Full Text Available "Fast track surgery" is a model of care pathway that is gradually replacing and incorporating all the other models so far applied in surgery. In particular, this is possible thanks to minimally invasive procedures widely disseminated for the several benefits they offer. The authors present a preliminary study of laparoscopic appendectomy using endo-GIA as a model of fast track surgery. At the Department of Pediatric Surgery of the University of Siena, from December 2008 to May 2009 were carried out 10 surgery procedures of laparoscopic appendectomy. Patients were subjected to emergency surgery for acute appendicitis diagnosed by clinical examination, laboratory tests and ultrasound study. The mean age was 10.8 years (range 7-14 years. All procedures were performed under general anesthesia with the patient in supine decubitus and using three trocars. The first 12 mm, was introduced through the umbilical incision with "open" approach, the second, 12 mm in the left iliac fossa and the third, 5 mm, in sovrapubic seat. In each patient the appendectomy was carried out with endo-GIA (a linear stapling device that can be used for the section of appendix and vessels. Results: Any patient needed to convert to “open surgery”. The duration of surgery procedure was in mean 80 minutes (range 60-90 minutes. In any case intraoperative complications were observed. In 1 patient (10% further surgery procedure with technique "open" was necessary due to presence of purulent exudate in peritoneal cavity, depending to severity of endo-abdominal infection. The hospitalization was in mean 4.3 days (range 3-10 days with intestinal canalization on the 1st post-operative day. Laparoscopic appendectomy is a feasible and safe method with advantages for patients such as lower incidence of septic complications (better toilet of peritoneal cavity and possible placement of drainage, reduced time of hospitalization and convalescence, better control of postoperative pain, and
Meyfroidt Geert; Güiza Fabian; Cottem Dominiek; De Becker Wilfried; Van Loon Kristien; Aerts Jean-Marie; Berckmans Daniël; Ramon Jan; Bruynooghe Maurice; Van den Berghe Greet
Abstract Background The intensive care unit (ICU) length of stay (LOS) of patients undergoing cardiac surgery may vary considerably, and is often difficult to predict within the first hours after admission. The early clinical evolution of a cardiac surgery patient might be predictive for his LOS. The purpose of the present study was to develop a predictive model for ICU discharge after non-emergency cardiac surgery, by analyzing the first 4 hours of data in the computerized medical record of ...
Full Text Available Abstract Background The intensive care unit (ICU length of stay (LOS of patients undergoing cardiac surgery may vary considerably, and is often difficult to predict within the first hours after admission. The early clinical evolution of a cardiac surgery patient might be predictive for his LOS. The purpose of the present study was to develop a predictive model for ICU discharge after non-emergency cardiac surgery, by analyzing the first 4 hours of data in the computerized medical record of these patients with Gaussian processes (GP, a machine learning technique. Methods Non-interventional study. Predictive modeling, separate development (n = 461 and validation (n = 499 cohort. GP models were developed to predict the probability of ICU discharge the day after surgery (classification task, and to predict the day of ICU discharge as a discrete variable (regression task. GP predictions were compared with predictions by EuroSCORE, nurses and physicians. The classification task was evaluated using aROC for discrimination, and Brier Score, Brier Score Scaled, and Hosmer-Lemeshow test for calibration. The regression task was evaluated by comparing median actual and predicted discharge, loss penalty function (LPF ((actual-predicted/actual and calculating root mean squared relative errors (RMSRE. Results Median (P25-P75 ICU length of stay was 3 (2-5 days. For classification, the GP model showed an aROC of 0.758 which was significantly higher than the predictions by nurses, but not better than EuroSCORE and physicians. The GP had the best calibration, with a Brier Score of 0.179 and Hosmer-Lemeshow p-value of 0.382. For regression, GP had the highest proportion of patients with a correctly predicted day of discharge (40%, which was significantly better than the EuroSCORE (p Conclusions A GP model that uses PDMS data of the first 4 hours after admission in the ICU of scheduled adult cardiac surgery patients was able to predict discharge from the ICU as a
Meyer, A A; Fakhry, S M; Sheldon, G F
Surgical critical care (SCC) was recently identified as an essential component of general surgery by the American Board of Surgery (ABS). Previous studies have found limited attention to critical care education in general surgery programs. This survey was developed to determine the changes in critical care education, following the emphasis by the ABS. The survey determined the format for SCC education, the time and resources committed, and the views of the program directors toward SCC. Program directors of all 296 approved general surgery residencies were surveyed, with a 79% response. Most program directors (91%) agree that SCC is an essential component of general surgery, and 72% believe a separate intensive care unit (ICU) rotation should be used in SCC education. Education in SCC was provided by a separate ICU service in 110 (47%) of the programs. The remaining 53% used care of patients in the ICU during traditional services as their educational experience. The average ICU rotation for surgery residents was 9 weeks and usually occurred in the second year of training. In 97% of the 110 programs with an ICU service, lectures and conferences were conducted regularly. Seventeen programs sponsored critical care fellowships, and 25 additional programs were considering them. Ninety percent of surgical ICU services had faculty that consisted exclusively of surgeons or surgeons and other specialists. Only 53% of surgeons attending on an ICU service had a reduction in their other responsibilities. Despite overwhelming agreement that critical care is an essential component of general surgery, less than half of the training programs have an ICU service to coordinate resident education in SCC. If surgeons are to continue to provide total care to their patients, there needs to be increased commitment to SCC education. PMID:2763037
Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This increasing complexity demands a multidisciplinary approach rearranging pre-, peri- and postoperative care in a way safety, efficiency and high quality are guaranteed. The safety and quality of healthca...
Quality of Care (QoC) plays a central role in the way healthcare is delivered. In the world of thoracic surgery for lung cancer, surgeons are faced with complex and sometimes high-risk surgical resections on an aging patient population with an increasing incidence of frail physical health. This incr
Vargens, O; Berterö, Carina
This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gyna...
Full Text Available Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. Facility: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. Indications for vitiligo surgery : Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. Preoperative counseling and Informed consent: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure
Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod; Argenziano, Michael; Alexander, John; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES To determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data, routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients, mean age of 64 ± 13 years, 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%) and C. Difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions, among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAI was on average nearly three times as much as readmissions not related to HAI. CONCLUSIONS Hospital cost, length of stay, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. PMID:25572505
Background Enhanced Recovery After Surgery (ERAS) programs are associated with reduced hospital morbidity and mortality. The aim of the present study was to evaluate whether the introduction of ERAS care improved the adverse events in colorectal surgery. In a cohort study, mortality, morbidity, and length of stay were compared between ERAS patients and carefully matched historical controls. Methods Patients were matched for their type of disease, the type of surgery, P-Possum (Portsmouth-Poss...
ÇİLİNGİR, Dr. Dilek; BAYRAKTAR, Prof.Dr. Nurhan
Day surgery is defined as interventions that serve planned operation and discharging on the same day of the patients who are determined as appropriate for day surgery before operation. New surgical techniques and improvement of interventions methods, anesthesia and analgesia techniques, asepsis and using antibiotics affected development of day surgery. Preoperative evaluation, operation, discharge and postoperative observation constitute phases of day surgery process. The success of day ...
Parsad Davinder; Gupta Somesh
Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. Physician′s qualifications: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropri...
Carlene Johnson Stoklossa
Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.
Shandip Kumar Sinha; Sujoy Neogi
Neonatal transport is associated with complications, more so in sick and unstable neonates who need immediate emergency surgery. To circumvent these problems, surgery in Neonatal intensive care unit (NICU) is proposed for these neonates. This article reviews the literature regarding feasibility of this novel concept and based on the generated evidence, suggest the NICU planners to always include infrastructure for this. Also neonatal surgical team can be developed that could be transported.
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel;
patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...
This podcast provides health information for amputees on how to take care of yourself after an amputation or other surgery. Created: 2/18/2010 by National Center on Birth Defects and Developmental Disability, Disability and Health Program. Date Released: 2/18/2010.
Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)
Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn;
. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing...... emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome...... measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. DISCUSSION: This trial evaluates the benefits and possible harm of intermediate care. The results may...
Mandrioli, Matteo; Inaba, Kenji; Piccinini, Alice; Biscardi, Andrea; Sartelli, Massimo; Agresta, Ferdinando; Catena, Fausto; Cirocchi, Roberto; Jovine, Elio; Tugnoli, Gregorio; Di Saverio, Salomone
The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a
Mowry, Marianne J; Gabel, Mollie A
Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation. PMID:26509403
Vester-Andersen, M; Waldau, T; Wetterslev, J; Møller, M H; Rosenberg, J; Jørgensen, L N; Jakobsen, J C; Møller, Ann
BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in...
Objective To analyze the effect of a new model in the nursing care ward round in the hand surgery department.Methods The implementation of nursing care ward round in the hand surgery department was retrospectively analyzed.Results The comprehensive quality of nurses were increased obviously when the new model ward round was implemented.Patients were more satisfied with the work of nursing care.The evaluation of new model ward round by nurses was higher than before.Conclusions The new model of nursing ward round showed a great help for increasing the comprehensive quality of nurses,the responsibility awareness of nurses and the nursing quality.It presented an significant application value by developing new nursing care technique and helping establish harmonious relationship between the nursing staff and patients.%目的 探析护理业务查房新模式在手外科病房的临床应用效果.方法 对2010年1月至2012年12月手外科病房实施护理业务查房新模式进行回顾性分析.结果 护理业务查房新模式实施后,手外科护士的综合素质水平明显提高,患者对护理工作的满意度明显提高,护理人员对新的查房模式效果评价与以往查房效果比较差异有统计学意义.结论 护理业务查房新模式对提高护士综合素质,增强护士责任意识,提高护理质量,拓展护理新技术新业务,促进护患关系和谐发展,具有显著的应用价值.
von dem Knesebeck Olaf; Blum Karl; Frie Kirstin; Klein Jens
Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI) and the ...
Aihuan Chen; Ronghua Ye; Yanchan Liu; Weici Liu; Jingyi Lin
Purpose:To investigate the important experience of nursing care of the laryngeal mask airway (LMA) in children under-going cataract surgery. Methods: Fifty-five children undergoing cataract surgery were anesthetized by inhaling sevoflurane through a LMA and re-ceived perioperative nursing care. The safety of perioperative nursing for these children was also evaluated. Results:Through perioperative nursing care and psychological counseling for children with LMA,.all patients were anes-thetized without complications and underwent successful surgeries..No severe postoperative complications were ob-served. Conclusion: Nursing care specific for LMA is a vital part of the success of anesthesia and pediatric cataract surgery.
... a non-covered incident of treatment (such as nonadjunctive dental care or cosmetic surgery) but only... Initial Surgery or Treatment AGENCY: Office of the Secretary, Department of Defense. ACTION: Proposed rule... on a determination that a waiver authorizing the original non-covered surgery or treatment...
von dem Knesebeck Olaf
Full Text Available Abstract Background Little is known about the association between job stress and job performance among surgeons, although physicians' well-being could be regarded as an important quality indicator. This paper examines associations between psychosocial job stress and perceived health care quality among German clinicians in surgery. Methods Survey data of 1,311 surgeons from 489 hospitals were analysed. Psychosocial stress at work was measured by the effort-reward imbalance model (ERI and the demand-control model (job strain. The quality of health care was evaluated by physicians' self-assessed performance, service quality and error frequency. Data were collected in a nationwide standardised mail survey. 53% of the contacted hospitals sent back the questionnaire; the response rate of the clinicians in the participating hospitals was about 65%. To estimate the association between job stress and quality of care multiple logistic regression analyses were conducted. Results Clinicians exposed to job stress have an increased risk of reporting suboptimal quality of care. Magnitude of the association varies depending on the respective job stress model and the indicator of health care quality used. Odds ratios, adjusted for gender, occupational position and job experience vary between 1.04 (CI 0.70-1.57 and 3.21 (CI 2.23-4.61. Conclusion Findings indicate that theoretical models of psychosocial stress at work can enrich the analysis of effects of working conditions on health care quality. Moreover, results suggest interventions for job related health promotion measures to improve the clinicians' working conditions, their quality of care and their patients' health.
Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali
Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors mu...
Full Text Available Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.
Presented is an assessment of the cost-effectiveness of cataract surgery using cost and services data from the Lumbini Zonal Eye Care Programme in Nepal. The analysis suggests that cataract surgery may be even more cost-effective than previously reported. Under a "best estimate" scenario, cataract surgery had a cost of US$5.06 per disability-adjusted life year (DALY). This places it among the most cost-effective of public health interventions. Sensitivity analysis indicates that cataract surg...
M. van Middelkoop (Marienke); S.M. Rubinstein (Sidney); R.W.J.G. Ostelo (Raymond); M.W. van Tulder (Maurits); W.C. Peul (Wilco); B.W. Koes (Bart); A.P. Verhagen (Arianne)
textabstractObjective: General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck
Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl;
Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine, the...
Gärtner, Rune; Callesen, Torben; Kroman, Niels Thorndahl; Kehlet, Henrik
Extant literature shows that women having undergone breast cancer surgery have substantial problems at the post-anaesthesia care unit (PACU). Based on nursing reports and elements of the discharge scoring system recommended by The Danish Society of Anaesthesiology and Intensive Care Medicine, the...... present prospective, observational study aims to determine why these patients stayed at PACU....
Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali
Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. PMID:26855897
Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...
Aliya Ahmed; Naveed Latif; Robyna Khan
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries w...
Varshika M. Bhana; Annali D.H. Botha
Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expo...
Carlene Johnson Stoklossa; Suneet Atwal
Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews ...
Minkman, Mirella M.N
textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created....
Blake C Alkire, MD; Dr. Nakul P Raykar, MD; Mark G Shrime, MD; Thomas G Weiser, MD; Prof. Stephen W Bickler, MD; John A Rose, MD; Cameron T Nutt, BA; Sarah L M Greenberg, MD; Meera Kotagal, MD; Johanna N Riesel, MD; Micaela Esquivel, MD; Tarsicio Uribe-Leitz, MD; George Molina, MD; Prof. Nobhojit Roy, MD; John G Meara, MD
Background: More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. Methods: We modelled access to surgical services in 196 countries with respect to four dimensions: timelines...
Full Text Available Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP, or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process.
Valeria Calcaterra; Selene Ostuni; Irene Bonomelli; Simonetta Mencherini; Marco Brunero; Elisa Zambaiti; Savina Mannarino; Daniela Larizza; Riccardo Albertini; Carmine Tinelli; Gloria Pelizzo
Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, g...
Kaye, Deborah R; Mullins, Jeffrey K; Carter, H Ballentine; Bivalacqua, Trinity J
Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered. PMID:25535000
Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.
OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical
Rago, Rocco; Franceschini, Francesca; Tomassini, Carlo R
Today's poorer income on the one hand and the more and more unbearable costs on the other, call for solutions to maintain public health through proper and collective care. We need to think of a new dimension of health, to found a modern and innovative approach, which can combine the respect of healthcare rights with the optimization of resources. Worldwide, franchises serving millions of people every year succeed in limiting operating costs and still offer a service and a quality equal to single businesses. Let's imagine every single Day Surgery Unit (DSU), within its own hospital, as a single trade: starting a process of centralized management and subsequent affiliation with other DSUs, they would increase their healthcare offer by means of solid organization, efficiency and foresight that with a strong focus on innovation and continuous updating, thus increasing its range of consumers and containing management costs. The Short Hospitalization System (SHS) is the proposed project, which is not only a type of hospitalization which is different from the ordinary, but also an innovative clinical-organizational model, with an important economic impact, where the management and maximization of the different hospital flows (care, professional, logistical, information), as well as the ability to implement strategies to anticipate them are crucial. The expected benefits are both clinically and socially relevant. Among them: 1) best practice build up; 2) lower impact on daily habits and increased patient satisfaction; 3) reduction of social and health expenditure. PMID:25532492
Payan, Yohan; Chabanas, Matthieu; Pelorson, Xavier; Vilain, Coriandre; Levy, Patrick; Luboz, Vincent; Perrier, Pascal
This paper presents the biomechanical finite element models that have been developed in the framework of the computer-assisted maxillofacial surgery. After a brief overview of the continuous elastic modelling method, two models are introduced and their use for computer-assisted applications discussed. The first model deals with orthognathic surgery and aims at predicting the facial consequences of maxillary and mandibular osteotomies. For this, a generic three-dimensional model of the face is...
