. The groups were similar in age, BMI, diabetes, tobacco use, mean number of prior abdominal/pelvic surgeries, and advanced stage disease. ERAS patients had a shorter hospital stay (6.7 days pre-ERAS vs 4.2 days ERAS, p = 0.003), used less narcotic in the 24 h prior to discharge (74.0 MME pre-ERAS vs 25.8 MME ERAS, p = 0.002), and filled prescriptions at time of discharge for less narcotic (519.9 MME pre-ERAS vs 339.7 MME ERAS, p = 0.011). After hospital discharge, ERAS patients filled fewer additional prescriptions (52.4% pre-ERAS, vs 29.4% ERAS, p = 0.012). In total, ERAS patients filled prescriptions for 55% fewer narcotics in the three months after surgery than the pre-ERAS group (1101.4 MME pre-ERAS vs 492.1 MME ERAS, p < 0.001). CONCLUSIONS Institution of an ERAS protocol appears to decrease the narcotic needs of patients in the three months after ovarian cancer surgery.
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Affiliation(s)
- Allison H Kay
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America.
| | - Monica Venn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Renata Urban
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
| | - Barbara Goff
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195, United States of America
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Franc BL, Copeland TP, Thombley R, Park M, Marafino B, Dean ML, Boscardin WJ, Rugo HS, Seidenwurm D, Sharma B, Johnston SR, Dudley RA. Geographic Variation in Postoperative Imaging for Low-Risk Breast Cancer. J Natl Compr Canc Netw 2019; 16:829-837. [PMID: 30006425 DOI: 10.6004/jnccn.2018.7024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/12/2018] [Indexed: 11/17/2022]
Abstract
Background: The objective of this study was to examine the presence and magnitude of US geographic variation in use rates of both recommended and high-cost imaging in young patients with early-stage breast cancer during the 18 month period after surgical treatment of their primary tumor. Methods: Using the Truven Health MarketScan Commercial Database, a descriptive analysis was conducted of geographic variation in annual rates of dedicated breast imaging and high-cost body imaging of 36,045 women aged 18 to 64 years treated with surgery for invasive unilateral breast cancer between 2010 and 2012. Multivariate hierarchical analysis examined the relationship between likelihood of imaging and patient characteristics, with metropolitan statistical area (MSA) serving as a random effect. Patient characteristics included age group, BRCA1/2 carrier status, family history of breast cancer, combination of breast surgery type and radiation therapy, drug therapy, and payer type. All MSAs in the United States were included, with areas outside MSAs within a given state aggregated into a single area for analytic purposes. Results: Descriptive analysis of rates of imaging use and intensity within MSA regions revealed wide geographic variation, irrespective of treatment cohort or age group. Increased probability of recommended postoperative dedicated breast imaging was primarily associated with age and treatment including both surgery and radiation therapy, followed by MSA region (odds ratio, 1.42). Increased probability of PET use-a high-cost imaging modality for which postoperative routine use is not recommended in the absence of specific clinical findings-was primarily associated with surgery type followed by MSA region (odds ratio, 1.82). Conclusions: In patients with breast cancer treated for low-risk disease, geography has effects on the rates of posttreatment imaging, suggesting that some patients are not receiving beneficial dedicated breast imaging, and high-cost nonbreast imaging may not be targeted to those groups most likely to benefit.
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MESH Headings
- Adult
- Antineoplastic Agents, Hormonal/therapeutic use
- Breast/diagnostic imaging
- Breast/pathology
- Breast/surgery
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Chemoradiotherapy, Adjuvant/standards
- Databases, Factual/statistics & numerical data
- Diagnostic Imaging/economics
- Diagnostic Imaging/methods
- Diagnostic Imaging/statistics & numerical data
- Facilities and Services Utilization/economics
- Facilities and Services Utilization/statistics & numerical data
- Female
- Geography
- Humans
- Mastectomy
- Middle Aged
- Neoplasm Recurrence, Local/diagnostic imaging
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Neoplasms, Second Primary/diagnostic imaging
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/therapy
- Postoperative Care/economics
- Postoperative Care/standards
- Postoperative Care/statistics & numerical data
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant/statistics & numerical data
- Retrospective Studies
- United States
- Young Adult
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26
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Moustafa GA, Borkar DS, Borboli-Gerogiannis S, Greenstein SH, Lorch AC, Vasan RA, Kloek CE. Optimization of cataract surgery follow-up: A standard set of questions can predict unexpected management changes at postoperative week one. PLoS One 2019; 14:e0221243. [PMID: 31536500 PMCID: PMC6752806 DOI: 10.1371/journal.pone.0221243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose There is limited evidence to inform the optimal follow-up schedule after cataract surgery. This study aims to determine whether a standardized question set can predict unexpected management changes (UMCs) at the postoperative week one (POW1) timepoint. Setting Massachusetts Eye and Ear, Harvard Medical School. Design Prospective cohort study. Methods Two-hundred-and-fifty-four consecutive phacoemulsification cases having attended an examination between postoperative days 5–14. A set of 7 ‘Yes’ or ‘No’ questions were administered to all participants by a technician at the POW1 visit. Patient answers along with perioperative patient information were recorded and analyzed. Outcomes were the incidence of UMCs at POW1. Results The incidence of UMCs was zero in uneventful cataract cases with unremarkable history and normal postoperative day one exam if no positive answers were given with the question set demonstrating 100% sensitivity (p<0.0001). A test version with 5 questions was equally sensitive in detecting UMCs at POW1 after cataract surgery. Conclusion In routine cataract cases with no positive answers to the current set of clinical questions, a POW1 visit is unlikely to result in a management change. This result offers the opportunity for eye care providers to risk-stratify patients who have had cataract surgery and individualize follow-up.
