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Sample records for accelerated perioperative care

  1. Peri-operative care.

    Science.gov (United States)

    Baston, Helen

    2004-05-01

    This is the third 'midwifery basics' series aimed at student midwives, and focuses on midwifery care during labour. This article provides a summary of peri-operative care for women who experience caesarean birth. Students are encouraged to seek further information through a series of activities, and to link theory with practice by considering the issues relating to the care of the woman described in the short vignette.

  2. [Perioperative management of transthoracic oesophagectomies : Fundamentals of interdisciplinary care and new approaches to accelerated recovery after surgery].

    Science.gov (United States)

    Lambertz, R; Drinhaus, H; Schedler, D; Bludau, M; Schröder, W; Annecke, T

    2016-06-01

    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.

  3. Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up

    Directory of Open Access Journals (Sweden)

    Hansen Torben B

    2008-04-01

    Full Text Available Abstract Background In Denmark, approximately 12,000 hip and knee arthroplasties were performed in 2006, and the hospital costs were close to US$ 110,000,000. In a randomized clinical trial, we have recently demonstrated the efficacy of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty compared to current intervention under ideal circumstances. We do not, however, know whether these results could be reached under usual circumstances of healthcare practice. We therefore investigated whether length of stay after implementation of accelerated perioperative care and rehabilitation after hip and knee arthroplasty could be reduced in a normal healthcare setting, and how the achieved results matched those observed during the randomized clinical trial. Methods An effectiveness study as a before-after trial was undertaken in which all elective primary total hip and total knee arthroplasty patients were divided into a before-implementation group receiving the current perioperative procedure, and an after-implementation group receiving the new accelerated perioperative care and rehabilitation procedures as provided by a new multi-disciplinary organization. We used the Breakthrough Series Collaborative Model for implementation. The primary outcome measure was in hospital length of stay (LOS, and the secondary outcome measure was adverse effects within 3 months postoperatively. Results We included a total of 247 patients. Mean LOS was significantly (P Conclusion Accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty was successfully and effectively implemented. Results obtained during usual hospital circumstances matched the results achieved under ideal circumstances in this group of patients.

  4. Digital health and perioperative care.

    Science.gov (United States)

    Fotis, Theofanis

    2017-06-01

    According to the U.S. Food and Drug Administration 'the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalised medicine, and is used by providers and other stakeholders in their efforts to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalised for patients (FDA 2016). More recently, Paul Sonier, a digital health strategist and founder of the Linkedin digital health group with more than 40,000 members, defined digital health as 'the convergence of the digital and genomic revolutions with health, healthcare, living, and society' (storyofdigitalhealth.com 2016). Copyright the Association for Perioperative Practice.

  5. Evidence for the perioperative care of mastectomized women

    Directory of Open Access Journals (Sweden)

    Carla Monique Lopes Mourão

    2014-01-01

    Full Text Available This study aimed to evaluate the evidence available in the literature about the perioperative care provided to women submitted to mastectomy. An integrative review of scientific literature conducted in MEDLINE, CINAHL, LILACS, and SciELO databases, published from 2000 to 2011, using the controlled descriptors: preoperative care; preoperative period; intraoperative care; intraoperative period; postoperative care; postoperative period; perioperative care; perioperative period; and mastectomy. The sample of this review consisted of seven articles. The evidence pointed as perioperative care of mastectomy the pharmacological management of pain in different surgical periods. Despite the difficulty in presenting a consensus of evidence for perioperative care of mastectomy, there was concern on the part of professionals to minimize/prevent pre-, intra- and post-operative pain. Nursing should be aware, both of the update of pharmacological treatments in pain management and the development of future research related to nursing care in the perioperative period of mastectomy.

  6. Transcultural nursing in perioperative patient care.

    Directory of Open Access Journals (Sweden)

    Anna Kostka

    2017-06-01

    Full Text Available Jehovah's Witnesses is a religious association, who refuses blood transfusions even in life-threatening conditions. There are several alternative methods, implemented for use with patients that religion, whose task is to reduce the risk of bleeding and hemorrhage in the perioperative period. Good cooperation of the therapeutic team, the selection of appropriate treatment, the use of recommended methods of anesthesia, surgical techniques and proper nursing care with careful monitoring of post-operative complications and quick response if they leave, they contribute to the improvement of health.

  7. [Aspects of perioperative care in patients with diabetes].

    Science.gov (United States)

    Pestel, G; Closhen, D; Zimmermann, A; Werner, C; Weber, M M

    2013-01-01

    Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.