Tanner, J; Kiernan, M; Hilliam, R; Davey, S; Collins, E; Wood, T; Ball, J; Leaper, D
Introduction In 2010 a care bundle was introduced by the Department of Health (DH) to reduce surgical site infections (SSIs) in England. To date, use of the care bundle has not been evaluated despite incorporating interventions with resource implications. The aim of this study was to evaluate the DH SSI care bundle in open colorectal surgery. Methods A prospective cohort design was used at two teaching hospitals in England. The baseline group consisted of 127 consecutive patients having colorectal surgery during a 6-month period while the intervention group comprised 166 patients in the subsequent 6 months. SSI and care bundle compliance data were collected using dedicated surveillance staff. Results Just under a quarter (24%) of the patients in the baseline group developed a SSI compared with just over a quarter (28%) in the care bundle group (p>0.05). However, compliance rates with individual interventions, both before and after the implementation of the bundle, were similar. Interestingly, in only 19% of cases was there compliance with the total care bundle. The single intervention that showed an associated reduction in SSI was preoperative warming (p=0.032). Conclusions The DH care bundle did not reduce SSIs after open colorectal surgery. Despite this, it is not possible to state that the bundle is ineffective as compliance rates before and after bundle implementation were similar. All studies evaluating the effectiveness of care bundles must include data for compliance with interventions both before and after implementation of the care bundle; poor compliance may be one of the reasons for the lower than expected reduction of SSIs. PMID:26924481
M.M.N. Minkman (Mirella)
textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated c
Wikberg, Anita; Eriksson, Katie
The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration. PMID:18840233
Andrews, E J
Enhanced recovery programmes have been studied in randomised trials with evidence of quicker recovery of gut function, reduced morbidity, mortality and hospital stay and improved physiological and nutritional outcomes. They aim to reduce the physiological and psychological stress of surgery and consequently the uncontrolled stress response. The key elements, reduced pre-operative fasting, intravenous fluid restriction and early feeding after surgery, are in conflict with traditional management plans but are supported by strong clinical evidence. Given the strength of the current data enhanced recovery should now be the standard of care.
Full Text Available Aim: To report the results of the early discharge of children after hypospadias repair with an indwelling catheter. Materials and Methods: To facilitate early the discharge of children after hypospadias repair, the author adopted the technique of draining the indwelling urinary catheter into diapers in children undergoing this operation. Home catheter care was taught to the mother; the dressings and catheters were subsequently managed in the outpatient clinic. Results: Over a 2-year period, 43 children were managed by this technique and were sent home within 24-48 h after the operation with an indwelling catheter. Minor problems requiring outpatient visits to the surgeon occurred in nine (20% children after discharge from the hospital. All the nine children were successfully managed as outpatients and no child required rehospitalisation. The catheter remained in position for 5 days in all the children. The overall results were satisfactory with an acceptable (7% fistula rate. Conclusions: It is possible to reduce the duration of the hospital stay of children after hypospadias repair without compromising on the final results.
Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of
Leite, E.S.; Uva, A.S. [Lisbon Univ., National School of Public Health/New (Portugal)
Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of
Full Text Available Background: In India, cardiothoracic (CT surgery training follows a 3+3-year model, where 3 years of general surgery residency with certification (MS/DNB is required for entering 3 years of thoracic surgery residency (MCh/DNB. There are two certifying boards at the national level. One being the Medical Council of India (MCI, which oversees the major accreditation process involving the undergraduate and postgraduate medical education in India, and the other being the National Board of Examinations (NBE, which was formed for the purpose of establishing a uniform standard of postgraduate medical education. Recently, the latter body has come up with an alternative model for thoracic surgery residency in India. This model includes an integrated 6-year residency, with lesser emphasis on general surgical skills and greater exposure to CT surgery. Conclusions: Changes to the current model of training for CT surgery is the need of the hour and should be initiated very soon by the MCI to meet the future demand for CT surgeons in India. An integrated training program is essential to create a new generation of cardiovascular specialists. Future directions to achieve this goal must include modifications to the undergraduate programs so as to infuse interest for CT surgery in the young minds of medical students.
Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão
This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...
Tominaga, Tetsuro; Nonaka, Takashi; Takeshita, Hiroaki; Honda, Yuichiro; Nagura, Hiroki; Shiraishi, Toshio; Kunizaki, Masaki; Sumida, Yorihisa; Hidaka, Shigekazu; Sawai,Terumitsu; Nagayasu, Takeshi
Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon c...
Tetsuro Tominaga; Takashi Nonaka; Hiroaki Takeshita; Yuichiro Honda; Hiroki Nagura; Toshio Shiraishi; Masaki Kunizaki; Yorihisa Sumida; Shigekazu Hidaka; Terumitsu Sawai; Takeshi Nagayasu
Introduction: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending co...
Sukhminder Jit Singh Bajwa; Sukhwinder Kaur Bajwa
The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful su...
Conclusion: An ideal surgical procedure for a pilonidal sinus should be one aiming at reducing hospital stay, minimizing tissue assault, promoting early work resumption, and preventing recurrence. The method described in this paper was found to be simple, safe, and feasible as day-care surgery. The technique of sinotomy with a good wound and surrounding skin care is an ideal approach with a high chance of cure. The patients returned to their routine within a short duration of time. [Arch Clin Exp Surg 2012; 1(3.000: 138-141
Babar M Qureshi
Full Text Available Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.
Buchaillard, Stéphanie; Perrier, Pascal; Payan, Yohan
This paper presents the current achievements of a long term project aiming at predicting and assessing the impact of tongue and mouth floor surgery on tongue mobility. The ultimate objective of this project is the design of a software with which surgeons should be able (1) to design a 3D biomechanical model of the tongue and of the mouth floor that matches the anatomical characteristics of each patient specific oral cavity, (2) to simulate the anatomical changes induced by the surgery and the possible reconstruction, and (3) to quantitatively predict and assess the consequences of these anatomical changes on tongue mobility and speech production after surgery.
Varshika M. Bhana
Full Text Available Patients perceive the intensive care unit (ICU as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expose the cardiac patients to music as part of their routine postoperative care and to explore and describe their experiences of the music intervention. The findings of the research are to be the basis for making recommendations for the inclusion of music as part of the routine postoperative care received by cardiac surgery patients in the ICU. A qualitative research methodology, using a contextual, explorative and descriptive research design, was adopted. The population of the study was cardiac surgery patients admitted to the ICU of a public hospital. An unstructured interview was conducted with each participant and content analysis and coding procedures were used to analyse the data. Four main themes were identified in the results, namely practical and operational aspects of the music sessions; participants’ experiences; discomfort due to therapeutic apparatus and the ICU environment; and the role of music and recommendations for music as a therapeutic intervention. Participants’ experiences were mainly positive. Results focused on experiences of the music and also on the participants’ experiences of the operational aspects of the therapy, as well as factors within and around the participants.
Khan, Ashiya; Amitava, Abadan Khan; Rizvi, Syed Ali Raza; Siddiqui, Ziya; Kumari, Namita; Grover, Shivani
Context: Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block r...
Ashiya Khan; Abadan Khan Amitava; Syed Ali Raza Rizvi; Ziya Siddiqui; Namita Kumari; Shivani Grover
Context : Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE) versus manual small-incision cataract surgery (MSICS). Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block ...
Chabanas, M; Payan, Y; Boutault, F; Chabanas, Matthieu; Marecaux, Christophe; Payan, Yohan; Boutault, Franck
Two aspects required to establish a planning in orthognatic surgery are addressed in this paper. First, a 3D cephalometric analysis, which is clini-cally essential for the therapeutic decision. Then, an original method to build a biomechanical model of patient face soft tissue, which provides evaluation of the aesthetic outcomes of an intervention. Both points are developed within a clinical application context for computer aided maxillofacial surgery.
Luo, Li; Luo, Yong; You, Yang; Cheng, Yuanjun; Shi, Yingkang; Gong, Renrong
Most surgery scheduling is done 1 day in advance. Caused by lack of overall planning, this scheduling scheme often results in unbalanced occupancy time of the operating rooms. So we put forward a rolling horizon mixed integer programming model for the scheduling. Rolling horizon scheduling refers to a scheduling scheme in which cyclic surgical requests are taken into account. Surgical requests are updated daily. The completed surgeries are eliminated, and new surgeries are added to the scheduling list. Considering day-to-day demand for surgery, we develop a non-rolling scheduling model (NRSM) and a rolling horizon scheduling model (RSM). By comparing the two, we find that the quality of surgery scheduling is significantly influenced by the variation in demand from day to day. A rolling horizon scheduling will enable a more flexible planning of the pool of surgeries that have not been scheduled into this main blocks, and hence minimize the idle time of operating rooms. The strategy of the RSM helps balance the occupancy time among operating rooms. Using surgical data from five departments of the West China Hospital (WCH), we generate surgical demands randomly to compare the NRSM and the RSM. The results show the operating rooms' average utilization rate using RSM is significantly higher than when applying NRSM. PMID:27071394
Matheus Melo Pithon
Full Text Available OBJECTIVE: Investigate the quality of data available on the internet with respect to pain after orthognathic surgery.METHODS: A careful search was conducted on the Internet in December, 2012. The most accessed websites browsers were employed for research using the terms: "pain" and "orthognathic surgery" together. The first 30 results of each portal were examined, and after applying the exclusion criteria, 29 sites remained. All remaining websites went through an evaluation process with online tools that investigated the quality, level of reading, accessibility, usability and reliability.RESULTS: Assessment criteria outcomes were considered unfavorable. Texts were considered difficult to read with inappropriate language for the general public. The mean global validation for the 29 websites of the LIDA instrument was 65.10, thereby indicating a structure of medium quality.CONCLUSION: Information about post-orthognathic surgery pain available on the internet is poorly written and unreliable. Therefore, candidates for orthognathic surgery must seek information from specialists who, in turn, should indicate reliable sources.
Pithon, Matheus Melo; dos Santos, Elinailton Silva
OBJECTIVE: Investigate the quality of data available on the internet with respect to pain after orthognathic surgery. METHODS: A careful search was conducted on the Internet in December, 2012. The most accessed websites browsers were employed for research using the terms: "pain" and "orthognathic surgery" together. The first 30 results of each portal were examined, and after applying the exclusion criteria, 29 sites remained. All remaining websites went through an evaluation process with online tools that investigated the quality, level of reading, accessibility, usability and reliability. RESULTS: Assessment criteria outcomes were considered unfavorable. Texts were considered difficult to read with inappropriate language for the general public. The mean global validation for the 29 websites of the LIDA instrument was 65.10, thereby indicating a structure of medium quality. CONCLUSION: Information about post-orthognathic surgery pain available on the internet is poorly written and unreliable. Therefore, candidates for orthognathic surgery must seek information from specialists who, in turn, should indicate reliable sources. PMID:25628084
Lentz, Judy C
Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care. PMID:25296488
Bhatt, Aditi; Mittal, Sourabh; Gopinath, K S
The combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has gained worldwide acceptance for management of selected patients with peritoneal metastases from various cancers. Cytoreductive surgery is performed with the goal of removing all macroscopic disease and is coupled with perioperative chemotherapy (POC) in the form of HIPEC with or without EPIC (early postoperative intraperitoneal chemotherapy) to deal with the microscopic residual disease. These treatments entail the use of cytotoxic drugs in the operation theatre or in the intensive care unit where they are not commonly used and put the healthcare workers participating in the treatment at risk of exposure. CRS is performed with high voltage electrocautery generating a large amount of surgical smoke which is inhaled by the involved personnel and has potential health hazards. This article outlines the safety measures to be taken while performing CRS and POC. PMID:27065717
Jasper van der Slegt
Full Text Available BACKGROUND: Surgical site infections (SSI's are associated with severe morbidity, mortality and increased health care costs in vascular surgery. OBJECTIVE: To implement a bundle of care in vascular surgery and measure the effects on the overall and deep-SSI's rates. DESIGN: Prospective, quasi-experimental, cohort study. METHODS: A prospective surveillance for SSI's after vascular surgery was performed in the Amphia hospital in Breda, from 2009 through 2011. A bundle developed by the Dutch hospital patient safety program (DHPSP was introduced in 2009. The elements of the bundle were (1 perioperative normothermia, (2 hair removal before surgery, (3 the use of perioperative antibiotic prophylaxis and (4 discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures and this was used for feedback. RESULTS: Bundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. In total, 720 vascular procedures were performed during the study period and 75 (10.4% SSI were observed. Deep SSI occurred in 25 (3.5% patients. Patients with SSI's (28,5±29.3 vs 10.8±11.3, p<0.001 and deep-SSI's (48.3±39.4 vs 11.4±11.8, p<0.001 had a significantly longer length of hospital stay after surgery than patients without an infection. A significantly higher mortality was observed in patients who developed a deep SSI (Adjusted OR: 2.96, 95% confidence interval 1.32-6.63. Multivariate analysis showed a significant and independent decrease of the SSI-rate over time that paralleled the introduction of the bundle. The SSI-rate was 51% lower in 2011 compared to 2009. CONCLUSION: The implementation of the bundle was associated with improved compliance over time and a 51% reduction of the SSI-rate in vascular procedures. The bundle did not require expensive or potentially harmful interventions and is therefore an important tool to improve patient safety and reduce SSI's in patients undergoing
Full Text Available Day Care Surgery conducted under general anaesthesia, largely depends on anaesthetic agents which have shorter duration of action and hence are able to provide rapid recovery. In the present study we intend to compare the recovery profile of the two easily available agents in India i.e. isoflurane and halothane and compare their usefulness in day care surgery. MATERIALS AND METHODS: 50 patients were randomly divided into two groups of 25 each in age group of 18 to 60 years, of either sex, of American Society of Anaesthesiologists (ASA grade I or II undergoing different surgeries of short duration up to half an hour, after proper preoperative screening. In both the groups induction was done with propofol 2 mg/kg. In group I patients, 1.0 Minimum Alveolar Concentration (MAC halothane and in group II 1.0 MAC isoflurane was used for maintenance of general anesthesia along with mixture of oxygen and nitrous oxide in the ratio of 40: 60. Narcotics and anti sialogogues that cross blood brain barrier were avoided, which may interfere with the recovery patterns. Postoperative recovery was divided into two phases and both the groups were compared by means of various clinical tests. RESULT: We found that early recovery following Isoflurane was more rapid compared to Halothane. The psychomotor tests to assess the intermediate recovery also showed the significant difference between the two groups with P value <0.001. More number of patients was able to sit up at half an hour and stand at two hours in the isoflurane group compared to halothane group. CONCLUSION: Isoflurane is a useful and better anesthetic over halothane and offers a clear advantage when used for maintenance of anaesthesia for operations performed on a day-care basis.
Schmitt, D. V.
Full Text Available Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, DGTHG and the German Society for Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und lntensivmedizin, DGAI made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess the available monitoring methods with regard to indication, procedures, predication, limits, contraindications and risks for use. The differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilatators, inodilatators and calcium sensitizers and the use of intra-aortic balloon pumps will also be addressed. The guideline has been developed following the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF. The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the
Full Text Available Abstract Background Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay. The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst track multimodal management versus standard care was conceived to determine whether laparoscopic surgery, fast track perioperative care or a combination of both is to be preferred over open surgery with standard care in patients having segmental colectomy for malignant disease. Methods/design The LAFA-trial is a double blinded, multicenter trial with a 2 × 2 balanced factorial design. Patients eligible for segmental colectomy for malignant colorectal disease i.e. right and left colectomy and anterior resection will be randomized to either open or laparoscopic colectomy, and to either standard care or the fast track program. This factorial design produces four treatment groups; open colectomy with standard care (a, open colectomy with fast track program (b, laparoscopic colectomy with standard care (c, and laparoscopic surgery with fast track program (d. Primary outcome parameter is postoperative hospital length of stay including readmission within 30 days. Secondary outcome parameters are quality of life two and four weeks after surgery, overall hospital costs, morbidity, patient satisfaction and readmission rate. Based on a mean postoperative hospital stay of 9 +/- 2.5 days a group size of 400 patients (100 each arm can reliably detect a minimum difference of 1 day between the four arms (alfa = 0.95, beta = 0.8. With 100 patients in each arm a difference of 10% in subscales of the Short Form 36 (SF-36 questionnaire and social functioning can be detected. Discussion The LAFA-trial is a randomized controlled multicenter trial that will provide evidence on the merits of fast track perioperative care and laparoscopic colorectal surgery in
Kidak Levent B.