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Affiliation(s)
- Giannis A. Moustafa
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Durga S. Borkar
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania, United States of America
| | - Sheila Borboli-Gerogiannis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Scott H. Greenstein
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alice C. Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan A. Vasan
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carolyn E. Kloek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States of America
- * E-mail:
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Heathcote S, Duggan K, Rosbrugh J, Hill B, Shaker R, Hope WW, Fillion MM. Enhanced Recovery after Surgery (ERAS) Protocols Expanded over Multiple Service Lines Improves Patient Care and Hospital Cost. Am Surg 2019; 85:1044-1050. [PMID: 31638522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.
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Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L, Nelson G, Wilson RD. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol 2019; 221:247.e1-247.e9. [PMID: 30995461 DOI: 10.1016/j.ajog.2019.04.012] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [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: 02/11/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. OBJECTIVE The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge. STUDY DESIGN The literature search (1966-2017) used Embase and PubMed to search medical subject headings that included "Cesarean Section," "Cesarean Delivery," "Cesarean Section Delivery," and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines. RESULTS The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence. CONCLUSION As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.
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Affiliation(s)
- George A Macones
- Department of Obstetrics & Gynecology, Washington University in St Louis, St. Louis, MO.
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Stephen L Wood
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian J Wrench
- Sheffield Teaching Hospitals Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom
| | | | - Mikael Norman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Pettersson
- Division of Obstetrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital, Egerton Road, Guildford, United Kingdom
| | - Medhat M Shalabi
- Departments of Anesthesiology and Intensive Care, Alzahra Hospital, Dubai, United Arab Emirates
| | - Amy Metcalfe
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
| | - R Douglas Wilson
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR
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Gabbard J, Breznau C, Marterre B. Palliative Management Pearls for Postbariatric Surgery Patients #373. J Palliat Med 2019; 22:591-592. [PMID: 31063445 DOI: 10.1089/jpm.2019.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Garmpis N, Dimitroulis D, Garmpi A, Diamantis E, Spartalis E, Schizas D, Angelou A, Margonis GA, Farmaki P, Antoniou EA, Mantas D, Markatos K, Kontzoglou K, Damaskos C. Enhanced Recovery After Surgery: Is It Time to Change Our Strategy Regarding Laparoscopic Colectomy? In Vivo 2019; 33:669-674. [PMID: 31028183 PMCID: PMC6559898 DOI: 10.21873/invivo.11525] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/10/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 02/08/2023]
Abstract
Enhanced recovery after surgery or 'fast-track' methods are evidence-based protocols designed to standardize post-operative medical care, improve patient outcomes, promote early recovery, and reduce healthcare expenditure. Fast-track surgery is a multifunctional concept involving pre-, peri- and post-operative measures aiming to reduce the length of hospital stay and morbidity and complication rates, following elective abdominal surgery. Through the optimization of peri-operative care and the recovery process in adherence to these fast-track protocols, improved outcomes are reached, surgical trauma and post-operative stress are reduced, with less surgical pain, reduced complications, and shorter length of hospital stay. Fast-track care requires a multidisciplinary collaboration of all healthcare professionals, as well as a high rate of protocol compliance and a good organizational structure. Despite the existing evidence of the benefits of fast-track protocols in a variety of surgical procedures and the similar outcomes of laparoscopic colonic surgery compared to open surgery, clear evidence of the benefits of fast-track care after laparoscopic colonic surgery is yet to be clearly demonstrated.
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Affiliation(s)
- Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Garmpi
- Internal Medicine Department, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleftherios Spartalis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Paraskevi Farmaki
- First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios A Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kontzoglou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Wu XD, Xiao PC, Zhu ZL, Liu JC, Li YJ, Huang W. The necessity of routine postoperative laboratory tests in enhanced recovery after surgery for primary hip and knee arthroplasty: A retrospective cohort study protocol. Medicine (Baltimore) 2019; 98:e15513. [PMID: 31045842 PMCID: PMC6504266 DOI: 10.1097/md.0000000000015513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Over the last few decades, the concepts of minimally invasive surgery and enhanced recovery after surgery (ERAS) protocols have been introduced into the field of total joint arthroplasty (TJA), and tranexamic acid (TXA) has been widely used in TJA. Modern-day surgical techniques and perioperative care pathways of TJA have experienced unexpected improvements. Recently, the necessity of the practice of ordering routine postoperative laboratory tests for patients undergoing primary TJA has been challenged, especially in the context of implementation of ERAS protocols in TJA. These studies have consistently suggested that routine postoperative laboratory tests are not necessary in modern-day primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), and laboratory tests after surgery should only be obtained for patients with risk factors. However, it remains unclear whether routine postoperative laboratory tests after THA and TKA remains justified in the Chinese patient population. Therefore, we developed this study to address this issue. METHODS AND ANALYSIS This retrospective cohort study will include adult patients who underwent primary unilateral THA or TKA and received multimodal perioperative care pathways according to ERAS protocols. The following patient data will be collected from the electronic medical record system: patients' demographics, preoperative and postoperative laboratory values, operation time, intraoperative blood loss, TXA use, tourniquet use, postoperative length of stay, and any medical intervention directly related to abnormal laboratory values. The main study outcomes are the incidence of acute anemia requiring transfusion and incidence of hypoalbuminemia requiring albumin supplementation. The secondary outcomes are the rates of acute kidney injury, incidence of abnormal serum sodium level, incidence of abnormal serum potassium level, and incidence of abnormal serum calcium level. These clinical data will be analyzed to determine the incidence of abnormal postoperative laboratory values following primary unilateral THA and TKA; to clarify the frequency of any medical intervention directly related to abnormal postoperative laboratory values; and to identify risk factors that predispose patients to have abnormal postoperative laboratory results. STUDY REGISTRATION Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900020690.