  8. Perioperative care of the older patient

    NARCIS (Netherlands)

    E. Blommers; M. Klimek (Markus); K.A. Hartholt (Klaas); T.J.M. van der Cammen (Tischa); J. Klein (Jan); P. Noordzij (Peter)

    2011-01-01

    textabstractNearly 60% of the Dutch population undergoing surgery is aged 65 years and over. Older patients are at increased risk of developing perioperative complications (e.g., myocardial infarction, pneumonia, or delirium), which may lead to a prolonged hospital stay or death. Preoperative risk

  9. Participation in paediatric perioperative care: 'what it means for parents'.

    Science.gov (United States)

    Sjöberg, Carina; Svedberg, Petra; Nygren, Jens M; Carlsson, Ing-Marie

    2017-12-01

    To explore what it means for parents to participate in their children's paediatric perioperative care. Allowing parents to participate in paediatric perioperative care can make a major difference for children in terms of their well-being, a decreased need for painkillers, fewer sleeping disorders and a more positive experience for both parties. The nurse anaesthetist should have a holistic view and develop a shared vision for the child, the parents and for themselves to perform successful paediatric perioperative care. Descriptive qualitative study. The study was conducted in 2014. Data were collected in 20 narrative interviews with 15 mothers and five fathers who had experience of participating in their child's paediatric perioperative day surgery. The analysis was carried out with qualitative content analysis to describe the variations, differences and similarities in the experiences. The analysis revealed a main category that describes that parental participation in the context of paediatric perioperative care in day surgery meant 'having strength to participate despite an increased vulnerability'. Three generic categories with additional subcategories explained what was essential for the parents to be able to preserve this strength and participate in their child's care despite their increased vulnerability. The generic categories were named, 'gaining information about what will happen', 'being seen as a resource' and 'gaining access to the environment'. Efforts should be made to improve parents' roles and opportunities to participate in paediatric perioperative care. Nurse anaesthetists have a crucial role in enabling parents' participation and need knowledge to develop strategies and nursing interventions that meet parents' needs. © 2017 John Wiley & Sons Ltd.

  10. Perioperative care of an adolescent with postural orthostatic tachycardia syndrome

    Directory of Open Access Journals (Sweden)

    Kernan Scott

    2010-01-01

    Full Text Available Postural orthostatic tachycardia syndrome (POTS is a disorder characterized by postural tachycardia in combination with orthostatic symptoms without associated hypotension. Symptoms include light-headedness, palpitations, fatigue, confusion, and anxiety, which are brought on by assuming the upright position and usually relieved by sitting or lying down. Given the associated autonomic dysfunction that occurs with POTS, various perioperative concerns must be considered when providing anesthetic care for such patients. We present an adolescent with POTS who required anesthetic care during posterior spinal fusion for the treatment of scoliosis. The potential perioperative implications of this syndrome are discussed.

  11. Translation, adaptation and psychometric validation of the Good Perioperative Nursing Care Scale (GPNCS) with surgical patients in perioperative care

    DEFF Research Database (Denmark)

    Hertel-Joergensen, Michala; Abrahamsen, Charlotte; Jensen, Carsten

    2018-01-01

    patients were screened for eligibility; 215 were included. The full-scale model fit estimates were moderate. Factor loadings typically ranged from 0.65 to 0.97, except for the questions concerning Technical Skills (0.38-0.63) and Nursing Process (0.28). The Cronbach's alpha value for the total scale score......AIM: To test the psychometric validity of the Good Perioperative Nursing Care Scale (GPNCS), a self-administered questionnaire, following translation and adaptation. INTRODUCTION: Patients' satisfaction with and experience of nursing care in orthopaedic or perioperative settings are currently...... was 0.92, with subfactors ranging from 0.72 to 0.87. CONCLUSION: Providing evidence for quality, or lack thereof, the Danish version of the GPNCS is a valid tool for measuring surgical patients' experiences with perioperative nursing care. The electronic version proved practical. RELEVANCE TO CLINICAL...

  12. Optimization of peri-operative care in colorectal surgery

    NARCIS (Netherlands)

    Kornmann, V.N.N.

    2016-01-01

    Colorectal cancer is an important health issue, and colorectal surgery is increasingly being performed. During the last years, quality and safety of care, new surgical techniques and attention for peri-operative risks resulted in reduction of postoperative morbidity and mortality. Despite these

  13. Perioperative Care of the Transgender Patient.

    Science.gov (United States)

    Smith, Francis Duval

    2016-02-01

    Transgender patients are individuals whose gender identity is not related to their biological sex. Assuming a new gender identity that does not conform to societal norms often results in discrimination and barriers to health care. The exact number of transgender patients is unknown; however, these patients are increasingly seen in health care. Transgender individuals may experience provider-generated discrimination in health care facilities, including refusal of service, disrespect, and abuse, which contribute to depression and low self-esteem. Transgender therapies include mental health counseling for depression and low self-esteem, hormone therapy, and sex reassignment surgery. Health care professionals require cultural competence, an understanding of the different forms of patient identification, and adaptive approaches to care for transgender patients. VA (Veterans Affairs) hospitals provide a model for the care for transgender patients and staff. Copyright © 2016 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  14. Perioperative care following complex laryngotracheal reconstruction in infants and children