Full Text Available The aim of the study is to improve the General Surgery patients' treatment duration in order to eliminate the bottlenecks by speeding up the process. For this purpose, some model proposals were carried out to allow reorganizing the processes to serve more patients by improving the productivity of the clinic. The study has been carried out in the general surgery clinic at the well known, training and research hospital. First of all, the simulation model of the existing system was demonstrated. The simulation model has been developed via PROMODEL software program. In the simulation model installed, four scenarios have been established in order to determine the critical factors which effect patients’ waiting durations. Thus, the goal of the study was to reduce the waiting times by considering what-if analysis using simulation. The model has been worked on for six months and ten times repetitively, so to get some statistics. It has been determined that an improvement of 17% efficiency of operations in clinic may be considerable in case of reviewing and redesigning the processes of the General Surgery clinic. It was found that a decrease of 76, 57 and 52% in the duration patients’ being in the system for Medical Treatment (MTP, Operation (OP, and Urgent Operations (UOP, respectively. All outcomes of study showed that an improvement in the efficiency could be acquired without any financial burden for the hospital budget by enhancing the processes in General Surgery clinic via using simulation modeling.
Payan, Y; Pelorson, X; Vilain, C; Levy, P; Luboz, V; Perrier, P; Payan, Yohan; Chabanas, Matthieu; Pelorson, Xavier; Vilain, Coriandre; Levy, Patrick; Luboz, Vincent; Perrier, Pascal
This paper presents the biomechanical finite element models that have been developed in the framework of the computer-assisted maxillofacial surgery. After a brief overview of the continuous elastic modelling method, two models are introduced and their use for computer-assisted applications discussed. The first model deals with orthognathic surgery and aims at predicting the facial consequences of maxillary and mandibular osteotomies. For this, a generic three-dimensional model of the face is automatically adapted to the morphology of the patient by the mean of elastic registration. Qualitative simulations of the consequences of an osteotomy of the mandible can thus be provided. The second model addresses the Sleep Apnoea Syndrome. Its aim is to develop a complete modelling of the interaction between airflow and upper airways walls during respiration. Dynamical simulations of the interaction during a respiratory cycle are computed and compared with observed phenomena.
Kehlet, H.; Wilmore, D.W.
implementation issues were based on data published within the past 5 years from major anesthesiological and surgical journals, using systematic reviews where appropriate instead of multiple references of original work. DATA SYNTHESIS: Based on an increasing amount of multinational, multicenter cohort studies......, randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......, despite being based on a combination of evidence-based unimodal principles of care, recent surveys have demonstrated slow adaptation and implementation of the fast-track methodology. CONCLUSION: Multimodal evidence-based care within the fast-track methodology significantly enhances postoperative recovery...
Bevan, Priscilla J W
Near-infrared spectroscopy (NIRS) is non-invasive, easy to use, and offers real-time monitoring of the oxygen content of cerebral tissue. An effective and user-friendly method of cerebral monitoring stands to offer a significant advance in patient care during adult cardiac surgery, particularly for surgery in which the continuity of cerebral vessels may be compromised. While the current evidence does not definitively show improvement in neurological outcomes, it can be argued that the overall risk to benefit ratio falls on the side of NIRS. NIRS also gives information about the oxygenation of systemic tissues. It may be that in surgery that does not involve the aortic arch, the value of NIRS will be in increased individualisation of patient management and improved systemic perfusion, impacting general outcomes as much as neurological outcomes. This review will summarise the need for neuromonitoring and the principles of NIRS. It will examine the thresholds used to define desaturation, the evidence for clinical benefit from NIRS, and the criticisms and limitations of NIRS. It will also discuss the uses of NIRS beyond improving neurological outcomes alone. PMID:25735719
This volume focuses on the biomechanical modeling of biological tissues in the context of Computer Assisted Surgery (CAS). More specifically, deformable soft tissues are addressed since they are the subject of the most recent developments in this field. The pioneering works on this CAS topic date from the 1980's, with applications in orthopaedics and biomechanical models of bones. More recently, however, biomechanical models of soft tissues have been proposed since most of the human body is made of soft organs that can be deformed by the surgical gesture. Such models are much more complicated to handle since the tissues can be subject to large deformations (non-linear geometrical framework) as well as complex stress/strain relationships (non-linear mechanical framework). Part 1 of the volume presents biomechanical models that have been developed in a CAS context and used during surgery. This is particularly new since most of the soft tissues models already proposed concern Computer Assisted Planning, with ...
Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663
ZHANG Chun-xiao; XU Jian-ping; GE Yi-peng; WEI Yu; YANG Yan; LIU Feng; SHI Yi
Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation (FuwaiSCORE), the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery (the STS model), the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the initial Parsonnet's score (the Parsonnet model) in predicting prolonged intensive care unit (ICU) stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow (H-L) goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic (ROC) curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P＞0.1. The area under ROC curve of the FuwaiSCORE was 0.81 (95%C/0.78-0.84). Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.
Walter E. Longo
The specialty of colon and rectal surgery, a specialty of general surgery, has evolved from the field of proctology. Clinical care has demonstrated decreased number of patients requiring intestinal stomas, improved quality of life in patients with benign anorectal disorders, and more favorable results in patients afflicted with primary and recurrent colorectal cancer. Basic science investigations have spawned from clinical questions such as the molecular biology of colorectal cancer, use of c...
Lagow, Elaine E.; Leeper, Barbara “Bobbi”; Jennings, Linda W.; Ramsay, Michael A.E.
Patients undergoing coronary artery bypass surgery and/or heart valve surgery using a median sternotomy approach coupled with the use of cardiopulmonary bypass often experience pulmonary complications in the postoperative period. These patients are initially monitored in an intensive care unit (ICU) but after discharge from this unit to the ward they may still have compromised pulmonary function. This dysfunction may progress to significant respiratory failure that will cause the patient to r...
Connor, Martin; Cooper, Helen; McMurray, Anne
This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve ...
Toma, M; Busam, A; Ortmaier, T; Raczkowsky, J.; Höpner, C; Marmulla1, R.
This paper presents our research in medical workflow modeling for computer- and robot-based surgical intervention in maxillofacial surgery. Our goal is to provide a method for clinical workflow modeling including workflow definition for pre- and intra-operative steps, analysis of new methods for combining conventional surgical procedures with robot- and computer-assisted procedures and facilitate an easy implementation of hard- and software systems.
Full Text Available Statement of the Problem: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. Purpose: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. Materials and Method: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013 were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward. Operation time, sex, intraoperative Estimated Blood Loss (EBL, postoperative complications, ICU admission, and unwanted complications resulting from staying in ICU were assessed. Results: Of 210 patients undergoing bimaxillary orthognathic surgery, 59 patients (28.1% were postoperatively admitted to the ICU and 151 in the maxillofacial ward (71.9%. There was not statistically significant difference in age and sex between the two groups (p> 0.05. The groups were significantly different in terms of operation time (p< 0.001. Blood loss For ICU admitted patients was 600.00±293.621mL and for those who were hospitalized in the ward was 350.00±298.397 mL. Statistically significant differences were found between the two groups (p< 0.001. Moreover, there was a direct linear correlation between operation time and intraoperative estimated blood loss and this relationship was statistically significant (r=0.42, p< 0.001. Patients with maxillary impaction and setback plus mandibular advancement plus genioplasty were among the most ICU admitted patients (44%, while these patients were only 20% of all patients who were admitted to the ward. As a final point, the result illustrated that patients who were admitted to the ICU experienced more complication such as bleeding, postoperative nausea, and pain (p< 0.001. Conclusion: Orthognathic surgery patients
Full Text Available Neutrophil gelatinase-associated lipocalin (NGAL is a protein of lipocalin family highly expressed in various pathologic states and is an early biomarker of acute kidney injury in cardiac surgery. We performed an observational study to evaluate the role of NGAL in predicting postoperative intensive care stay in high-risk patients undergoing cardiac surgery. We enrolled 27 consecutive patients who underwent high-risk cardiac surgery with cardiopulmonary bypass. Urinary NGAL (uNGAL was measured before surgery, at intensive care unit (ICU arrival and 24 h later. Univariate and multivariate predictors of ICU stay were performed. uNGAL was 18.0 (8.7-28.1 ng/mL at baseline, 10.7 (4.35-36.0 ng/mL at ICU arrival and 29.6 (9.65-29.5 24 h later. The predictors of prolonged ICU stay at the multivariate analysis were body mass index (BMI, uNGAL 24 h after surgery, and aortic cross-clamp time. The predictors of high uNGAL levels 24 h after at a multivariate analysis were preoperative uNGAL and logistic European System for Cardiac Operative Risk Evaluation. At a multivariate analysis the only independent predictors of prolonged ICU stay were BMI, uNGAL 24 h after surgery and aortic cross-clamp time.
Full Text Available Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period or the non-music group (standard postoperative care. Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001. Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.
Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu
Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.
WU Lixin; LIU Zhengyu; Robert Gallimore; Michael Notaro; Robert Jacob
A new modeling concept, referred to as Modeling Surgery, has been recently developed at University of Wisconsin-Madison. It is specifically designed to diagnose coupled feedbacks between different climate components as well as climatic teleconnections within a specific component through systematically modifying the coupling configurations and teleconnective pathways. It thus provides a powerful means for identifying the causes and mechanisms of low-frequency variability in the Earth's climate system. In this paper, we will give a short review of our recent progress in this new area.
Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R
The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process. PMID:27018909
Federal Laboratory Consortium — The ASR services for NHLBI research animals include: animal model development, surgery, surgical support, post-operative care as well as technical services such as...
War, said Carl von Clausewitz, is a cameleon. In this century, each armed conflict has proved to be unique, particularly in its medical aspects, with its own features and teaching its won lessons. As recent events show, no conflict is a fact of the past. Medical care delivered to war casualties depend on the circumstances of the war, on the medical resources available, but also on the price that cultures or circumstances place on it. Everything separates these two paradigms; on the one hand the "precious" casualty of western armies whose medical support is organized in a concept (forward medical and surgical care, ultra-rapid medical evacuation) tailored to each case, and as close as possible to the medical care of a civilian trauma patient whose models remains the North-American ballistic wound managed in trauma centers; on the other hand, civilian victims, in large numbers, in poor and disorganized countries, often abandoned to their own fate or sorted by "epidemiological" triage, which guarantees a distribution, as efficient as possible, of limited medical care. In war, advanced medical care and precarious medicine may work side by side according to two logics which do not exclude one another and constantly improve. PMID:9297902
Kassab, Ghassan S; An, Gary; Sander, Edward A; Miga, Michael I; Guccione, Julius M; Ji, Songbai; Vodovotz, Yoram
In this era of tremendous technological capabilities and increased focus on improving clinical outcomes, decreasing costs, and increasing precision, there is a need for a more quantitative approach to the field of surgery. Multiscale computational modeling has the potential to bridge the gap to the emerging paradigms of Precision Medicine and Translational Systems Biology, in which quantitative metrics and data guide patient care through improved stratification, diagnosis, and therapy. Achievements by multiple groups have demonstrated the potential for (1) multiscale computational modeling, at a biological level, of diseases treated with surgery and the surgical procedure process at the level of the individual and the population; along with (2) patient-specific, computationally-enabled surgical planning, delivery, and guidance and robotically-augmented manipulation. In this perspective article, we discuss these concepts, and cite emerging examples from the fields of trauma, wound healing, and cardiac surgery. PMID:27015816
Grema Umar Sambo; Aminu Bakari; Musa Thomas Samdi; Garba Mohammed Mainasara; Joseph Yohanna; Abdullahi Musa Kirfi
Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from Jul...
Sumathi Matta; Jiwon Park; Ghanshyam Palamaner Subash Shantha; Rohit C Khanna; Gullapalli N Rao
Purpose To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI), India. Methods The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs) and attached vision centres (VCs) that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We au...
French, Daniel G; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien
Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes. PMID:26941968
Peduto, V A; Mezzetti, D; Properzi, M; Giorgini, C
To compare ease of maintenance and recovery characteristics of sevoflurane and propofol plus fentanyl in day-care anaesthesia, 60 outpatients undergoing elective surgery of up to 3 h duration were randomized to receive sevoflurane or propofol as their primary anaesthetic. Induction was always carried out with propofol, but a fentanyl bolus 5 microg kg-1 was added in the propofol group. Anaesthesia was supplemented with up to 70% N2O. Significantly shorter times to extubation (10.03 min +/- 3.2 SD vs. 17.2 +/- 7.3; P < 0.001) and emergence (10.4 +/- 3.1 vs. 16.8 +/- 6.4; P < 0.001) were observed in the sevoflurane group. Patients treated with sevoflurane felt less confused, showed better performances in the digit symbol substitution test and achieved higher modified Aldrete scores sooner in the post-operative course. Maintenance of anaesthesia with sevoflurane produces faster emergence and recovery than propofol plus fentanyl after anaesthesia of short to intermediate duration. PMID:10758459
Sukhminder Jit Singh Bajwa
Full Text Available The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.
Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.
Sukhminderjit Singh Bajwa
Full Text Available Background: Postoperative nausea and vomiting (PONV is one of the complications which hamper the successful implementation of day care surgical procedure in spite of the availability of so many antiemetic drugs and regimens for its prevention. The aim was to compare the prophylactic effects of intravenously (IV administered ondansetron and palonosetron on PONV prevention in patients undergoing laparoscopic gynecological surgery under general anesthesia. Methods: A prospective double-blind study comprised of 60 ASAI/II female patients between the age group of 25 and 40 years was carried out in the Departments of Anesthesiology and Obstetrics and Gynecology of our institute. Patients were randomly divided into two groups of 30 patients each in a double-blind manner. Group I received 8 mg of inj. ondansetron IV while group II received inj. palonosetron 0.075 mg IV 5 minutes before the induction of anesthesia. The need for rescue antiemetics, episodes of PONV and other side effects were observed for 6 hours in the postanesthesia care unit and thereafter complaints were received on phone after the discharge. At the end of study, results were compiled and statistical data was subjected to statistical analysis using Student two-tailed ′t′ and c2 test and value of P<0.05 was considered significant. Results: The demographical profile of the patients was comparable. Twenty and 13.33% of the patients in group I had nausea and vomiting episodes postoperatively as compared to 6.67% and 3.33%, respectively, in group II which was statistically significant (P<0.05. Twenty percent of the patients in group I experienced significant post-op headache as compared to 6.67% in group II. The mean rescue dose of antiemetic was significantly higher (10.6 mg in the group I as compared to group II (6.4 mg (P=0.036. The rest of parameters were comparable and statistically nonsignificant. Conclusions: Palonosetron is a comparatively better drug to prevent the PONV in
Kayış, Enis; Khaniyev, Taghi T; Suermondt, Jaap; Sylvester, Karl
For effective operating room (OR) planning, surgery duration estimation is critical. Overestimation leads to underutilization of expensive hospital resources (e.g., OR time) whereas underestimation leads to overtime and high waiting times for the patients. In this paper, we consider a particular estimation method currently in use and using additional temporal, operational, and staff-related factors provide a statistical model to adjust these estimates for higher accuracy.The results show that our method increases the accuracy of the estimates, in particular by reducing large errors. For the 8093 cases we have in our data, our model decreases the mean absolute deviation of the currently used scheduled duration (42.65 ± 0.59 minutes) by 1.98 ± 0.28 minutes. For the cases with large negative errors, however, the decrease in the mean absolute deviation is 20.35 ± 0.74 minutes (with a respective increase of 0.89 ± 0.66 minutes in large positive errors). We find that not only operational and temporal factors, but also medical staff and team experience related factors (such as number of nurses and the frequency of the medical team working together) could be used to improve the currently used estimates. Finally, we conclude that one could further improve these predictions by combining our model with other good prediction models proposed in the literature. Specifically, one could decrease the mean absolute deviation of 39.98 ± 0.58 minutes obtained via the method of Dexter et al (Anesth Analg 117(1):204-209, 2013) by 1.02 ± 0.21 minutes by combining our method with theirs. PMID:25501470
Sanghera, Sabina; Barton, Pelham; Bhattacharya, Siladitya; Horne, Andrew W; Roberts, Tracy Elizabeth
Objective Conduct an economic evaluation based on best currently available evidence comparing alternative treatments levonorgestrel-releasing intrauterine system, depot-medroxyprogesterone acetate, combined oral contraceptive pill (COCP) and ‘no treatment’ to prevent recurrence of endometriosis after conservative surgery in primary care, and to inform the design of a planned trial-based economic evaluation. Methods We developed a state transition (Markov) model with a 36-month follow-up. The model structure was informed by a pragmatic review and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per quality-adjusted life year (QALY). As available data were limited, intentionally wide distributions were assigned around model inputs, and the average costs and outcome of the probabilistic sensitivity analyses were reported. Results On average, all strategies were more expensive and generated fewer QALYs compared to no treatment. However, uncertainty attributing to the transition probabilities affected the results. Inputs relating to effectiveness, changes in treatment and the time at which the change is made were the main causes of uncertainty, illustrating areas where robust and specific data collection is required. Conclusions There is currently no evidence to support any treatment being recommended to prevent the recurrence of endometriosis following conservative surgery. The study highlights the importance of developing decision models at the outset of a trial to identify data requirements to conduct a robust post-trial analysis. PMID:27084280
Canbulat, Atilla; Goren, Suna; Moğol, Elif Başağan; Kaya, Fatma Nur
Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries. Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (S...