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Dowdy SC. Enhanced recovery after surgery for ovarian cancer. Clin Adv Hematol Oncol 2019; 17:217-219. [PMID: 31188812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sean C Dowdy
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Chai NL, Li HK, Linghu EQ, Li ZS, Zhang ST, Bao Y, Chen WG, Chiu PWY, Dang T, Gong W, Han ST, Hao JY, He SX, Hu B, Hu B, Huang XJ, Huang YH, Jin ZD, Khashab MA, Lau J, Li P, Li R, Liu DL, Liu HF, Liu J, Liu XG, Liu ZG, Ma YC, Peng GY, Rong L, Sha WH, Sharma P, Sheng JQ, Shi SS, Seo DW, Sun SY, Wang GQ, Wang W, Wu Q, Xu H, Xu MD, Yang AM, Yao F, Yu HG, Zhou PH, Zhang B, Zhang XF, Zhai YQ. Consensus on the digestive endoscopic tunnel technique. World J Gastroenterol 2019; 25:744-776. [PMID: 30809078 PMCID: PMC6385014 DOI: 10.3748/wjg.v25.i7.744] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/19/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
With the digestive endoscopic tunnel technique (DETT), many diseases that previously would have been treated by surgery are now endoscopically curable by establishing a submucosal tunnel between the mucosa and muscularis propria (MP). Through the tunnel, endoscopic diagnosis or treatment is performed for lesions in the mucosa, in the MP, and even outside the gastrointestinal (GI) tract. At present, the tunnel technique application range covers the following: (1) Treatment of lesions originating from the mucosal layer, e.g., endoscopic submucosal tunnel dissection for oesophageal large or circular early-stage cancer or precancerosis; (2) treatment of lesions from the MP layer, per-oral endoscopic myotomy, submucosal tunnelling endoscopic resection, etc.; and (3) diagnosis and treatment of lesions outside the GI tract, such as resection of lymph nodes and benign tumour excision in the mediastinum or abdominal cavity. With the increasing number of DETTs performed worldwide, endoscopic tunnel therapeutics, which is based on DETT, has been gradually developed and optimized. However, there is not yet an expert consensus on DETT to regulate its indications, contraindications, surgical procedure, and postoperative treatment. The International DETT Alliance signed up this consensus to standardize the procedures of DETT. In this consensus, we describe the definition, mechanism, and significance of DETT, prevention of infection and concepts of DETT-associated complications, methods to establish a submucosal tunnel, and application of DETT for lesions in the mucosa, in the MP and outside the GI tract (indications and contraindications, procedures, pre- and postoperative treatments, effectiveness, complications and treatments, and a comparison between DETT and other operations).
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Affiliation(s)
- Ning-Li Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hui-Kai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yu Bao
- Department of Gastroenterology and Hepatology, Sichuan Cancer Hospital and Institute, Chengdu 610000, Sichuan Province, China
| | - Wei-Gang Chen
- Department of Gastroenterology, First Affiliated Hospital of School of Medicine, Shihezi University, Shihezi 832002, Xinjiang Uygur Autonomous Region, China
| | - Philip WY Chiu
- Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Tong Dang
- Department of Gastroenterology, the Second Affiliated Hospital of Baotou Medical College, Baotou 014030, Inner Mongolia Autonomous Region, China
| | - Wei Gong
- Department of Gastroenterology, Shenzhen Hospital of Southern Medical University, Shenzhen 518000, Guangdong Province, China
| | - Shu-Tang Han
- Gastrointestinal Endoscopy Center, Affiliated Hospital of Nanjing Traditional Chinese Medicine University, Nanjing 210029, Jiangsu Province, China
| | - Jian-Yu Hao
- Department of Gastroenterology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shui-Xiang He
- Department of Gastroenterology, the First Affiliated Hospital of Xi’an Jiao Tong University, Xi’an 710000, Shaanxi Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Endoscopy, Eastern Hepatobiliary Surgical Hospital Affiliated to Naval Medical University, Shanghai 200438, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Endoscopy, Eastern Hepatobiliary Surgical Hospital Affiliated to Naval Medical University, Shanghai 200438, China
| | - Xiao-Jun Huang
- Department of Gastroenterology, the Second Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China
| | - Yong-Hui Huang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
| | - Zhen-Dong Jin
- Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, the Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - James Lau
- Department of Gastrointestinal Endoscopy, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Peng Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Rui Li
- Department of Gastroenterology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - De-Liang Liu
- Department of Gastroenterology, Second Xiangya Hospital of Central South University, Changsha 410000, Hunan Province, China
| | - Hai-Feng Liu
- Department of Gastroenterology, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China
| | - Jun Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xiao-Gang Liu
- Department of Gastroenterology, Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
| | - Zhi-Guo Liu
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
| | - Ying-Cai Ma
- Department of Digestion, Qinghai Provincial People’s Hospital, Xining 810007, Qinghai Province, China
| | - Gui-Yong Peng
- Department of Gastroenterology, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Long Rong
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Hong Sha
- Department of Gastroenterology and Hepatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong Province, China
| | | | - Jian-Qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing 100700, China
| | - Shui-Sheng Shi
- Endoscopy Center, the Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | | | - Si-Yu Sun
- Endoscopy Center, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Gui-Qi Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100020, China
| | - Wen Wang
- Department of General Surgery, Fuzhou General Hospital, Fuzhou 350025, Fujian Province, China
| | - Qi Wu
- Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hong Xu
- Endoscopy Center, the First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Mei-Dong Xu
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ai-Ming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Fang Yao
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100020, China
| | - Hong-Gang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan University, Wuhan 430060, Hubei Province, China
| | - Ping-Hong Zhou
- Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Bin Zhang
- Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Hangzhou 310006, Zhejiang Province, China
| | - Ya-Qi Zhai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
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Costa Romero M, Lalaguna Mallada P, Díaz Gómez NM. [Skin to skin contact after cesarean delivery.Theme update and actuation proposal]. Rev Esp Salud Publica 2019; 93:e201902006. [PMID: 30773531 PMCID: PMC10308826] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 01/31/2019] [Indexed: 06/09/2023] Open
Abstract
Skin to skin contact (SSC) between mother and child immediately after birth is now considered to be an indicator of good clinical practice as it offers multiple benefits for both: it reduces stress levels of the mother, it facilitates affective bonding, breastfeeding and the newborns adaptation to extra-uterine life. However, in the vast majority of hospitals, mother and child are separated until complete recovery following a caesarean section, which can be several hours. In this article the advantages of SSC after a caesarean section, were analyzed, as well as the main difficulties in order to carry it out, which include maternal or neonatal instability and the reticence of the professionals themselves. An actuation procedure model is detailed, for its implementation in a safe manner and that at the same time, contribute to humanize the birth.