Berlin: Fridrich Ebert Stiftung, 2015 - (Magbunduku, E.), s. 7-15 [Global Care Chains: Why should we care?. Berlin (DE), 22.10.2014-23.10.2014] Institutional support: RVO:68378025 Keywords : care * migration * gender Subject RIV: AO - Sociology, Demography http://www.fes.de/GPol/pdf/Global_Care_Chains_Conference_Reader2015.pdf
Boshkoska, Biljana Mileva; Damij, Talib; Jelenc, Franc; Damij, Nadja
We provide a continuation of the existing Activity Table Modeling methodology with a modular spreadsheets simulation. The simulation model developed is comprised of 28 modeling elements for the abdominal surgery cycle process. The simulation of a two-week patient flow in an abdominal clinic with 75 beds demonstrates the applicability of the methodology. The simulation does not include macros, thus programming experience is not essential for replication or upgrading the model. Unlike the existing methods, the proposed solution employs a modular approach for modeling the activities that ensures better readability, the possibility of easily upgrading the model with other activities, and its easy extension and connectives with other similar models. We propose a first-in-first-served approach for simulation of servicing multiple patients. The uncertain time duration of the activities is modeled using the function "rand()". The patients movements from one activity to the next one is tracked with nested "if()" functions, thus allowing easy re-creation of the process without the need of complex programming. PMID:26004999
Stanford, Fatima Cody; Johnson, Erica D.; Claridy, Mechelle D.; Earle, Rebecca L.; Kaplan, Lee M.
Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight. PMID:26339506
Fatima Cody Stanford
Full Text Available Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH. We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39 were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822 or those 50+ (OR: 0.03, 95% CI: 0.004–0.321. Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.
Khumalo, Thembelihle; Maasdorp, Valerie
There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals.
Komorowski Andrzej L.
Full Text Available The aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery.
Appropriate use of information and communication technology (ICT) and mechatronic (MT) systems is viewed by many experts as a means to improve workflow and quality of care in the operating room (OR). This will require a suitable information technology (IT) infrastructure, as well as communication and interface standards, such as specialized extensions of DICOM, to allow data interchange between surgical system components in the OR. A design of such an infrastructure, sometimes referred to as surgical PACS, but better defined as a Therapy Imaging and Model Management System (TIMMS), will be introduced in this article. A TIMMS should support the essential functions that enable and advance image guided therapy, and in the future, a more comprehensive form of patient-model guided therapy. Within this concept, the 'image-centric world view' of the classical PACS technology is complemented by an IT 'model-centric world view'. Such a view is founded in the special patient modelling needs of an increasing number of modern surgical interventions as compared to the imaging intensive working mode of diagnostic radiology, for which PACS was originally conceptualised and developed. The modelling aspects refer to both patient information and workflow modelling. Standards for creating and integrating information about patients, equipment, and procedures are vitally needed when planning for an efficient OR. The DICOM Working Group 24 (WG-24) has been established to develop DICOM objects and services related to image and model guided surgery. To determine these standards, it is important to define step-by-step surgical workflow practices and create interventional workflow models per procedures or per variable cases. As the boundaries between radiation therapy, surgery and interventional radiology are becoming less well-defined, precise patient models will become the greatest common denominator for all therapeutic disciplines. In addition to imaging, the focus of WG-24 is to serve
Khanna, Rohit C; Kaza, Srivalli; Palamaner Subash Shantha, Ghanshyam; Virender S Sangwan
Objective To compare the outcomes of manual small incision cataract surgery (MSICS) and phacoemulsification performed by ophthalmology trainees. Design Retrospective cohort design. Setting Tertiary eye care centre. Participants A total of 1029 subjects underwent cataract surgeries with MSICS technique or phacoemulsification by trainees during one quarter (July–September 2007). Only 484 (47%) subjects were males. Surgeries which were primarily large incision extracapsular or intracapsular cata...
Three-dimensional visualization for planning and guidance is still not routinely available for minimally invasive cardiac surgery (MICS). This can be addressed by providing the surgeon with subject-specific geometric models derived from 3D preoperative images for planning of port locations or to rehearse the procedure. For guidance purposes, these models can also be registered to the subject using intraoperative images. In this paper, we present a method for extracting subject-specific heart geometry from preoperative MR images. The main obstacle we face is the low quality of clinical data in terms of resolution, signal-to-noise ratio, and presence of artefacts. Instead of using these images directly, we approach the problem in three steps: (1) generate a high quality template model, (2) register the template with the preoperative data, and (3) animate the result over the cardiac cycle. Validation of this approach showed that dynamic subject-specific models can be generated with a mean error of 3.6 ± 1.1 mm from low resolution target images (6 mm slices). Thus, the models are sufficiently accurate for MICS training and procedure planning. In terms of guidance, we also demonstrate how the resulting models may be adapted to the operating room using intraoperative ultrasound imaging
Grema Umar Sambo
Full Text Available Background: Otologic surgeries that endure are based on a detailed knowledge of anatomy, physiology, and pathology of the temporal bone. Ear surgeries are challenging to most otolaryngologists practicing in Nigeria. The aim was to present a 5 years review of indications, types, complications, success, and limitations of the ear surgeries at the study center. Materials and Methods: A 5 years retrospective review of all the otologic surgeries are done under general and local anesthesia from July, 2009 to July, 2014. Results: There were 1067 patients who had ear, nose, and throat surgeries within the period under review, out of which 68 were ear surgeries. Prevalence was 6.37%, there were 25 (37% males and 43 (63% females, male: female 1:1.7. Age ranged from 1 to 58 years, mean age 21 ± 6 years. Chronic suppurative otitis media was the most common diagnosis 39 (57.4% and indication for tympanoplasty 31 (46.6%. Meatocanaloplasty was the least with 2 (2.9%, mastoidectomy 7 (10.3%, myringotomy and grommet insertion 11 (16.2%, excisional biopsy 7 (10.3%, foreign body removal 4 (5.90%, tympanomastoidectomy 3 (4.40%, and pinnaplasty 3 (4.40%. Forty-one (60.3% achieved resolution of symptoms while 8 (11.8% had persistence of symptoms. One (1.5% had revision surgery. The success rate is about 60.3% within the period under review. Postoperative complications (facial nerve paralysis, persistence discharge from the mastoid cavity, worsened deafness, postauricular fistula were seen in 14 (20.6%. While 4 (5.9% were lost to follow-up. Conclusion: Ear surgeries are still underdeveloped when compared to nose and throat surgeries in our center. Complication (chronic suppurative otitis media was the most common indication for ear surgery. Provision of adequate training facilities, especially in the field of otology and review of the training curriculum for otorhinolaryngology residency in Nigeria is indispensable.
Lagow, Elaine E; Leeper, Barbara Bobbi; Jennings, Linda W; Ramsay, Michael A E
Patients undergoing coronary artery bypass surgery and/or heart valve surgery using a median sternotomy approach coupled with the use of cardiopulmonary bypass often experience pulmonary complications in the postoperative period. These patients are initially monitored in an intensive care unit (ICU) but after discharge from this unit to the ward they may still have compromised pulmonary function. This dysfunction may progress to significant respiratory failure that will cause the patient to return to the ICU. To investigate the severity and incidence of respiratory insufficiency once the patient has been discharged from the ICU to the ward, this study used transcutaneous carbon dioxide monitoring to determine the incidence of unrecognized inadequate ventilation in 39 patients undergoing the current standard of care. The incidence and severity of hypercarbia, hypoxia, and tachycardia in post-cardiac surgery patients during the first 24 hours after ICU discharge were found to be high, with severe episodes of each found in 38%, 79%, and 44% of patients, respectively. PMID:24082412
Kumari, Archana; Nigam, Aruna
Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514
Full Text Available Abstract Background Model surgery is an integral part of the planning procedure in orthognathic surgery. Most concepts comprise cutting the dental cast off its socket. The standardized spacer plates of the KD-MMS provide for a non-destructive, reversible and reproducible means of maxillary and/or mandibular plaster cast separation. Methods In the course of development of the system various articulator types were evaluated with regard to their capability to provide a means of realizing the concepts comprised of the KD-MMS. Special attention was dedicated to the ability to perform three-dimensional displacements without cutting of plaster casts. Various utilities were developed to facilitate maxillary displacement in accordance to the planning. Objectives of this development comprised the ability to implement the values established in the course of two-dimensional ceph planning. Results The system - KD-MMS comprises a set of hardware components as well as a defined procedure. Essential hardware components are red spacer and blue mounting plates. The blue mounting plates replace the standard yellow SAM mounting elements. The red spacers provide for a defined leeway of 8 mm for three-dimensional movements. The non-destructive approach of the KD-MMS makes it possible to conduct different model surgeries with the same plaster casts as well as to restore the initial, pre-surgical situation at any time. Thereby, surgical protocol generation and gnathologic splint construction are facilitated. Conclusions The KD-MMS hardware components in conjunction with the defined procedures are capable of increasing efficiency and accuracy of model surgery and splint construction. In cases where different surgical approaches need to be evaluated in the course of model surgery, a significant reduction of chair time may be achieved.
Kumari, Archana; Nigam, Aruna
Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional statu...
de Boer, Jan C; Adriani, Paul; van Houwelingen, Jan Willem; Geerts, A
This article introduces the Game Maturity Model for the healthcare industry as an extension to the general Game Maturity Model and describes the usage by two case studies of applied health games. The Game Maturity Model for healthcare provides a practical and value-adding method to assess existing games and to determine strategic considerations for application of applied health games. Our forecast is that within 5 years the use and development of applied games will have a role in our daily lives and the way we organize health care that will be similar to the role social media has today. PMID:26859720
Jamrozik Klaudia; Rusek Jakub; Szozda Dominik; Karbowski Krzysztof
The paper presents the application results of reverse engineering technology for planning the plastic surgery. First step is digitalization of the patient body. It is realized by 3D structured light scanner. The scanning data are transferred into 3dsMax software and used for planning plastic surgery. The planning effect is shown using stereoscopy visualization method.
Full Text Available Context : Cost-effectiveness analysis should continually assess competing health care options especially in high volume environments like cataract surgery. Aims: To compare the cost effectiveness of phacoemulsification (PE versus manual small-incision cataract surgery (MSICS. Settings and Design: Prospective randomized controlled trial. Tertiary care hospital setting. Subjects and Methods: A total of 52 consenting patients with age-related cataracts, were prospectively recruited, and block randomized to PE or MSICS group. Preoperative and postoperative LogMAR visual acuity (VA, visual function-14 (VF-14 score and their quality-adjusted life years (QALYs were obtained, and the change in their values calculated. These were divided by the total cost incurred in the surgery to calculate and compare the cost effectiveness and cost utility. Surgery duration was also compared. Statistical Analysis Used: Two group comparison with Student′s t-test. Significance set at P < 0.05; 95% confidence interval (CI quoted where appropriate. Results: Both the MSICS and PE groups achieved comparative outcomes in terms of change (difference in mean [95% CI] in LogMAR VA (0.03 [−0.05−0.11], VF-14 score (7.92 [−1.03−16.86] and QALYs (1.14 [−0.89−3.16]. However, with significantly lower costs (INR 3228 [2700-3756], MSICS was more cost effective, with superior cost utility value. MSICS was also significantly quicker (10.58 min [6.85-14.30] than PE. Conclusions: MSICS provides comparable visual and QALY improvement, yet takes less time, and is significantly more cost-effective, compared with PE. Greater push and penetration of MSICS, by the government, is justifiably warranted in our country.
As the number of corneal refractive procedures increases annually, concerns about their long-term stability and predictability have become the center of attention in the ophthalmic community. This thesis focuses on developing quantitative biomechanical models of the cornea that will overcome shortcomings of previous models and incorporate new observations of corneal elastic properties. Our intent is to provide a more accurate model of the corneal structure to guide current and future developments. The second chapter shows that neural networks could rapidly prototype practical solutions to obtain a better estimate of the average corneal power using the contrast and image size parameters provided by the topographic systems. After establishing improved measurements of the corneal shape the thesis focuses on the development of various corneal models. The analytical model proposed shows that geometric optics, corneal structural properties and surgical nomograms could be used to gain a better understanding of corneal response to surgical interventions. The predictions of this model are closer to the values provided by the published nomograms and clinical data than that obtained by the traditional geometric model. Three surgical procedures (Ultrafast Laser-Automated Lamellar Keratomileusis, Corneal Transplant and Intrastromal Refractive Keratectomy) were simulated using the finite element method. A new formulation was developed that simulates the changes on corneal curvature after refractive surgery when the stiffness inhomogeneities across the corneal thickness are considered. It has been shown that the predictability of the surgical outcome is improved when the stiffness inhomogeneities and nonlinearities of the deformations are included in the finite element simulations. Moreover, a finite element formulation has been developed first time to characterize the intrastromal refractive keratectomy procedure. An inhomogeneous (small displacements) model was identified as an
Pitt, Martin; Monks, Thomas; Allen, Michael
The growing complexity of health care coupled with the ever-increasing pressures to ensure efficient and effective use of limited resources have encouraged policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This presentation surveys the breadth of approaches available to support delivery and design across many areas and levels of ...
Arriaga, Patrícia; Pacheco, Catarina
This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care).…
Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R
: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients. PMID:26308640
Kadu, Mudathira K; Stolee, Paul
Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identi...
Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira
Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum...
Štembírek, Jan; Buchtová, Marcela; Putnová, I.; Stehlík, L.; Kyllar, M.; Jonszta, T.; Míšek, Ivan
Praha : Czech Association for Maxillo-Facial Surgery , 2010. s. 1-1. [Trilateral Czech-Slovak-Polish Symposium on Oral and Maxillo Surgery /7./. 01.10.2010-02.10.2010, Praha] R&D Projects: GA ČR(CZ) GP304/08/P289; GA AV ČR IAA600450904 Institutional research plan: CEZ:AV0Z50450515 Keywords : minipig Subject RIV: FF - HEENT, Dentistry
Objective was to evaluate the effect of transferring open-heart surgery patients from the operating room to the intensive care unit on hemodynamic parameters and blood gases. The study was conducted as a prospective, observational study at the German Hospital, Istanbul, Turkey in 2007. Hemodynamic, blood gas values and oxygen saturation measured by pulse oximetry SpO2 values were recorded in 37 patients who undergone open-heart surgery. Data were evaluated by descriptive statistical methods, Friedman's test and correlation analysis. Thirty-seven patients were included in this study. The low systolic and diastolic arterial blood pressure values prior to transfer, while patients were still under the effect of anesthesia, increased during the transfer and to one and 30 minutes after completion of transfer and return to normal values p<0.05. The SpO2 value measured at 30 minutes after completion of transfer was higher than the first value p<0.05. The pH p<0.001 and arterial partial pressure of oxygen p<0.001 values at the beginning of the transfer had significantly increased at the end of transfer and arterial partial pressure of carbon dioxide values had significantly decreased p<0.001. The transfer of open-heart surgery patients was observed to safe. (author)
Veroff David R
Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or
INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of most...
Braverman-Panza, Jill; Horn, Deborah Bade
The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108
Trastek, Victor F; Hamilton, Neil W; Niles, Emily E
Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. PMID:24486078
Mollemans, Wouter; Schutyser, Filip; Nadjmi, Nasser; Suetens, Paul
Mollemans W., Schutyser F., Nadjmi N., Suetens P., ''Very fast soft tissue predictions with mass tensor model for maxillofacial surgery planning systems'', International congress series 19th international congress and exhibition on computer assisted radiology and surgery - CARS 2005, vol. 1281, pp. 491-496, June 22-25, 2005, Berlin, Germany.
Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.
Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.
The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…
Yan, Zhiyue; Wang, Yiming; Shou, Xuefei; Su, Jianguang; Lang, Liwei
Objective: To explore the surgical therapeutic effects in the endocrine and reproductive system of women with prolactinoma at child-bearing age, and to investigate the potential influencing factors for therapeutic outcome. Methods: This retrospective study was performed using the medical records of 99 cases of female patients with pituitary PRL adenomas at child-bearing age, who underwent transsphenoidal surgery and took standard perioperative care from January, 2013 to June, 2013 in Huashan hospital, in which micro adenoma (≤1 cm) of 68 cases, large adenomas (> 1 cm) of 31 cases, 88 cases were total resection, 9 cases were subtotal resection, and 2 cases were massive resection. Retrospective study on the preoperative serum level of PRL, menstruation, galactorrhea and reproductive function, etc. Patients were followed up in 1, 3, 6 and 12 months after operation for endocrine indicators, the situation of menstruation and pregnancy. Results: Overall, 88.9%, 9.1%, and 2% patients underwent total, subtotal, and massive resection of prolactinoma in 99 cases of patients. Before accepting transsphenoidal surgery and standard care, all 99 cases with serum PRL level higher than normal 25 ng/ml, 71.7% (71 cases, all total resection) patients had their serum PRL 0.05). 14 patients out of 17 infertility patients got pregnant after surgery. Conclusion: Transsphenoidal operation combining standardized nursing measures is an effective way to treat pituitary PRL adenoma, and it has high cure rate on abnormal menstruation caused by pituitary PRL adenoma which can recover the fertility of female patients. The preoperative serum level of prolactin could be used as an indicator for postoperative improvement in the endocrine system. The serum level of prolactin on the first day after operation could accurately reflect prognosis, so be regarded as one of the assessment factors for surgical therapeutic effect. PMID:26885105
Tejaswini Arunachala Murthy
Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.
Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M
For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy. PMID:16163102
Khoundabi, Batoul; Kazemnejad, Anoshirvan; Mansourian, Marjan; Kazempoor Dizaji, Mehdi; Hashemian, Seyed Mohammadreza
Background: Admission to the intensive care unit (ICU) is often complicated by early acute kidney injury (AKI). AKI is associated with high rates of mortality and morbidity. Risk factors and incidence of AKI have been notably high following non-cardiac surgery in the past decade. The aim of this study was to determine the hazard rate of AKI, the effect of risk factors of AKI and also to assess the changes in urine output (UO) as a predictor of AKI using joint modeling in patients undergoing n...
E. De la Poza
Full Text Available Plastic surgery practice grows continuously among the women in Western countries due to their body image dissatisfaction, aging anxiety, and an ideal body image propagated by the media. The consumption growth is so important that plastic surgery is becoming a normal practice among women, like any other cosmetic product, with the risk of suffering psychopathology disorders in the sense that plastic surgery could be employed as an instrument to recover personal self-esteem or even happiness. Plastic surgery practice depends on economic, demographic, and social contagion factors. In this paper, a mathematical epidemiological model to forecast female plastic surgery consumption in Spain is fully constructed. Overconsumer subpopulation is predicted and simulated. Robustness of the model versus uncertain parameters is studied throughout a sensitivity analysis.
P. Di Carlo; GULOTTA, G.; Casuccio, A; Pantuso, G.; Raineri, SM; Airò Farulla, C; BONVENTRE, S.; Guadagnino, G; D Ingrassia; COCORULLO, G.; C. Mammina; Giarratano, A
Background Abdominal surgery carries significant morbidity and mortality, which is in turn associated with an enormous use of healthcare resources. We describe the clinical course of 30 Intensive Care Unit (ICU) patients who underwent abdominal surgery and showed severe infections caused by Klebsiella pneumoniae sequence type (ST) 258 producing K. pneumoniae carbapenemase (KPC-Kp). The aim was to evaluate risk factors for mortality and the impact of a combination therapy of colistin plus reco...
Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
Taddei, Alessandro; Dalmiani, Stefano; Vellani, Antonio; Piccini, Giacomo; Rocca, Emiliano; Carducci, T; Borghini, R; Marcheschi, Paolo; Macerata, Alberto
During last ten years the Hospital Information System (HIS) was developed at Institut e of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical s ide into the OG. Monasterio Foundationo (FGM) by joint efforts of CNR, Tuscany Region and Universi ties. G. Pasquinucci Heart Hospital (GPH) in Massa, currently one of the two FGMoes sections, i s specialised in Cardiology and Cardiac Surgery (adult and pediatric)
Taddei, Alessandro; Dalmiani, Stefano; Vellani, Antonio; Rocca, E.; Piccini, Giacomo; Carducci, T; Gori, A.; Borghini, R; Marcheschi, Paolo; Mazzarisi, Alessandro; Salvatori, Cristina; Macerata, Alberto; Varanini, Maurizio
During the last ten years the Hospital Information System (HIS) was developed at the Institute of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical side into the "Gabriele Monasterio Foundation" (FGM) by joint efforts of CNR, Tuscany Region and Universities. At G.Pasquinucci Heart Hospital (GPH), currently FGM's section in Massa, the HIS was adapted and extended to Cardiac Surgery and Pediatric Cardiology. Data archiving and middleware integration th...
Arash Momeni; Kim, Rebecca Y.; Wan, Derrick C.; Ali Izadpanah; Lee, Gordon K.
Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents’ perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three...
Jedid-Jah Jonker; Klarita Sadiraj; Isolde Woittiez; Michiel Ras; Meike Morren
Original title: Verklaringsmodel verpleging en verzorging 2007. Population ageing means the demand for and take-up of care is likely to increase sharply in the coming years. Older people make particularly heavy use of home care, nursing homes and care homes, collectively referred to as 'nursing and care'. The Dutch Ministry of Health, Welfare and Sport is therefore interested in the likely trend in nursing and care in the coming decades. This study presents forecasts of the demand for and tak...
Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational
In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.
Saudah, Noer; Nursalam; Meriana; Sulistyono, Agus
The role of parents has done less during the preterm infant care in hospitals caused dependence in caring for the baby. The objective of the research was to development a model of independence of the mother in the care of preterm infants with experiential learning approach based theory of goal attainment. Research's design used analytic…
Fodor, L.; Ciuce, C.; Fodor, M.; Shrank, C.; Lapid, O.; Kon, M.; Ramon, Y.; Ullmann, Y.
A varying period of training followed by examinations is the usual way to become a specialist in one of the many fields of Medicine. Plastic Surgery is one of the surgical fields that require good technical and cognitive skills. The best way to train and evaluate a candidate is hard to judge. The mo
Herbert, Chris; Medd, Claire
Telehealth is a proven tool for reducing costs, improving quality of life, reducing hospital visits/length of stay and enhancing relationships between patients and community nurses. There have been many trials demonstrating these benefits, and findings have always demonstrated return on investment. However, uptake has been slow—68% of providers have no plans to roll out a telehealth solution in the next 24 months. Through a decade of ethnographic research, Care Innovations has visited 20 coun...
Ahaus Kees TB; Vermeulen Robbert P; Minkman Mirella MN; Huijsman Robbert
Abstract Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the i...
Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine
Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academi...
Marshall, Catherine; And Others
This paper identifies four models of educational administration--the rational, mechanistic, organic, and bargaining models--and argues that a fifth model of leadership--a caring model--is needed. The ethic of caring (Nodding, 1986) is reciprocal, natural, and ethical and emphasizes connection, responsibilities, and relationships. Creating a model…
Campbell, James P; Vaughn, Byron P
Despite improvements in medical therapies for Crohn's disease (CD), up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and standardizing postoperative assessments are essential in preventing clinical recurrence of CD. In this review, we discuss the assessment, monitoring, and treatment of postoperative CD patients. We address the various individual risk factors as well as composite risk factors. Medications used for primary CD treatment can be used in the postoperative setting to prevent endoscopic or clinical recurrence with varying efficacy, although the cost-effectiveness of these approaches are not fully understood. Future directions for postoperative CD management include evaluation of newer biologic agents such as anti-integrin therapy and fecal microbiota transplant for prevention of recurrence. Development of a standard preoperative risk assessment tool to clearly stratify those at high-risk of recurrence is necessary to guide empiric therapy. Lastly, the incorporation of noninvasive testing into disease monitoring will likely lead to early detection of endoscopic recurrence that will allow for tailored treatment to prevent clinical recurrence. PMID:27540307
Baig, Rashid; A Chaudhry, Tanveer; Kukreja, Saajan; Shakil, Sidra; Ahmad, Khabir
This single group cohort study, undertaken at Aga Khan University Hospital, Karachi, from Jan 2012 to September 2013, assessed patients' satisfaction, spectacle independence and visual disturbance after implantation of multifocal IOLs. A total of 39 patients who underwent bilateral cataract surgery with multifocal IOL implantation were included for telephonic interviews. The mean age of participants was 55.5 ± 8.1 years. The mean follow up time was 9.60 ± 3.19 months. The overall satisfaction rate after surgery was found to be 84.6% and there was no statistically significant association of satisfaction with gender, age or education. In all 84.6%, 94.9% and 84.6% people had spectacle independence for far, intermediate and near, respectively. More than half of participants (59%) had some degree of visual disturbance. In this study, multifocal IOL implantation provided high levels of satisfaction and spectacle independence despite notable risk of halo or glare symptoms at night. Therefore, careful patient selection and preoperative counselling regarding possible risks and benefits is recommended. PMID:27339580
Ball, Chad G.; Keaney, Marilyn A.; Chun, Rosaleen; Groleau, Michelle; Tyssen, Michelle; Keyte, Jennifer; Broderick, Timothy J.; Kirkpatrick, Andrew W.
BackgroundMultiple nations are actively pursuing manned exploration of space beyond low-earth orbit. The responsibility to improve surgical care for spaceflight is substantial. Although the use of parabolic flight as a terrestrial analogue to study surgery in weightlessness (0 g) is well described, minimal data is available to guide the appropriate delivery of anesthesia. After studying anesthetized pigs in a 0 g parabolic flight environment, our group developed a comprehensive protocol describing prolonged anesthesia in a parabolic flight analogue space surgery study (PFASSS). Novel challenges included a physically remote vivarium, prolonged (>10 h) anesthetic requirements, and the provision of veterinary operating room/intensive care unit (ICU) equivalency on-board an aircraft with physical dimensions of medication, and induction protocols on Yorkshire-cross specific pathogen-free (SPF) pigs. Several constant rate infusion (CRI) intravenous anesthetic combinations were tested. In each regimen, opioids were administered to ensure analgesia. Ventilation was supported mechanically with blended gradients of oxygen. The best performing terrestrial 1 g regime was flight tested in parabolic flight for its effectiveness in sustaining optimal and prolonged anesthesia, analgesia, and maintaining hemodynamic stability. Each flight day, a fully anesthetized, ventilated, and surgically instrumented pig was transported to the Flight Research Laboratory (FRL) in a temperature-controlled animal ambulance. A modular on-board surgical/ICU suite with appropriate anesthesia/ICU and surgical support capabilities was employed. ResultsThe mean duration of anesthesia (per flight day) was 10.28 h over four consecutive days. A barbiturate and ketamine-based CRI anesthetic regimen supplemented with narcotic analgesia by bolus administration offered the greatest prolonged hemodynamic stability through an IV route (within multiple transport vehicles and differing gravitational environments
Desebbe, Olivier; Lanz, Thomas; Kain, Zeev; Cannesson, Maxime
Contrary to the intraoperative period, the current perioperative environment is known to be fragmented and expensive. One of the potential solutions to this problem is the newly proposed perioperative surgical home (PSH) model of care. The PSH is a patient-centred micro healthcare system, which begins at the time the decision for surgery is made, is continuous through the perioperative period and concludes 30 days after discharge from the hospital. The model is based on multidisciplinary involvement: coordination of care, consistent application of best evidence/best practice protocols, full transparency with continuous monitoring and reporting of safety, quality, and cost data to optimize and decrease variation in care practices. To reduce said variation in care, the entire continuum of the perioperative process must evolve into a unique care environment handled by one perioperative team and coordinated by a leader. Anaesthesiologists are ideally positioned to lead this new model and thus significantly contribute to the highest standards in transitional medicine. The unique characteristics that place Anaesthesiologists in this framework include their systematic role in hospitals (as coordinators between patients/medical staff and institutions), the culture of safety and health care metrics innate to the specialty, and a significant role in the preoperative evaluation and counselling process, making them ideal leaders in perioperative medicine. PMID:26613678
Patrícia Arriaga; Catarina Pacheco
This study investigated the effects of hospital Clown Doctors intervention on child and caregiver preoperative anxiety at the entrance to the surgery care unit and separation from caregivers. A total of 88 children (aged 4-12 years) were assigned to one of the following two groups: Clown Doctors intervention or control group (standard care). Independent observational records using the modified Yale Preoperative Anxiety Scale instrument assessed children’s anxiety, while the State-Trait Anxiet...
Bangash, HK; Ibrahimi, OA; Green, LJ; Alam, M.; Eisen, DB; Armstrong, AW
BACKGROUND: The public preference for provider type in performing cutaneous surgery and cosmetic procedures is unknown in the United States. METHODS: An internet-based survey was administered to the lay public. Respondents were asked to select the health care provider (dermatologist, plastic surgeon, primary care physician, general surgeon, and nurse practitioner/physician's assistant) they mostly prefer to perform different cutaneous cosmetic and surgical procedures. RESULTS: Three hundred f...
Purpose: To determine the efficacy of definitive surgery and radiation in patients aged 70 years and older with supratentorial glioblastoma multiforme. Methods and Materials: We selected elderly patients (≥ 70 years) who had primary treatment for glioblastoma multiforme at our tertiary care institution from 1977 through 1996. The study group (n = 102) included 58 patients treated with definitive radiation, 19 treated with palliative radiation, and 25 who received no radiation. To compare our results with published findings, we grouped our patients according to the applicable prognostic categories developed by the Radiation Therapy Oncology Group (RTOG): RTOG group IV (n = 6), V (n = 70), and VI (n = 26). Patients were retrospectively assigned to prognostic group IV, V, or VI based on age, performance status, extent of surgery, mental status, neurologic function, and radiation dose. Treatment included surgical resection and radiation (n 49), biopsy alone (n = 25), and biopsy followed by radiation (n = 28). Patients were also stratified according to whether they were optimally treated (gross total or subtotal resection with postoperative definitive radiation) or suboptimally treated (biopsy, biopsy + radiation, surgery alone, or surgery + palliative radiation). Patients were considered to have a favorable prognosis (n = 39) if they were optimally treated and had a Karnofsky Performance Status (KPS) score of at least 70. Results: The median survival for patients according to RTOG groups IV, V, and VI was 9.2, 6.6, and 3.1 months, respectively (log-rank, p < 0.0004). The median overall survival was 5.3 months. The definitive radiation group (n = 58) had a median survival of 7.3 months compared to 4.5 months in the palliative radiation group (n = 19) and 1.2 months in the biopsy-alone group (p < 0.0001). Optimally treated patients had a median survival of 7.4 months compared to 2.4 months in those suboptimally treated (p < 0.0001). The favorable prognosis group had an
Trilk, Jennifer L; Kennedy, Ann Blair
More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity. PMID:25757003
Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff;
The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... with sound leadership, research and a model of care, there is an opportunity to help reduce the burden of the leading cause of disability in the world....
Deutsch, Madeline B
Transgender people have a gender identity different from their birth-assigned sex. Transgender people may seek gender-affirming surgeries to align their body with their identified gender. With increasing visibility of transgender identities, and recognition of the importance of gender-affirming care, has come a policy shift toward mandated coverage or provision of blanket exclusions of these procedures by insurance companies and Medicaid. The World Professional Association for Transgender Health provides guidance to mental health professionals evaluating patients for gender-affirming surgeries, including making a diagnosis and assessing for capacity to consent. However the expansion of covered gender-affirming surgeries to safety-net populations has highlighted the need for an expanded presurgical process which includes a psychosocial assessment and care navigation. The proposed framework expands the preoperative assessment to include these components, and can be used to guide both health systems and insurance providers in the development of transgender medicine programs. PMID:27180683
McLaughlin, Nancy; Ricardo L. Carrau; Daniel F. Kelly; Prevedello, Daniel M.; Kassam, Amin B.
Background: During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Methods: Pubmed and Medline databases were searched for pu...
W.C. Peul (Wilco); W.B. van den Hout (Wilbert); R. Brand (René); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)
textabstractObjectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. I
Peul, W.C.; Hout, van den W.B.; Brand, R.; Thomeer, R.T.W.M.; Koes, B.W.