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Affiliation(s)
- Marta Costa Romero
- Neonatología. Hospital Universitario de Cabueñes. Gijón. Asturias. España
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Qazi SH, Dogar SA, Dogar SA, Fitzgerald T, Saleem A, Das JK. Global perspective of paediatric surgery in low and middle income countries. J PAK MED ASSOC 2019; 69(Suppl 1):S108-S111. [PMID: 30697032] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is huge burden of paediatric surgical diseases in low and middle income countries. Issues behind such a scenario include lack of trained paediatric surgeons, higher mortality due to infections, and poor postoperative care. The possible solution is improvement in the existing structure, which is government hospitals, because they are the most prevalent form of healthcare delivery in such countries. Proper coding system, research and identification of paediatric bellwether procedures can improve the existing health system. Task shifting and sharing can help in many areas. The doctors leaving their countries for better training and employment options should be properly incentivised locally. A lot can be done in terms of providing infrastructure, finances, changing mind-sets, developing expertise, making registry and rehabilitation. By doing so, millions of paediatric mortalities can be prevented in low and middle income countries.
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Affiliation(s)
| | | | | | | | - Ayesha Saleem
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes chronic, disabling and progressive conditions that need a complex approach and management. Although several attempts have been made to standardize the care of IBD patients, no clear definitions of a global 'standard of care' are currently available. METHODS We performed a systematic review of the available literature, searching for all relevant data concerning three main domains of standards of quality of care in IBD patients: structure, process and outcomes. From the literature search, 2394 abstracts were retrieved, and 62 relevant papers were included in the final review. RESULTS Standards of quality of care in IBD include several aspects that can be summarized in three identified domains: structure, process and outcomes. The suggested structure of an IBD Unit includes a multi-disciplinary approach, effective referral processes, improved access using helplines, and departmental guidelines/pathways with identification of measurable quality indicators. Coordinated care models which incorporate a multi-disciplinary approach, structured clinical pathways or processes for the diagnosis, monitoring and treatment of IBD, fast-track recovery from IBD surgery, designated IBD clinics, virtual clinics and telemanagement are currently considered the main standards for process, although supporting data are limited. Several consensus statements on outcomes and quality indicators have been reported, focusing on outcomes in symptoms, function and quality of life restoration, survival and disease control, in addition to effective healthcare utilization. CONCLUSIONS The results of this systematic review can provide the basis for general recommendations for standards of quality of care in IBD.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Mariangela Allocca
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Maria Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Sofie Coenen
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Catarina Fidalgo
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal
| | - Lisa Younge
- Barts Health - Royal London Hospital, London, UK
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Beyaz S. Do diabetic patients who undergo transtibial amputation receive adequate treatment? Ann Ital Chir 2019; 90:335-340. [PMID: 30946028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
AIMS To determine if patients who undergo below-knee amputation (BKA) for intractable wounds caused by diabetes complications receive adequate treatment before surgery. MATERIALS AND METHODS The study included a total of 528 patients who underwent transtibial amputation for diabetic foot. All patients were assessed on the basis of duration of preoperative treatment, HbO therapy, negative wound pressure therapy (NPWT), peripheral vascular angioplasty (PVA) treatment, wound cultures, antibiotic medications, consultations with plastic and vascular surgeons, need for hemodialysis treatment, use of anticoagulant treatment as an inpatient, and assessment of blood sugar regulation by an endocrinologist. HbA1c, BUN, Creatinine, ESR, and CRP values attained for preoperative assessment were noted. RESULTS Eighteen patients (3.5%) received HbO therapy, 35 (6.7%) NPWT therapy and 347 (65.7%) anticoagulant treatment. Wound cultures were taken in 317 patients (60.5%) and 390 (73.9%) received preoperative antibiotic treatment. 45 (8.6%) patients were assessed by plastic surgeon with 22 (4.2%) subsequently undergoing surgery by the plastic surgeon. Vascular surgeons assessed 163 patients (30.9%) and performed procedures on 45 patients (8.6%). Endocrinologists assessed 316 patients (59.8%) and implemented blood sugar regulation. PVA treatment was performed in 246 patients (46.6%). Patients who were managed medically for more than 7 days after the initial assessment received more HbO therapy (p=0.037), anticoagulant treatment (p=0.015), IV antibiotics (0.001), blood sugar regulation attempts (p=0.001), and PVA therapy (0.001) and had more cultures taken (p=0.001). These patients also received overall more diagnostic and treatment modalities than those that received definitive surgical intervention within 7 days. CONCLUSIONS The duration of time patients with diabetes-related foot problems who see orthopedic surgeons for longer periods of time receive more treatment modalities and are referred more often to specialists before transtibial amputation surgery. We believe that delayed presentation is one of the main obstacles prohibiting adequate treatment for these patients. KEY WORDS Diabetic foot, Transtibial amputation, Treatment.