Objectives: To evaluate the effects of early lumbar disc surgery compared with prolonged conservative care for patients with sciatica over two years of follow-up. Design: Randomised controlled trial. Setting: Nine Dutch hospitals. Participants: 283 patients with 6-12 weeks of sciatica. Interventions
Leung, Patricia; Chiu, Chun Hung; Ho, Ka Man; Gomersall, Charles David; Underwood, Malcolm John
Introduction Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. Methods and analysis 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong—New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. Trial registration number ChiCTR-IOR-15006971. PMID:27334883
Lambertz, R; Drinhaus, H; Schedler, D; Bludau, M; Schröder, W; Annecke, T
Locally advanced carcinomas of the oesophagus require multimodal treatment. The core element of curative therapy is transthoracic en bloc oesophagectomy, which is the standard procedure carried out in most specialized centres. Reconstruction of intestinal continuity is usually achieved with a gastric sleeve, which is anastomosed either intrathoracically or cervically to the remaining oesophagus. This thoraco-abdominal operation is associated with significant postoperative morbidity, not least because of a vast array of pre-existing illnesses in the surgical patient. For an optimal outcome, the careful interdisciplinary selection of patients, preoperative risk evaluation and conditioning are essential. The caseload of the centres correlates inversely with the complication rate. The leading surgical complication is anastomotic leakage, which is diagnosed endoscopically and usually treated with the aid of endoscopic procedures. Pulmonary infections are the most frequent non-surgical complication. Thoracic epidural anaesthesia and perfusion-orientated fluid management can reduce the rate of pulmonary complications. Patients are ventilated protecting the lungs and are extubated as early as possible. Oesophagectomies should only be performed in high-volume centres with the close cooperation of surgeons and anaesthesia/intensive care specialists. Programmes of enhanced recovery after surgery (ERAS) hold further potential for the patient's quicker postoperative recovery. In this review article the fundamental aspects of the interdisciplinary perioperative management of transthoracic oesophagectomy are described. PMID:27245922
This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical r...
Wylie, Kevan; Knudson, Gail; Khan, Sharful Islam; Bonierbale, Mireille; Watanyusakul, Suporn; Baral, Stefan
The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people. PMID:27323926
Cai, Ming; Cao, Xia; Fang, Xiao; Wang, Xu-dong; Zhang, Li-li; Zheng, Jia-wei; Shen, Guo-fang
Flipped classroom is a new teaching model which is different from the traditional teaching method. The history and characteristics of flipped classroom teaching model were introduced in this paper. A discussion on how to establish flipped classroom teaching protocol in oral and maxillofacial surgery education was carried out. Curriculum transformation, construction of education model and possible challenges were analyzed and discussed. PMID:27063134
Neumann, Patrick; Siebert, Dirk; Schulz, Armin; Faulkner, Gabriele; Krauss, Manfred; Tolxdorff, Thomas
Our main research work is the realization of a completely computer-based maxillofacial surgery planning system. An important step toward this goal is the availability of virtual tools for the surgeon to interactively define bone segments from skull and jaw bones. The easy-to-handle user interface employs visual and force-feedback devices to define subvolumes of a patient's volume dataset. The defined subvolumes together with their spatial arrangements lead to an operation plan. We have evaluated modern low-cost, force- feedback devices with regard to their ability to emulate the surgeon's working procedure.
... The experts in face, mouth and jaw surgery. Cleft Lip / Palate and Craniofacial Surgery This type of surgery is ... the carefully orchestrated, multiple-stage correctional program for cleft lip and palate patients. The goal is to help restore the ...
Rudow, Dianne LaPointe; Swartz, Kathleen; Phillips, Chelsea; Hollenberger, Jennifer; Smith, Taylor; Steel, Jennifer L
Solid organ transplantation as a treatment for end stage organ failure has been an accepted treatment option for decades. Despite advances in medicine and technology, and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen. Living donation has been an option that has increased the number of transplants despite the continued shortage of deceased organs. In the early 2000s live donor transplantation reached an all-time high in the United States. As a result, a consensus meeting was convened in 2000 to increase the oversight of living donor transplantation. Both the Centers for Medicare and Medicaid Services and the United Network for Organ Sharing developed regulations that transplant programs performing live donor transplantation. These regulations and guidelines involve the education, evaluation, informed consent process and living donor follow-up care. Two areas in which had significant changes included the psychosocial and the independent living donor advocate (ILDA) evaluation. The purpose of this paper was to outline the current regulations and guidelines associated with the psychosocial and ILDA evaluation as well as provide further recommendations for the administration of a high quality evaluation of living donors. The goals and timing of the evaluation and education of donors; qualifications of the health care providers performing the evaluation; components of the evaluation; education provided to donors; documentation of the evaluation; participation in the selection committee meeting; post-decline and post-donation care of donors is described. Caveats including the paired donor exchange programs and non-directed and directed donation are also considered. PMID:26293351
30 days Mortality (1 and ndash;pulmonary embolus. Operative time (minutes: THE-234, TTE-322. Blood loss (ml/patient: THE-265, TTE-380. Hospital stays (days: THE-7.3, TTE-10. Conclusions: 79% of properly selected and evaluated cases underwent MIES, with one Mortality and 26 events of morbidity. 6% required conversion. The procedure detected inoperability in 16% cases. The nodal yield, status of margins, operative time, blood loss and hospital stay indicates that MIES has a future to become a standard of care in the treatment of esophageal cancers. [Int J Res Med Sci 2015; 3(8.000: 2046-2052
Gavilanes, A.; Heineman, E; Herpers, M.; Blanco, C; BURGE, D.
AIM—To evaluate the advantages, disadvantages, and short term morbidity and mortality of major surgical interventions performed in the neonatal intensive care unit. METHODS—A retrospective case review of 45 neonates was performed from April 1991 to September 1995. The characteristics of the patients were: gestational age 29 (SD 4) weeks (range 24 to 41 weeks); birthweight 1305 (870) g ( range 540 to 4040 g); presurgical weight 1430 (895) g ( range 550 to 4370 g); postconceptional age at surge...
Full Text Available BACKGROUND Anaesthetic management of patients with oromaxillofacial surgeries poses quite a few challenges to both anaesthesiologist and operating surgeons. This is because the corrective procedure demands fixation of fractures, repair of soft tissue injuries and maintaining occlusion all without compromising the cosmetic aspect. Though securing the airway takes the precedence, it is of paramount importance that it should not interfere with the surgical techniques. METHODS Seventy one patients of maxillofacial injuries, operated over a period of five years between February 2011 and December 2015 in Indira Gandhi Medical College Hospital at Puducherry were reviewed. All patients were reviewed in relation to age, type of injury, etiology, bones involved and method of airway management. RESULTS The major etiology of injuries were road traffic accidents (79%. Majority of patients were young in the age group of 21-40 years (55%. Fracture mandible (46% was the most common injury. Airway secured by nasotracheal route with direct visualization of vocal cords was the most common (90%, followed by submental route (10%. CONCLUSION This analysis showed in maxillofacial procedures, trauma is the leading cause in this part of India also. Male preponderance, maximum injuries are seen in third and fourth decade of life and other findings that are correlating well with other studies. Nasotracheal intubation is the method of choice in securing the airway during the maxillofacial procedures. Submental intubation can be considered as a viable option when nasotracheal intubation is not possible due to the involvement of base of the skull or midfacial fractures.
Marseille, E; Brand, R
The cost-effectiveness of public health cataract programs in low-income countries has been well documented. Equity, another important dimension of program quality which has received less attention is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females. For both genders, the cataract blind over 55 received proportionately fewer services than younger people blind from cataract. Blind males aged 45-54 had a 500% higher rate of surgical coverage than blind males over 65. Blind females aged 35-44 had nearly a 600% higher rate of surgical coverage than blind females over 65. There was wide variation in overall surgical coverage between geographic zones, but little variation by terrain type, an indicator of the logistical difficulties in delivery of services. Members of the two highest caste groupings had somewhat lower surgical coverage than members of lower castes. Program managers should consider developing methods to increase services to women and to those over 65. Reaching these populations will become increasingly important as those most readily served receive surgery and members of the under-served groups form a growing portion of the remaining cataract backlog. PMID:10175620
Bharadwaj, Shishira; Trivax, Brandon; Tandon, Parul; Alkam, Bilal; Hanouneh, Ibrahim; Steiger, Ezra
Postoperative infectious complications are independently associated with increased hospital length of stay (LOS) and cost and contribute to significant inpatient morbidity. Many strategies such as avoidance of long periods of preoperative fasting, re-establishment of oral feeding as early as possible after surgery, metabolic control and early mobilization have been used to either prevent or reduce the incidence of postoperative infections. Despite these efforts, it remains a big challenge to our current healthcare system to mitigate the cost of postoperative morbidity. Furthermore, preoperative nutritional status has also been implicated as an independent risk factor for postoperative morbidity. Perioperative nutritional support using enteral and parenteral routes has been shown to decrease postoperative morbidity, especially in high-risk patients. Recently, the role of immunonutrition (IMN) in postoperative infectious complications has been studied extensively. These substrates have been found to positively modulate postsurgical immunosuppression and inflammatory responses. They have also been shown to be cost-effective by decreasing both tpostoperative infectious complications and hospital LOS. In this review, we discuss the postoperative positive outcomes associated with the use of perioperative IMN, their cost-effectiveness, current guidelines and future clinical implications. PMID:27081153
Vincent Q. Trinh
Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.
A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system＇s services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.
目的：探讨无痛病房模式在肛肠术后患者护理中的效果。方法：将2013年6月至2013年12月在我院接受肛肠手术的156例患者，随机分为普通护理组和无痛护理组各78例。前者给予常规护理，后者则在常规护理的基础上实施无痛病房护理模式，分析比较两组患者的护理情况及满意率。结果：采用无痛病房模式的无痛护理组患者疼痛程度得分显著低于普通护理组，患者对护理人员的护理方式接受程度、护理服务质量满意度得分均显著高于普通护理组，差异具有统计学意义(均p<0.03)。结论：实施无痛病房模式的疼痛护理，减轻了患者的术后疼痛，促进了患者的康复，使患者术后镇痛效果满意度显著提高。%Objective: To investigate the effect of pain in anorectal surgery ward model of patient care. Methods: June 2013 to December 2013 in our hospital anorectal surgery, 156 patients were randomly divided into general nursing care groups and each group 78 cases painless. The former received routine care, the latter on the basis of the implementation of routine nursing care model painless ward, analysis and comparison of two groups of patient care conditions and satisfaction. RESULTS: The degree of pain painless painless care ward patients scored significantly lower than model group of ordinary care, nursing care of patients the way for acceptance, care quality of service satisfaction scores were significantly higher than usual care group, the difference is statistical y significance (al p <0.03). Conclusion: The implementation painless pain care ward mode, reducing the patient's postoperative pain, and promote the rehabilitation of patients, so that patients significantly improved analgesia satisfaction.
Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951
Lindley, Lisa C.
One of the many difficult moments for families of children with life-limiting illnesses is to make the decision to access pediatric hospice care. Although determinants that influence families’ decisions to access pediatric hospice care have been recently identified, the relationship between these determinants and access to pediatric hospice care have not been explicated or grounded in accepted healthcare theories or models. Using the Andersen Behavioral Healthcare Utilization Model, this arti...
Falkenberg Torkel; Warenmark Anders; Halpin Jeremy; Sundberg Tobias
Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple st...
Stoneham, M; Murray, D; Foss, N
undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely......National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...
Vedel Isabelle; Ghadi Veronique; De Stampa Matthieu; Routelous Christelle; Bergman Howard; Ankri Joel; Lapointe Liette
Background Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Th...
Griffin, D R; Dickenson, E J; Wall, P D H; Donovan, J L; Foster, N E; Hutchinson, C E; Parsons, N; Petrou, S; Realpe, A; Achten, J; Achana, F; Adams, A; Costa, M L; Griffin, J; Hobson, R; Smith, J
Introduction Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. Methods We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). Ethics and dissemination Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer
Kroneman, M.; Oort, M. van; Groenewegen, P.; Jong, D. de
The aim of this paper is providing a first step in explaining variations in day surgery rates among Dutch hospitals. A theoretical model was set up to explain variations based on diffusion theory and environmental characteristics. We tried to test our model by means of routinely collected data from
Migden, Michael; Chavez-Frazier, Arianne; Nguyen, Tri
The use of video in the informed consent process has been well documented in the literature to improve patient satisfaction, understanding, comprehension, and to decrease anxiety. At the MD Anderson Mohs Surgery Unit, we use high-definition (HD) audiovisual (AV) modules to assist with the delivery of informed consent and to educate patients on the subject of postoperative wound care. The purpose of this work was to develop HD-AV media to inform patients of the risks, benefits, and alternatives of Mohs surgery before they are asked to sign the consent form and to educate patients on basic wound care after Mohs Surgery. The use of a HD virtual surgeon and nurse in the videos educates the patient, allowing the surgeon and nursing staff to attend to other patients within the Mohs Surgery Unit. Using HD digital recording equipment, we captured real-time HD-AV media to explain the risks, alternatives, and benefits of Mohs surgery (surgeon explanation) and to give detailed instructions for postoperative wound care (nurse explanation). Once captured, HD modules were created and stored on a central University of Texas-MD Anderson Cancer Center server in the Texas Medical Center approximately 1 mile from the Mohs Surgery Unit. The full-screen HD modules are accessed on demand at the point of need with the use of standard institutional computers within any of the Mohs's center's examination/surgical suites. An early evaluation of this quality improvement initiative was performed to measure patient satisfaction, efficiency, and efficacy of the videos followed by physician/nurse discussion compared with physician/nurse discussion alone. Early evaluation of HD-AV modules used for the delivery of informed consent and postoperative wound care in the MD Anderson Mohs surgery Unit revealed that patient satisfaction was maintained and that this medium was preferred by patients in the video group over physician/nurse discussion alone. The HD modules allowed increased efficiency and
Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States commercial payer population: potential economic implications of a new minimally invasive technology
Full Text Available Stacey J Ackerman,1 David W Polly Jr,2 Tyler Knight,3 Karen Schneider,4 Tim Holt,5 John Cummings Jr6 1Covance Market Access Services Inc., San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc., Gaithersburg, MD, USA; 4Covance Market Access Services Inc., Sydney, Australia; 5Montgomery Spine Center, Orthopedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USA Introduction: Low back pain is common and treatment costly with substantial lost productivity and lost wages in the working-age population. Chronic low back pain originating in the sacroiliac (SI joint (15%–30% of cases is commonly treated with nonoperative care, but new minimally invasive surgery (MIS options are also effective in treating SI joint disruption. We assessed whether the higher initial MIS SI joint fusion procedure costs were offset by decreased nonoperative care costs from a US commercial payer perspective. Methods: An economic model compared the costs of treating SI joint disruption with either MIS SI joint fusion or continued nonoperative care. Nonoperative care costs (diagnostic testing, treatment, follow-up, and retail pharmacy pain medication were from a retrospective study of Truven Health MarketScan® data. MIS fusion costs were based on the Premier's Perspective™ Comparative Database and professional fees on 2012 Medicare payment for Current Procedural Terminology code 27280. Results: The cumulative 3-year (base-case analysis and 5-year (sensitivity analysis differentials in commercial insurance payments (cost of nonoperative care minus cost of MIS were $14,545 and $6,137 per patient, respectively (2012 US dollars. Cost neutrality was achieved at 6 years; MIS costs accrued largely in year 1 whereas nonoperative care costs accrued over time with 92% of up front MIS procedure costs offset by year 5. For patients with lumbar spinal fusion, cost neutrality
Full Text Available To evaluate cataract surgery visual outcomes and associated risk factors in rural secondary level eye care centers of L V Prasad Eye Institute (LVPEI, India.The Eye Health pyramid of LVPEI has a network of rural secondary care centres (SCs and attached vision centres (VCs that provide high quality comprehensive eye care with permanent infrastructure to the most disadvantaged sections of society. The most common procedure performed at SCs is cataract surgery. We audited the outcome of a random sample of 2,049 cataract surgeries done from October 2009-March 2010 at eight rural SCs. All patients received a comprehensive ophthalmic examination, both before and after surgery. The World Health Organization recommended cataract surgical record was used for data entry. Visual outcomes were measured at discharge, 1-3 weeks and 4-11 weeks follow up visits. Poor outcome was defined as best corrected visual acuity <6/18.Mean age was 61.8 years (SD: 8.9 years and 1,133 (55.3% surgeries were performed on female patients. Pre-existing ocular co-morbidity was present in 165 patients (8.1%. The most common procedure was small incision cataract surgery (SICS with intraocular lens (IOL implantation (91.8%. Intraoperative complications were seen in 29 eyes (1.4%. At the 4-11 weeks follow-up visit, based on presenting visual acuity (PVA, 61.8% had a good outcome and based on best-corrected visual acuity (BCVA, 91.7% had a good outcome. Based on PVA and BCVA, those with less than 6/60 were only 2.9% and 1.6% respectively. Using multivariable analysis, poor visual outcomes were significantly higher in patients aged ≥70 (OR 4.63; 95% CI 1.61, 13.30, in females (OR 1.58; 95% CI 1.04, 2.41, those with preoperative comorbidities (odds ratio 4.68; 95% CI 2.90, 7.57, with intraoperative complications (OR 8.01; 95% CI 2.91, 22.04, eyes that underwent no IOL or anterior chamber-IOL (OR 12.63; 95% CI 2.65, 60.25 and those undergoing extracapsular cataract extraction (OR 9
Baomin Dong; Tianpeng Zhou
One perplexing observation is that although men and women have different comparative advantages, cooperation is often only seen during child-bearing and rearing periods. One interpretation is that the juvenile offspring serves as an indivisible public goods to facilitate cooperation between opposite sexes of adults. We show that moral hazard in maternal parental care will either force the father to pay the mother a rent in order to induce optimal care (when the child is of intrinsic high qual...