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Bajsová S, Klát J. ERAS protocol in gynecologic oncology. Ceska Gynekol 2019; 84:376-385. [PMID: 31826636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN Review article. SETTINGS Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.
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Gibb ACN, Crosby MA, McDiarmid C, Urban D, Lam JYK, Wales PW, Brockel M, Raval M, Offringa M, Skarsgard ED, Wester T, Wong K, de Beer D, Nelson G, Brindle ME. Creation of an Enhanced Recovery After Surgery (ERAS) Guideline for neonatal intestinal surgery patients: a knowledge synthesis and consensus generation approach and protocol study. BMJ Open 2018; 8:e023651. [PMID: 30530586 PMCID: PMC6303622 DOI: 10.1136/bmjopen-2018-023651] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Enhanced Recovery After Surgery (ERAS) guidelines integrate evidence-based practices into multimodal care pathways designed to optimise patient recovery following surgery. The objective of this project is to create an ERAS protocol for neonatal abdominal surgery. The protocol will identify and attempt to bridge the gaps between current practices and best evidence. Our study is the first paediatric ERAS protocol endorsed by the International ERAS Society. METHODS A research team consisting of international clinical and family stakeholders as well as methodological experts have iteratively defined the scope of the protocol in addition to individual topic areas. A modified Delphi method was used to reach consensus. The second phase will include a series of knowledge syntheses involving a rapid review coupled with expert opinion. Potential protocol elements supported by synthesised evidence will be identified. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to determine strength of recommendations and the quality of evidence. The third phase will involve creation of the protocol using a modified RAND/UCLA Appropriateness Method. Group consensus will be used to rate each element in relation to the quality of evidence supporting the recommendation and the appropriateness for guideline inclusion. This protocol will form the basis of a future implementation study. ETHICS AND DISSEMINATION This study has been registered with the ERAS Society. Human ethics approval (REB 18-0579) is in place to engage patient families within protocol development. This research is to be published in peer-reviewed journals and will form the care standard for neonatal intestinal surgery.
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Affiliation(s)
- Ashleigh C N Gibb
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Megan A Crosby
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Caraline McDiarmid
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Denisa Urban
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Y K Lam
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul W Wales
- Department of Pediatric Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Megan Brockel
- Department of Pediatric Anesthesia, University of Colorado, Aurora, Colorado, USA
| | - Mehul Raval
- Department of Pediatric Anesthesia, University of Colorado, Aurora, Colorado, USA
- Department of Pediatric Surgery, Northwestern University, Chicago, Illinois, USA
| | - Martin Offringa
- Department of Neonatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Erik D Skarsgard
- Department of Pediatric Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Tomas Wester
- Department of Pediatric Surgery, Karolinska University, Stockholm, Sweden
| | - Kenneth Wong
- Department of Surgery, University of Hong Kong, Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - David de Beer
- Department of Pediatric Anesthesia, Great Ormond Street Hospital, London, UK
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary E Brindle
- Department of Surgery, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Martin TJ, Patel SA, Tran M, Eltorai AS, Daniels AH, Eltorai AEM. Patient Factors Associated with Successful Incentive Spirometry. R I Med J (2013) 2018; 101:14-18. [PMID: 30384513] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Incentive spirometers (IS) are commonly prescribed after various surgical procedures with the intended effect of reducing postoperative pulmonary complications. Factors associated with correct use of IS by postoperative patients has not previously been studied. METHODS A cross-sectional analysis of postoperative patients was completed to assess whether patients knew how to correctly inhale on their IS. For each patient, the following variables were collected: whether the device was within arm's reach of the patient, if the patient reported having used their IS, if they considered the IS to be helpful, and if they felt more confident using IS after a brief educational intervention was performed by study investigators. RESULTS A total of 26.2% (11/42) of patients failed to use their IS correctly, and 38.1% (16/42) denied ever using the device in their postoperative care. Device location, perceived benefit, and previous use were identified as statistically significant determinants of successful use. Following a brief educational intervention by a physician, 73.8% (31/42) of patients were more confident in their ability to use IS during the remainder of their care. DISCUSSION A substantial portion of postoperative patients failed to correctly utilize their IS. Device proximity to the patient, patient perspectives on potential benefits of IS, and previous use of the device may affect correct use. Patient education and optimization of device placement should be considered to increase compliance during IS implementation.
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Affiliation(s)
- Thomas J Martin
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Shyam A Patel
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Megan Tran
- Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Alan H Daniels
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, RI
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Park RCW, Bresler AY, Bansal AP, Baredes S. Outcomes in microvascular head and neck reconstruction in the setting of restricted residency hours. Am J Otolaryngol 2018; 39:522-526. [PMID: 29903624 DOI: 10.1016/j.amjoto.2018.06.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Resident duty hour restrictions can limit the frequency of resident flap checks at smaller institutions with "home" call. Institutions are compensating with adjuvant nursing flap checks as well as incorporating technology; however, this management remains controversial. METHODS A prospective cohort of 122 free flaps for reconstruction of the head and neck by a single surgeon. Demographic information, operative details, postoperative care, and flap outcomes were recorded. RESULTS Over 42 months, 122 free flaps were performed on 115 patients. The overall flap success rate was 96%. The flap success rate at 72 h was 98% and 96% at the time of discharge with reexploration rates of 11.6%. The intraoperative and postoperative salvage rates were 71% and 64.3% respectively. CONCLUSION Limited resident flap checks combined hourly nurse flap checks and an implantable Doppler is an effective monitoring protocol for academic programs in the setting of residency duty hour restrictions.