Vanessa Bertoglio Comassetto Antunes de Oliveira
Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.
Ahmed, Faheem; Mays, Nicholas; Ahmed, Naeem; Bisognano, Maureen; Gottlieb, Gary
Following the global economic recession, health care systems have experienced intense political pressure to contain costs without compromising quality. One response is to focus on improving the continuity and coordination of care, which is seen as beneficial for both patients and providers. However, cultural and structural barriers have proved difficult to overcome in the quest to provide integrated care for entire populations. By holding groups of providers responsible for the health outcomes of a designated population, in the United States, Accountable Care Organizations are regarded as having the potential to foster collaboration across the continuum of care. They could have a similar role in England's National Health Service. However, it is important to consider the difference in context before implementing a similar model, adapted to suit the system's strengths. Working together, general practice federations and the Academic Health Science Networks could form the basis of accountable care in England. PMID:26079144
Full Text Available Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents’ perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three distinct sections: demographic information, current state of aesthetic surgery training, and residents’ perception regarding the quality of aesthetic surgery training. Results. A total of 86 senior plastic surgery residents completed the survey. Twenty-three, 24, and 39 residents were in integrated, combined, and independent residency programs, respectively. No statistically significant differences were seen with respect to number of aesthetic surgery procedures performed, additional training received in minimal-invasive cosmetic procedures, median level of confidence with index cosmetic surgery procedures, or perceived quality of aesthetic surgery training. Facial aesthetic procedures were felt to be the most challenging procedures. Exposure to minimally invasive aesthetic procedures was limited. Conclusion. While the educational experience in aesthetic surgery appears to be similar, weaknesses still exist with respect to training in minimally invasive/nonsurgical aesthetic procedures.
Reliability methods have been widely used in risk analysis of medical surgeries. In this study, the authors combine a fault tree with Markov models to assess time independent- and dependent factors together. Dynamics are integrated in the traditional fault tree, and meanwhile the processes of solving Markov are simplified with the modular approach. Continuous time Markov chains are adopted in evaluating the failure probability of a gastric esophageal surgery after categorizing basic events in the fault tree, and a certain time dependent variables, such as failure rate of medical equipment, surgery frequency, and rescue timeliness are involved into risk analysis. A case is studied with data collected from a general hospital, to illustrate the operational process of the proposed method. Results based on the inputs show that taking rescue actions into consideration can reduce the gap between the result of fault tree analysis and the reality. Sensitivity analysis for measuring the impacts of the above time relevant variables is conducted, as well as limitations of the Markov model are discussed. - Highlights: ► Time independent and dependent factors in a surgery are assessed together. ► Processes of solving Markov models are simplified with a modular approach. ► Continuous time Markov chains are adopted in evaluating surgery risk. ► Analytical results highlight the effects of rescue actions.
Prijatelj, Vesna; Rajkovič, Vladislav; Šušteršič, Olga
The purpose of our research is to reduce risks and hence prevent errors in the health care process. The aim is to design an organizational information model using error prevention methods for risk assessment in a clinical setting. The model is based on selected indicators of quality nursing care, resulting from the world-known theoretical and practical models combined with experience in the Slovenian health care. The proposed organizational information model and software solution has a significant impact on the professional attention, communication and information, critical thinking, experience and knowledge. PMID:27332383
Full Text Available We present a new system that can be used in combination with an array of ultrasonic piezoelectric sensors and has application in surgical navigation procedures. Using the proposed assembly, the maneuverability of the surgical tools can be enhanced and the incidence of potentially damaging contact with non-target tissue can be reduced. The emphasis of our work was based on controlling the motion of the surgical tools so that they can readily move around a biological tissue. According to the results of the simulation performed, the direction of the tool can be monitored and controlled continuously and hence the outcome of the surgery can be improved. Another important parameter that incorporated in the simulation was the distance between the tool and the tissue. The simulation results show that the proper control of the tool movement can keep the distance between the two at a certain predetermined value while the tool passing by the tissue. In the collision avoidance scheme, the transducers located on the lateral side of the surgical tool mainly act as the distance detector to keep the distance between the lateral surface of the tool and the tissue surface at a constant value of 5 mm.
目的：探讨腹腔镜手术治疗子宫内膜异位症围手术期的护理效果。方法将74例子宫内膜异位症患者分为两组，对照组采用常规护理模式护理，观察组在对照组基础上采用综合护理模式护理。结果观察组患者的总满意度为97.30%，对照组患者的总满意度为72.97%，对比差异显著（P＜0.05）。结论腹腔镜手术治疗子宫内膜异位症患者在围手术期实施综合护理模式，能够明显提高患者对护理工作的满意度，值得在临床上大力推广。%Objective To investigate the laparoscopic surgery for endometriosis perioperative nursing effect.Methods74 cases of uterine endometriosis patients were divided into two groups, the control group received routine nursing care model, the observation group in the control group on the basis of a comprehensive care model of care. ResultsThe overall satisfaction of patients in the observation group was 97.30%, the total satisfaction of the patients in the control group was 72.97%.Conclusion Laparoscopic surgery endometriosis patients in the perioperative period the implementation of integrated care model can signiifcantly improve patient satisfaction with care, and worthy of clinical promoting.
Julia Abelson; Brian Hutchison
A common element in many countries’ health system reform agenda is an emphasis on changes to the organization, financing and delivery of primary health care. Numerous objectives for primary health care reform have been cited in jurisdictions around the world with different approaches being taken toward achieving stated objectives. This paper reviews the literature which has described and evaluated experiences with different primary health care delivery models in Canadian and other jurisdictio...
Fevang, Elisabeth; Kverndokk, Snorre; Røed, Knut
This paper presents a model of informal care to parents. We assume that the child participates in the labour market and gains in utility from consumption and leisure. In addition it has altruistic motivation to give informal care to its elderly parent. We show how the labour income, labour supply and informal caregiving are affected by exogenous factors such as the education level, wage rate, other supply of care, travel distance and inheritance.
Introduction Primary health care in The Netherlands evolves from small general practices to multidisciplinary teams. Research on the effects on outcomes of organization of primary care is hardly available. Aims Develop a conceptual model to be able to systematically arrange empirical evidence on the effects of different types of organizations of integrated (primary) care. Methods During an expert meeting of directors of health centres we identified essential elements which they consider impor...
Background: The Patterns of Care Study (PCS) was imported to Japan from the United States in July 1996. A preliminary outcome analysis of the PCS for esophageal cancer patients in Japan was made with special reference to age, because the elderly population is rapidly increasing in Japan. Patients and Methods: From July 1996 to February 1998, external PCS audits were performed for 37 institutions nationwide and detailed information of 561 esophageal cancer patients treated during the period 1992-1994 was collected by using the fifth PCS data format developed in the United States. This format was provided courtesy of the American College of Radiology. For this study, patients who had not undergone surgery (n = 336) were selected. The patients were classified into three age groups: < 65 years old (n = 119), between 65 and 74 years (n = 93), and 75 years or older (n =123). Cox's proportional hazards model was used for the statistical analysis, with survival, acute/subacute complication and late complication of grade 3 or more based on RTOG criteria, as the endpoints. Results: Significant prognostic factors for the entire non-surgery group were Karnofsky Performance Status (KPS) (p 0.0007), stage (p = 0.0001), and external irradiation dose (p = 0.0001). For the younger group, KPS (p = 0.0004), stage (p = 0.0197), and utilization of brachytherapy (p = 0.0010) were significant, while for the intermediate age group it was KPS (p = 0.0027), history of pulmonary disease (p = 0.0339), stage (p = 0.0001), and external dose (p = 0.0001), and for the elderly group, stage (p = 0.0001) and external irradiation dose (p = 0.0224) were significant. Significant risk factors for complications for the entire group were stage (p = 0.0411), external dose (p = 0.0163), and stratification of institution (academic vs. nonacademic) (p = 0.0114). Significant risk factors for the younger group were history of pulmonary disease (p = 0.0495) and external dose (p = 0.0037), and the other age
Reeves, Barnaby C; Pike, Katie; Rogers, Chris A; Brierley, Rachel Cm; Stokes, Elizabeth A; Wordsworth, Sarah; Nash, Rachel L; Miles, Alice; Mumford, Andrew D; Cohen, Alan; Angelini, Gianni D; Murphy, Gavin J
BACKGROUND Uncertainty about optimal red blood cell transfusion thresholds in cardiac surgery is reflected in widely varying transfusion rates between surgeons and cardiac centres. OBJECTIVE To test the hypothesis that a restrictive compared with a liberal threshold for red blood cell transfusion after cardiac surgery reduces post-operative morbidity and health-care costs. DESIGN Multicentre, parallel randomised controlled trial and within-trial cost-utility analysis from a UK NHS and Personal Social Services perspective. We could not blind health-care staff but tried to blind participants. Random allocations were generated by computer and minimised by centre and operation. SETTING Seventeen specialist cardiac surgery centres in UK NHS hospitals. PARTICIPANTS Patients aged > 16 years undergoing non-emergency cardiac surgery with post-operative haemoglobin research steps to address the new hypothesis about the possible harm of red blood cell transfusion. TRIAL REGISTRATION Current Controlled Trials ISRCTN70923932. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 60. See the NIHR Journals Library website for further project information. PMID:27527344
Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L; Serrano, Neftali
After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.
Comparison of the costs of nonoperative care to minimally invasive surgery for sacroiliac joint disruption and degenerative sacroiliitis in a United States Medicare population: potential economic implications of a new minimally-invasive technology
Full Text Available Stacey J Ackerman1, David W Polly Jr2, Tyler Knight3, Karen Schneider4, Tim Holt5, John Cummings61Covance Market Access Services Inc, San Diego, CA, USA; 2University of Minnesota, Orthopaedic Surgery, Minneapolis, MN, USA; 3Covance Market Access Services Inc, Gaithersburg, MD, USA; 4Covance Market Access Services Inc, Sydney, NSW, Australia; 5Montgomery Spine Center, Orthopaedic Surgery, Montgomery, AL, USA; 6Community Health Network, Neurosurgery, Indianapolis, IN, USAIntroduction: The economic burden associated with the treatment of low back pain (LBP in the United States is significant. LBP caused by sacroiliac (SI joint disruption/degenerative sacroiliitis is most commonly treated with nonoperative care and/or open SI joint surgery. New and effective minimally invasive surgery (MIS options may offer potential cost savings to Medicare.Methods: An economic model was developed to compare the costs of MIS treatment to nonoperative care for the treatment of SI joint disruption in the hospital inpatient setting in the US Medicare population. Lifetime cost savings (2012 US dollars were estimated from the published literature and claims data. Costs included treatment, follow-up, diagnostic testing, and retail pharmacy pain medication. Costs of SI joint disruption patients managed with nonoperative care were estimated from the 2005–2010 Medicare 5% Standard Analytic Files using primary International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM diagnosis codes 720.2, 724.6, 739.4, 846.9, or 847.3. MIS fusion hospitalization cost was based on Diagnosis Related Group (DRG payments of $46,700 (with major complications - DRG 459 and $27,800 (without major complications - DRG 460, weighted assuming 3.8% of patients have complications. MIS fusion professional fee was determined from the 2012 Medicare payment for Current Procedural Terminology code 27280, with an 82% fusion success rate and 1.8% revision rate. Outcomes were
Kornstad, Tom; Thoresen, Thor Olav
Abstract: A discrete choice model for labor supply and child care for mothers of preschoolers is presented. The mothers are assumed to make choices from a finite set of job possibilities and from a finite set of child care options. The options in the markets for child care are characterized by opening hours, fees and a number of quality attributes, such as mode of care. Similarly, jobs are characterized by a (fixed) wage rate, working hours and a number of variables related to job satisfac...
Langenhoff, B S; Krabbe, P F M; Ruers, T J M
AIMS: Seeking the best available treatment for patients with colorectal liver metastases may be complex due to the interpretation of many variables. In this study conjoint analysis is used to develop a decision model to help clinicians selecting patients eligible for surgery of liver metastases. MET
Luboz, V; Swider, P; Payan, Y; Luboz, Vincent; Chabanas, Matthieu; Swider, Pascal; Payan, Yohan
This paper addresses an important issue raised for the clinical relevance of Computer-Assisted Surgical applications, namely the methodology used to automatically build patient-specific Finite Element (FE) models of anatomical structures. From this perspective, a method is proposed, based on a technique called the Mesh-Matching method, followed by a process that corrects mesh irregularities. The Mesh-Matching algorithm generates patient-specific volume meshes from an existing generic model. The mesh regularization process is based on the Jacobian matrix transform related to the FE reference element and the current element. This method for generating patient-specific FE models is first applied to Computer-Assisted maxillofacial surgery, and more precisely to the FE elastic modelling of patient facial soft tissues. For each patient, the planned bone osteotomies (mandible, maxilla, chin) are used as boundary conditions to deform the FE face model, in order to predict the aesthetic outcome of the surgery. Seven F...
Burcharth, J; Pommergaard, H-C; Klein, M;
used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia was......Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could be...... performed by testing tissue strips from the healed fascia versus the unincised control fascia 7 and 28 days postoperatively. Results: During the six experiments a healing model was created that produced significantly weaker coherent fascia when compared with the control tissue measured in terms of...
Full Text Available In any secondary level eye care clinic, a number of tasks must be completed. In different countries and different settings, different people will carry out these tasks. The manager is responsible for ensuring that all the tasks are covered, that people are carefully selected to perform them, and that staff are supported and managed. The International Centre for Advancement of Rural Eye Care (ICARE, within the L.V. Prasad Eye Institute (LVPEI in India, has evolved an eye care team to provide secondary level eye care services to a population of 0.5 to 1 million. The ICARE model emphasises that all cadres of clinical and non-clinical personnel are equally important. Below is a description of the range of jobs at secondary level centres. The tertiary centre at LVPEI manages leadership and training for this model.
Veras, Renato Peixoto; Caldas, Célia Pereira; da Motta, Luciana Branco; de Lima, Kenio Costa; Siqueira, Ricardo Carreño; Rodrigues, Renata Teixeira da Silva Vendas; Santos, Luciana Maria Alves Martins; Guerra, Ana Carolina Lima Cavaletti
A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change. PMID:24897058
Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well known cause of ARF, have not been accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003 to February 2004.Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males and mean age was 39+-19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites, and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerural diseases and 11 (12.3%) had obstructive uropathy associated with ARF; cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16(18%) died and 14(16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated PPD poisoning. (author)
Elfar, John; Menorca, Ron Martin Garcia; Reed, Jeffrey Douglas; Stanbury, Spencer
Composite bone models are increasingly used in orthopaedic biomechanics research and surgical education-applications that traditionally relied on cadavers. Cadaver bones are suboptimal for many reasons, including issues of cost, availability, preservation, and inconsistency between specimens. Further, cadaver samples disproportionately represent the elderly, whose bone quality may not be representative of the greater orthopaedic population. The current fourth-generation composite bone models provide an accurate reproduction of the biomechanical properties of human bone when placed under bending, axial, and torsional loads. The combination of glass fiber and epoxy resin components into a single phase has enabled manufacturing by injection molding. The high level of anatomic fidelity of the cadaver-based molds and negligible shrinkage properties of the epoxy resin results in a process that allows for excellent definition of anatomic detail in the cortical wall and optimized consistency of features between models. Recent biomechanical studies of composites have validated their use as a suitable substitute for cadaver specimens. PMID:24486757
Teresa Bago d’Uva
This paper explores different approaches to econometric modelling of count measures of health care utilisation, with an emphasis on latent class models. A new model is proposed that combines the features of the two most common approaches- the hurdle model and the finite mixture Negative Binomial. Additionally, the panel structure of the data is taken into account. The proposed model is shown to perform better than the existing models for a particular application with data from the RAND Health...