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Affiliation(s)
- Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States.
| | - Amishav Y Bresler
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Amy P Bansal
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, United States
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Jiang W, Wang L, Zhang J, Shen H, Dong W, Zhang T, Li X, Wang K, Du J. Effects of postoperative non-steroidal anti-inflammatory drugs on long-term survival and recurrence of patients with non-small cell lung cancer. Medicine (Baltimore) 2018; 97:e12442. [PMID: 30278522 PMCID: PMC6181525 DOI: 10.1097/md.0000000000012442] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve postoperative fever, surgery pain, and inflammation. In addition, NSAIDs have anticancer activity and may reduce the risk and mortality of several cancers. However, the association between postoperative NSAIDs and the clinical outcome of non-small cell lung cancer (NSCLC) patients with fever after surgery is not fully understood. We performed a retrospective study of NSCLC patients who underwent surgery between July 2011 and June 2012, aiming to evaluate the effect of postoperative NSAIDs on overall survival (OS) and progression-free survival (PFS). Differences in clinical data between the postoperative NSAIDs group and non-NSAIDs groups were analyzed by Chi-square tests. Kaplan-Meier curves method and Cox regression analysis were conducted for survival analysis. The primary and secondary endpoints were OS and PFS, respectively. This retrospective study included 347 NSCLC patients. There were no significant differences in the clinical characteristics between the NSAIDs group and non-NSAIDs group except for age (P = .024) and differential degree (P = .040). Administration of postoperative NSAIDs was related to longer OS (hazards ratio [HR] 0.528, 95% confidence interval [CI] 0.278-0.884, P = .006) and longer PFS (HR 0.557, 95% CI 0.317-0.841, P = .002) in the multivariate Cox regression model. Subgroup analysis showed statistically significant differences in elderly individuals, male subjects, low smoking index, poor differentiation, and non-adenocarcinoma subgroups, respectively. In conclusion, the administration of postoperative NSAIDs was related to longer OS and PFS in NSCLC patients with postoperative fever.
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Affiliation(s)
- Wensheng Jiang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
- Department of Cardiothoracic Surgery, Yantaishan Hospital, Yantai
| | - Liguang Wang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | - Jiangang Zhang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | - Hongchang Shen
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | | | - Tiehong Zhang
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
| | | | - Kai Wang
- Department of Healthcare Respiratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Jiajun Du
- Institute of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan
- Department of Thoracic Surgery
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Vrijmoeth T, Kramers C, Dahan A, Koelemay MJW. [Prevention of prolonged opioid use after surgery]. Ned Tijdschr Geneeskd 2018; 162:D2802. [PMID: 30209901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In the last decade, the number of opioid users in the Netherlands is sharply increasing. Opioids are the cornerstone of postoperative pain management. The postoperative period is therefore an important period to be aware of needless and possible persistent opioid use. Identification of patients at risk for persistent opioid use, limitation of opioid prescriptions and clear guidelines and communication about the follow-up of postoperative pain will be necessary to prevent opioid misuse. Awareness of the above-mentioned measures will hopefully help to stop further growth of opioid use, and thereby avert an American scenario.
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Affiliation(s)
| | - C Kramers
- Radboudumc, afd. Farmacologie, Toxicologie en Interne Geneeskunde, Nijmegen
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Shelton FR, Ishii H, Mella S, Chew D, Winterbottom J, Walijee H, Brown R, Chisholm EJ. Implementing a standardised discharge analgesia guideline to reduce paediatric post tonsillectomy pain. Int J Pediatr Otorhinolaryngol 2018; 111:54-58. [PMID: 29958614 DOI: 10.1016/j.ijporl.2018.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Received: 02/04/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To reduce readmission for pain control post-paediatric tonsillectomy. INTRODUCTION Paediatric tonsillectomy is a common procedure in the UK. Uncontrolled pain at home is a common reason for re-admission and therefore adequate analgesic control following paediatric tonsillectomy is vital for a smooth post-operative recovery. Analgesic regimens at a district general hospital in England were audited and a standardised protocol was subsequently implemented. METHODS A retrospective audit from September 2014 to August 2015 was completed. Discharge analgesic regimens and readmission rates post-tonsillectomy for recurrent tonsillitis in 2-17 year-old children were studied in a large general hospital in the United Kingdom. A standardised weight-based algorithm was used to dose scheduled regular paracetamol for 2 weeks. Second cycle prospective audit ran from December 2015 to November 2016. RESULTS In cycle 1, 151 children (mean age, 7.9 years) underwent tonsillectomy for tonsillitis, 25 (16.6%) of whom were readmitted. 12 (7.9%) experienced postoperative haemorrhage, 13 (8.6%) required pain control, and one (1.2%) had infection. The discharging analgesic regimen varied widely and often included purchase of over-the-counter ibuprofen and paracetamol. In cycle 2, 118 children (mean age, 8.8 years) underwent tonsillectomy, 17 (14.4%) were readmitted; 12 (10.2%) had post-operative haemorrhage, 0 needed pain control, 5 (4.2%) had other problems. There was a significant reduction in readmission for pain control (p = 0.0027) from 7.3% to 0% in the study. There was no significant change in overall readmission rate (16.6%-14.4%) or postoperative haemorrhage rate (8.9% overall). DISCUSSION Analgesia prescription post tonsillectomy varies widely and over the counter prescriptions of ibuprofen and paracetamol is based on age rather than weight with patients receiving inadequate analgesic doses. A readily available standardised postoperative analgesic protocol can significantly reduce readmission rates for pain control following paediatric tonsillectomy.
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Affiliation(s)
- Fenella R Shelton
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK.
| | - Hirotaka Ishii
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Sophie Mella
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Dylan Chew
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Jemma Winterbottom
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Hussein Walijee
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Rachel Brown
- Department of Anaesthesia, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
| | - Edward J Chisholm
- Department of Otolaryngology and Head and Neck Surgery, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, UK
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White EM, Smith JG, Trotta RL, McHugh MD. Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce. J Am Geriatr Soc 2018; 66:1137-1143. [PMID: 29558568 PMCID: PMC6105464 DOI: 10.1111/jgs.15355] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/21/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD. DESIGN Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states. SETTING Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531). PARTICIPANTS Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170). MEASUREMENTS Thirty-day mortality and failure to rescue (death after a complication). RESULTS Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92-0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. CONCLUSION Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.
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Affiliation(s)
- Elizabeth M White
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica G Smith
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca L Trotta
- University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Lorenc ZP, Ablon G, Few J, Gold MH, Goldberg DJ, Mandy S, Nestor MS, Weinkle SH. Expert Consensus on Achieving Optimal Outcomes With Absorbable Suspension Suture Technology for Tissue Repositioning and Facial Recontouring. J Drugs Dermatol 2018; 17:647-655. [PMID: 29879252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A complete approach to facial rejuvenation includes restoration of the skin's surface, relaxation of muscles that contribute to hyperkinetic movement, revolumization, and repositioning/recontouring of descended tissues and fat pads. After receiving 510(k) clearance from the US Food and Drug Administration (FDA) in 2015, the Silhouette InstaLift™ absorbable suspension suture became the only available non-surgical technique for repositioning of facial tissue. In January 2017, a consensus paper presented a review of the literature on the efficacy and safety of absorbable suspension sutures and provided information on treatment procedures. Since that time, the clinical experience of the authors has further shaped their treatment practices, highlighting the need for additional guidelines to support an optimal treatment approach. This update will expand upon the 2017 consensus paper on the safety and efficacy of absorbable suspension sutures and provide guidance for obtaining consistently high patient satisfaction with the procedure. Recommendations are based on the extensive clinical experience of expert physicians with absorbable suspension sutures over the past 2.5 years. Here, the authors provide guidance on full face assessment and treatment to support maximum benefit and provide patient selection and procedural recommendations. In addition, the authors stress the benefits of the dual mechanisms of action within the absorbable suspension suture: the immediate lift and volumizing over time that together lead to the outcome of recontouring. J Drugs Dermatol. 2018;17(6):647-655.
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Baldini A, Fassi Fehri H, Cerantola Y, Bayle F, Ravier E, Belot PY, Arnouil N, Colombel M, Badet L. [Do initial experience with an enhanced recovery program after surgery (ERAS) improve postoperative outcomes after cystectomy?]. Prog Urol 2018; 28:351-358. [PMID: 29706465 DOI: 10.1016/j.purol.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 08/13/2017] [Revised: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the feasibility and the impact of an ERAS program after radical cystectomy for bladder cancer. MATERIALS AND METHODS This was a retrospective study comparing a historical pre ERAS group, including all the patients undergoing cystectomy for bladder cancer from January 2013 to December 2015 with a classic procedure, and an interventional ERAS group after introducing an enhanced recovery protocol before, during and after surgery, from February 2016. The principal outcome was the postoperative length of stay. Secondary outcomes mesures were impact on perioperative complication rate (Clavien classification≥3B), readmission rate, reanimation length of stay, ileus rate and adherence to the ERAS protocol. RESULTS There were no differences between the 2 groups as far as demographics characteristics are concerned. In total, 97 patients were included, 56 in the control group, and 41 in the ERAS group. The adherence to the protocol was about 65.8%. The ERAS group had statistically significantly shorter median length of stay (D19 versus D14; P: 0.021). The major complications rate (Clavien≥3B) were about 23.2% for the control group and 12.1% for the ERAS group (P: NS). The reinsertion of nasogastric tube were higher in the control group (39.3% vs 21.9%; P: NS) and the readmission rate was about 7.1% in the control group versus 14.6% in the ERAS group (P: NS). CONCLUSION In conclusion, introduction and application of an enhanced recovery protocol (ERAS) after cystectomy for bladder cancer allowed for better management of postoperative outcomes. It is clearly feasible in cystectomy, and improve significantly the median postoperative length of stay. Moreover, it may be effective in terms of faster return of bowel function and reduction of majors complications. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Baldini
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - H Fassi Fehri
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - Y Cerantola
- CHU Vaudois, 46, rue du Bugnon, 1011 Lausanne, Suisse.
| | - F Bayle
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - E Ravier
- Rhena clinique de Strasbourg, 15, boulevard Ohmacht, 67000 Strasbourg, France.
| | - P Y Belot
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - N Arnouil
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - M Colombel
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
| | - L Badet
- Hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France.