Padrosa, Josep Maria; Guarga, Àlex; Brosa, Francesc; Jiménez, Josep; Robert, Roger
The changes taking place in western countries require health systems to adapt to the public's evolving needs and expectations. The healthcare model in Catalonia is undergoing significant transformation in order to provide an adequate response to this new situation while ensuring the system's sustainability in the current climate of economic crisis. This transformation is based on converting the current disease-centred model which is fragmented into different levels, to a more patient-centred integrated and territorial care model that promotes the use of a shared network of the different specialities, the professionals, resources and levels of care, entering into territorial agreements and pacts which stipulate joint goals or objectives. The changes the Catalan Health Service (CatSalut) has undergone are principally focused on increasing resolution capacity of the primary level of care, eliminating differences in clinical practice, evolving towards more surgery-centred hospitals, promoting alternatives to conventional hospitalization, developing remote care models, concentrating and organizing highly complex care into different sectors at a territorial level and designing specific health codes in response to health emergencies. The purpose of these initiatives is to improve the effectiveness, quality, safety and efficiency of the system, ensuring equal access for the public to these services and ensuring a territorial balance. These changes should be facilitated and promoted using several different approaches, including implementing shared access to clinical history case files, the new model of results-based contracting and payment, territorial agreements, alliances between centres, harnessing the potential of information and communications technology and evaluation of results. PMID:26711056
McGirt, Matthew J; Sivaganesan, Ahilan; Asher, Anthony L; Devin, Clinton J
OBJECT Lumbar spine surgery has been demonstrated to be efficacious for many degenerative spine conditions. However, there is wide variability in outcome after spine surgery at the individual patient level. All stakeholders in spine care will benefit from identification of the unique patient or disease subgroups that are least likely to benefit from surgery, are prone to costly complications, and have increased health care utilization. There remains a large demand for individual patient-level predictive analytics to guide decision support to optimize outcomes at the patient and population levels. METHODS One thousand eight hundred three consecutive patients undergoing spine surgery for various degenerative lumbar diagnoses were prospectively enrolled and followed for 1 year. A comprehensive patient interview and health assessment was performed at baseline and at 3 and 12 months after surgery. All predictive covariates were selected a priori. Eighty percent of the sample was randomly selected for model development, and 20% for model validation. Linear regression was performed with Bayesian model averaging to model 12-month ODI (Oswestry Disability Index). Logistic regression with Bayesian model averaging was used to model likelihood of complications, 30-day readmission, need for inpatient rehabilitation, and return to work. Goodness-of-fit was assessed via R(2) for 12-month ODI and via the c-statistic, area under the receiver operating characteristic curve (AUC), for the categorical endpoints. Discrimination (predictive performance) was assessed, using R(2) for the ODI model and the c-statistic for the categorical endpoint models. Calibration was assessed using a plot of predicted versus observed values for the ODI model and the Hosmer-Lemeshow test for the categorical endpoint models. RESULTS On average, all patient-reported outcomes (PROs) were improved after surgery (ODI baseline vs 12 month: 50.4 vs 29.5%, p < 0.001). Complications occurred in 121 patients (6
Phillips, Charles D
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...
Darwich, A S; Pade, D; Rowland-Yeo, K; Jamei, M; A. Åsberg; Christensen, H; Ashcroft, D.M.; Rostami-Hodjegan, A
An increasing prevalence of morbid obesity has led to dramatic increases in the number of bariatric surgeries performed. Altered gastrointestinal physiology following surgery can be associated with modified oral drug bioavailability (F oral). In the absence of clinical data, an indication of changes to F oral via systems pharmacology models would be of value in adjusting dose levels after surgery. A previously developed virtual “post-bariatric surgery” population was evaluated through mimicki...
Wind, J.; Hofland, J.; Preckel, B.; Hollman, M.W.; Bossuyt, P.M.M.; Gouma, D.J.; Berge Henegouwen, M.I.; Fuhring, J.W.; Dejong, C.H.C.; Dam, R.M. van; Cuesta, M.A.; Noordhuis, A.; Jong, D. de; Zalingen, E. van; Engel, A.F.; Goei, T.H.; Stoppelaar, I.E. de; Tets, W.F. van; Wagensveld, B.A. van; Swart, A.; Elsen, M.J.L.J. van den; Gerhards, M.F.; Wit, L.Th. De; Siepel, M.A.M.; Geloven, A.A.W. van; Juttmann, J.-W.; Clevers, J.C.; Bemelman, W.A.
BACKGROUND: Recent developments in large bowel surgery are the introduction of laparoscopic surgery and the implementation of multimodal fast track recovery programs. Both focus on a faster recovery and shorter hospital stay.The randomized controlled multicenter LAFA-trial (LAparoscopy and/or FAst t
We give a simple model in the complex plane of the 0-surgery along a fibered knot of a closed 3-manifold M to yield a mapping torus M'. This model allows explicit relations between pseudoholomorphic curves in the symplectizations of M and M'. As an application we use it to compute the cylindrical contact homology of open books resulting from a positive Dehn twist on a torus with boundary.
Miguel Angel Maluf; Walter José Gomes; Ademir Massarico Bras; Thiago Cavalcante Vila Nova de Araújo; André Lupp Mota; Caio Cesar Cardoso; Rafael Viana dos S. Coutinho
ABSTRACT OBJECTIVE: Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS: First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was compr...
Sgouralis, Ioannis; Evans, Roger G.; Gardiner, Bruce S; Smith, Julian A.; Fry, Brendan C.; Layton, Anita T.
Abstract Acute kidney injury, a prevalent complication of cardiac surgery performed on cardiopulmonary bypass (CPB), is thought to be driven partly by hypoxic damage in the renal medulla. To determine the causes of medullary hypoxia during CPB, we modeled its impact on renal hemodynamics and function, and thus oxygen delivery and consumption in the renal medulla. The model incorporates autoregulation of renal blood flow and glomerular filtration rate and the utilization of oxygen for tubular ...
Metz R Douglas
Full Text Available Abstract Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.
The monitoring of safety in cardiac surgery is a complex process, which involves many clinical, practical, methodological and statistical issues. The objective of this thesis was to measure and to compare safety in cardiac surgery in The Netherlands using the Netherlands Association for Cardio-Thoracic Surgery (NVT) database. The safety of care is usually measured using patient outcomes. If outcomes are not available, the process and structure of care may be used. Outcomes should be adjusted ...
Bloemen-Vrencken, J.H.A.; de Witte, L.P.; Engels, J.P.G.M.; Van den Heuvel, W.J.A.; Post, M.W.M.
Abstract Purposes The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods The transmural care model was developed in cooperation w...
Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio
Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445
Deyo Richard A
Full Text Available Abstract Background Independent of efficacy, information on safety of surgical procedures is essential for informed choices. We seek to develop standardized methodology for describing the safety of spinal operations and apply these methods to study lumbar surgery. We present a conceptual model for evaluating the safety of spine surgery and describe development of tools to measure principal components of this model: (1 specifying outcome by explicit criteria for adverse event definition, mode of ascertainment, cause, severity, or preventability, and (2 quantitatively measuring predictors such as patient factors, comorbidity, severity of degenerative spine disease, and invasiveness of spine surgery. Methods We created operational definitions for 176 adverse occurrences and established multiple mechanisms for reporting them. We developed new methods to quantify the severity of adverse occurrences, degeneration of lumbar spine, and invasiveness of spinal procedures. Using kappa statistics and intra-class correlation coefficients, we assessed agreement for the following: four reviewers independently coding etiology, preventability, and severity for 141 adverse occurrences, two observers coding lumbar spine degenerative changes in 10 selected cases, and two researchers coding invasiveness of surgery for 50 initial cases. Results During the first six months of prospective surveillance, rigorous daily medical record reviews identified 92.6% of the adverse occurrences we recorded, and voluntary reports by providers identified 38.5% (surgeons reported 18.3%, inpatient rounding team reported 23.1%, and conferences discussed 6.1%. Trained observers had fair agreement in classifying etiology of 141 adverse occurrences into 18 categories (kappa = 0.35, but agreement was substantial (kappa ≥ 0.61 for 4 specific categories: technical error, failure in communication, systems failure, and no error. Preventability assessment had moderate agreement (mean weighted
Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung
In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).
Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...
Full Text Available Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a professional and research development, b health human resource planning, c regulation and legislation and d practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.
Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.
Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this stu
Ann McWilliams; Siobhan Quinlan Cooke; Niall Hanlon
The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential unit...
Bellini, Lisa M; Asch, David A.
Expanding primary care and ambulatory experiences in internal medicine training programs is limited by insufficient resources devoted to their development and implementation, heavy inpatient service demands and loyalty to the traditional inpatient based training model. Overcoming these barriers is a challenge likely to create new approaches to ambulatory education. The Pilot Education and Ambulatory Care (PACE) program at the Sepulveda VA is one such initiative that represents a multidiscipli...
Atkinson, J.M.; Garner, H.C.; Gilmour, W H
Objective: The aim of this study was to examine perceptions of the place of advance directives in mental health care. Methods: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. Results: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions be...
... and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia Awareness Obesity and Anesthesia Sleep Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Outpatient Surgery Surgery does ...
Matthew J. Teusink
Full Text Available Cost in shoulder surgery has taken on a new focus with passage of the Patient Protection and Affordable Care Act. As part of this law, there is a provision for Accountable Care Organizations (ACOs and the bundled payment initiative. In this model, one entity would receive a single payment for an episode of care and distribute funds to all other parties involved. Given its reproducible nature, shoulder arthroplasty is ideally situated to become a model for an episode of care. Currently, there is little research into cost in shoulder arthroplasty surgery. The current analyses do not provide surgeons with a method for determining the cost and outcomes of their interventions, which is necessary to the success of bundled payment. Surgeons are ideally positioned to become leaders in ACOs, but in order for them to do so a methodology must be developed where accurate costs and outcomes can be determined for the episode of care.
Full Text Available Objectives: A perception exists that clinicians in Oman are reluctant to adopt evidence-based practice (EBP. This pilot study was undertaken to study the feasibility of using EBP pathways at the point of care in otorhinolaryngology head and neck surgery. The ultimate aim was to facilitate EBP with the probability of developing a new system for implementing research findings/translational research at the clinical point of care. Methods: A cross-sectional prospective questionnaire pilot survey of clinicians at Sultan Qaboos University Hospital (SQUH, Oman, a tertiary care medical centre, was undertaken. Respondents included 135 physicians and surgeons with between 3 months and 25 years of clinical experience and included personnel ranging from interns to senior consultants, in areas ranging from primary care to specialist care. Results: Of those polled, 90% (95% confidence interval (CI 85–95% either strongly agreed or agreed that evidence-based practice protocols (EBPP could help in decision making. A total of 87.4% of participants (95% CI 81.8–93% either strongly agreed or agreed that EBPPs can improve clinical outcomes; 91.8% of participants (95% CI 87.2–96.4% would use and apply EBPP in day-to-day care if they were available at the point of care and embedded in the hospital information system. Conclusions: The perception that clinicians at SQUH are reluctant to adopt EBP is incorrect. The introduction of EBP pathways is very feasible at the primary care level. Institutional support for embedding EBP in hospital information systems is needed as well as further outcome research to assess the improvement in quality of care.
Bahcall, James K
Advances in endodontic surgery--from both a technological and procedural perspective-have been significant over the last 18 years. Although these technologies and procedural enhancements have significantly improved endodontic surgical treatment outcomes, there is still an ongoing challenge of overcoming the limitations of interpreting preoperative 2-dimensional (2-D) radiographic representation of a 3-dimensional (3-D) in vivo surgical field. Cone-beam Computed Tomography (CBCT) has helped to address this issue by providing a 3-D enhancement of the 2-D radiograph. The next logical step to further improve a presurgical case 3-D assessment is to create a surgical model from the CBCT scan. The purpose of this article is to introduce 3-D printing of CBCT scans for creating presurgical models for endodontic surgery. PMID:25197746
Buchaillard, Stéphanie; Perrier, Pascal; Payan, Yohan
This paper presents predictions of the consequences of tongue surgery on speech production. For this purpose, a 3D finite element model of the tongue is used that represents this articulator as a deformable structure in which tongue muscles anatomy is realistically described. Two examples of tongue surgery, which are common in the treatment of cancers of the oral cavity, are modelled, namely a hemiglossectomy and a large resection of the mouth floor. In both cases, three kinds of possible reconstruction are simulated, assuming flaps with different stiffness. Predictions are computed for the cardinal vowels /i, a, u/ in the absence of any compensatory strategy, i.e. with the same motor commands as the one associated with the production of these vowels in non-pathological conditions. The estimated vocal tract area functions and the corresponding formants are compared to the ones obtained under normal conditions
Sayuthi, Sani; Tharakan, John; Pieter, Maria Soccoro; Salmah, Win Mar; Madhavan, Manoharan; Tahir, Adnan; George, Jain
We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient’s cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients’ quality of life (QOLIE 31) were administered to refractory ep...
Campbell, James; Vaughn,Byron
James P Campbell, Byron P Vaughn Department of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA Abstract: Despite improvements in medical therapies for Crohn’s disease (CD), up to 70% of patients require surgery within 10 years of diagnosis. Surgery is not curative, and almost all patients will experience endoscopic recurrence, and many will go on to clinical recurrence. Identifying patients at high-risk of endoscopic recurrence and ...
Cacciatore, Joanne; Flint, Melissa
Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…
Rafael Denadai; Andréia Padilha Toledo; Luis Ricardo Martinhão Souto
Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching p...
QIU Zhi; YANG Yong; ZHANG Yi; SUN Yu-cheng
Background The 12th rib is an important anatomic marker in the process of percutaneous renal surgery; while the previous models without ribs can not provide close simulation conditions to human upper abdomen. To facilitate the learning and training of percutaneous renal access and intrarenal procedures under ultrasound and fluoroscopy guidance, we reported a biological bench model for percutaneous renal surgery. Methods The model was developed using an ex vivo porcine kidney with a longer than 3 cm ureter, a flap of full thickness of thoracic wall with skin, subcutaneous fascia, muscle and two ribs, as well as the standard equipment for percutaneous nephrolithotomy. The porcine kidney with a catheterized ureter was placed within the porcine flap and fixed to a wooden board with two long steel nails. Afterward, contrast medium or physiological saline (0.9% sodium chloride solution) was injected through the ureter, and the urinary system was examined with a fluoroscopy unit or an ultrasound. Artificial stone material was implanted in the renal pelvis. After practicing, the model could be dissected for kidney examination and a technical analysis. Results The advantage of this model was simple to set up and inexpensive, by using widely available material. The biological bench model can be employed for percutanous renal access, tract dilation, nephroscopy, and stone disintegration in the training and learning of clinical practice. Imaging is feasible under fluoroscopic and ultrasound guidance. The kidney models were utilized in hands on courses with over 100 people, and 90.5% attendants rated the porcine kidney model for simulation of percutaneous renal surgery as 'very helpful" or "helpful". Conclusion This biological training model simulates realistically the clinical procedure of percutaneous nephrolithotomy under fluoroscopic and ultrasound guidance.
Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care
Full Text Available Abstract Background To compare the lifetime costs of liberating patients from spectacles after cataract surgery by implanting the multifocal intraocular lens (IOL 'ReSTOR®' versus monofocal IOLs in France, Italy, Germany and Spain. Methods A Markov model was created to follow patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles after cataract surgery were obtained from clinical trials. Resource utilisation included implant surgery, IOLs, spectacles, visits to ophthalmologists and eye centres, transport, and time lost by patients. Economic perspectives were those of Society and Sickness Funds (SFs. Results The mean number of spectacles purchased after ReSTOR® was 1.34–1.61 and after monofocal IOLs 6.05–7.27. From the societal perspective, total cost estimates discounted by 3% were between €3,551 and €4,052 with ReSTOR® compared to €3,989 and €5,548 with monofocal IOLs. Undiscounted savings related to ReSTOR® ranged from €815 to €2,164. From the SFs' perspective total cost estimates discounted by 3% were between €2,150 and €2,524 with ReSTOR® compared to €2,324 and €2,610 with monofocal IOLs. Savings related to ReSTOR®, once costs discounted, ranged from €61 to €219. Discount and spectacle freedom prevalence rates were the most sensitive parameters. Conclusion The bulk of the savings related to ReSTOR® were realized outside the SF. From both a societal and SF perspective, savings, after a 3% discounting, achieved by liberating patients from spectacles counterbalanced the initially higher cost of ReSTOR®. ReSTOR® is a cost saving alternative to spectacles for patients requiring cataract surgery.
Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.