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Bergstrom JE, Scott ME, Alimi Y, Yen TT, Hobson D, Machado KK, Tanner EJ, Fader AN, Temkin SM, Wethington S, Levinson K, Sokolinsky S, Lau B, Stone RL. Narcotics reduction, quality and safety in gynecologic oncology surgery in the first year of enhanced recovery after surgery protocol implementation. Gynecol Oncol 2018; 149:554-559. [PMID: 29661495 DOI: 10.1016/j.ygyno.2018.04.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 01/30/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Enhanced Recovery After Surgery (ERAS) programs are mechanisms for achieving value-based improvements in surgery. This report provides a detailed analysis of the impact of an ERAS program on patient outcomes as well as quality and safety measures during implementation on a gynecologic oncology service at a major academic medical center. METHODS A retrospective review of gynecologic oncology patients undergoing elective laparotomy during the implementation phase of an ERAS program (January 2016 through December 2016) was performed. Patient demographics, surgical variables, postoperative outcomes, and adherence to core safety measures, including antimicrobial and venous thromboembolism (VTE) prophylaxis, were compared to a historical patient cohort (January 2015 through December 2015). Statistical analyses were performed using t-tests, Wilcoxon rank sum tests, and Chi squared tests. RESULTS The inaugural 109 ERAS program participants were compared to a historical patient cohort (n=158). There was no difference in BMI, race, malignancy, or complexity of procedure between cohorts. ERAS patients required less narcotics (70.7 vs 127.4, p=0.007, oral morphine equivalents) and PCA use (32.1% vs. 50.6%, p=0.002). Despite this substantial reduction in narcotics, ERAS patients did not report more pain and in fact reported significantly less pain by postoperative day 3. There were no differences in length of stay (5days), complication rates (13.8% vs. 20.3%, p=0.17) or 30-day readmission rates (9.5 vs 11.9%, p=0.54) between ERAS and historical patients, respectively. Compliance with antimicrobial prophylaxis was 97.2%. However, 33.9% of ERAS patients received substandard preoperative VTE prophylaxis. CONCLUSIONS ERAS program implementation resulted in reductions in narcotic requirements and PCA use without changes in length of stay or readmission rates. Compliance should be diligently audited during the implementation phase of ERAS programs, with special attention to adherence to pre-existing core safety measures.
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Affiliation(s)
- Jennifer E Bergstrom
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Marla E Scott
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yewande Alimi
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ting-Tai Yen
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Deborah Hobson
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Karime K Machado
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sarah M Temkin
- Virginia Commonwealth University, Department of Obstetrics and Gynecology, Richmond, VA, USA
| | - Stephanie Wethington
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kimberly Levinson
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Brandyn Lau
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA.
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Herrod PJJ, Cox M, Keevil H, Smith KJE, Lund JN. NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry 'wolf!'. Ann R Coll Surg Engl 2018; 100:275-278. [PMID: 29364019 PMCID: PMC5958846 DOI: 10.1308/rcsann.2017.0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Accepted: 11/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background and aims Late recognition of sepsis and consequent death remains a problem. To address this, the National Institute for Health and Care Excellence has published updated guidance recommending the use of the Quick Sequential Organ Failure Assessment (Q-SOFA) score when assessing patients at risk of sepsis following the publication of the Third International Consensus Definitions for Sepsis and Septic Shock. The trauma from major surgery produces a systemic inflammatory response syndrome (SIRS) postoperatively as part of its natural history, which may falsely trigger scoring systems. We aimed to assess the accuracy of Q-SOFA and SIRS criteria as recommended scores for early detection of sepsis and septic complications in the first 48hrs after colorectal cancer surgery. Methods We reviewed all elective major colorectal operations in a single centre during a 12-month period from prospectively maintained electronic records. Results One hundred and thirty nine patients were included in this study. In all, 29 patients developed postoperative infective complications in hospital. Nineteen patients triggered on SIRS without developing infective complications, while 42 patients triggered on Q-SOFA with no infective complications. The area under the ROC curve was 0.52 for Q-SOFA and 0.67 for SIRS. Discussion Q-SOFA appears to perform little better than a coin toss at identifying postoperative sepsis after colorectal cancer resection and is inferior to the SIRS criteria. More work is required to assess whether a combination of scoring criteria, biochemical markers and automated tools could increase accurate detection of postoperative infection and trigger early intervention.
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Affiliation(s)
- PJJ Herrod
- Department of General Surgery, Royal Derby Hospital, Derby, UK
| | - M Cox
- Department of General Surgery, Royal Derby Hospital, Derby, UK
| | - H Keevil
- Department of General Surgery, Royal Derby Hospital, Derby, UK
| | - KJE Smith
- Department of General Surgery, Royal Derby Hospital, Derby, UK
| | - JN Lund
- Department of General Surgery, Royal Derby Hospital, Derby, UK
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McElhiney LF. Basics of Compounding: Providing Pharmacy Services to Bariatric Surgery Patients. Int J Pharm Compd 2018; 22:30-39. [PMID: 29385384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
With the rise in obesity, more individuals are choosing bariatric surgery as a means to successfully lose weight and resolve co-morbidities. These patients need lifelong support from friends, family, and healthcare providers. Pharmacists need to be knowledgeable of the unique needs of these patients in order to provide information and recommendations on drug therapies and supplements. When a patient is wheeled out of the operating room following bariatric surgery, his or her life instantly changes. Like an infant, the patient has to slowly learn how to eat and drink again. Physical activity significantly increases. Taste perception changes. Serious medical problems, such as hypertension, type II diabetes, and hypercholesterolemia completely resolve within a couple of months. The patient has to be disciplined and follow the instructions of the bariatric team and other healthcare providers. Since the patient's gastrointestinal tract has been significantly altered, drug therapies may require some modifications too. Bariatric or weight loss surgery is definitely not the easy way to lose weight, but it is a very powerful tool for the patient. Weight loss, and maintaining that weight loss, is a lifelong journey for the patient that requires support from the bariatric team, healthcare provider(s), co-workers, friends, and family. Pharmacists may also provide support for these patients through counseling about their supplements, medications, and compounding medications to meet their specific needs.
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