    Directory of Open Access Journals (Sweden)

    Gupta Punkaj

    2010-01-01

    Full Text Available Laryngotracheal reconstruction (LTR involves surgical correction of a stenotic airway with cartilage interpositional grafting, followed by either placement of a tracheostomy and an intraluminal stent (two-stage LTR or placement of an endotracheal tube with postoperative sedation and mechanical ventilation for an extended period of time (single-stage LTR. With single-stage repair, there may be several perioperative challenges including the provision of adequate sedation, avoidance of the development of tolerance to sedative and analgesia agents, the need to use neuromuscular blocking agents, the maintenance of adequate pulmonary toilet to avoid perioperative nosocomial infections, and optimization of postoperative respiratory function to facilitate successful tracheal extubation. We review the perioperative management of these patients, discuss the challenges during the postoperative period, and propose recommendations for the prevention of reversible causes of extubation failure in this article. Optimization to ensure a timely tracheal extubation and successful weaning of mechanical ventilator, remains the primary key to success in these surgeries as extubation failure or the need for prolonged postoperative mechanical ventilation can lead to failure of the graft site, the need for prolonged Pediatric Intensive Care Unit care, and in some cases, the need for a tracheostomy to maintain an adequate airway.

  15. Focused Review of Perioperative Care of Patients with Pulmonary Hypertension and Proposal of a Perioperative Pathway.

    Science.gov (United States)

    Steppan, Jochen; Diaz-Rodriguez, Natalia; Barodka, Viachaslau M; Nyhan, Daniel; Pullins, Erica; Housten, Traci; Damico, Rachel L; Mathai, Stephen C; Hassoun, Paul M; Berkowitz, Dan E; Maxwell, Bryan G; Kolb, Todd M

    2018-01-15

    Morbidity and mortality risk increase considerably for patients with pulmonary hypertension (PH) undergoing non-cardiac surgery. Unfortunately, there are no comprehensive, evidence-based guidelines for perioperative evaluation and management of these patients. We present a brief review of the literature on perioperative outcomes for patients with PH and describe the implementation of a collaborative perioperative management program for these high-risk patients at a tertiary academic center.

  16. Perioperative care for lumbar microdiscectomy: a survey of Australasian neurosurgeons

    Science.gov (United States)

    Lim, Kai Zheong; Ghosh, Peter; Goldschlager, Tony

    2018-01-01

    Background Lumbar microdiscectomy is the most commonly performed spine surgery procedure. Over time it has evolved to a minimally invasive procedure. Traditionally patients were advised to restrict activity following lumbar spine surgery. However, post-operative instructions are heterogeneous. The purpose of this report is to assess, by survey, the perioperative care practices of Australasian neurosurgeons in the minimally invasive era. Methods A survey was conducted by email invitation sent to all full members of the Neurosurgical Society of Australasia (NSA). This consisted of 11 multi-choice questions relating to operative indications, technique, and post-operative instructions for lumbar microdiscectomy answered by an electronically distributed anonymized online survey. Results The survey was sent to all Australasian Neurosurgeons. In total, 68 complete responses were received (28.9%). Most surgeons reported they would consider a period of either 4 to 8 weeks (42.7%) or 8 to 12 weeks (32.4%) as the minimum duration of radicular pain adequate to offer surgery. Unilateral muscle dissection with unilateral discectomy was practiced by 76.5%. Operative microscopy was the most commonly employed method of magnification (76.5%). The majority (55.9%) always refer patients to undergo inpatient physiotherapy. Sitting restrictions were advised by 38.3%. Lifting restrictions were advised by 83.8%. Conclusions Australasian neurosurgical lumbar microdiscectomy perioperative care practices are generally consistent with international practices and demonstrate a similar degree of heterogeneity. Recommendation of post-operative activity restrictions by Australasian neurosurgeons is still common. This suggests a role for the investigation of the necessity of such restrictions in the era of minimally invasive spine surgery. PMID:29732417

  17. Making the invisible visible--operating theatre nurses' perceptions of caring in perioperative practice.

    Science.gov (United States)

    Blomberg, Ann-Catrin; Bisholt, Birgitta; Nilsson, Jan; Lindwall, Lillemor

    2015-06-01

    The aim of this study was to describe operating theatre nurses' (OTNs') perceptions of caring in perioperative practice. A qualitative descriptive design was performed. Data were collected with interviews were carried out with fifteen strategically selected operating theatre nurses from different operating theatres in the middle of Sweden. A phenomenographic analysis was used to analyse the interviews. The findings show that operating theatre nurses' perceptions of caring in perioperative practice can be summarised in one main category: To follow the patient all the way. Two descriptive categories emerged: To ensure continuity of patient care and keeping a watchful eye. The operating theatre nurses got to know the patient and as a result became responsible for the patient. They protected the patient's body and preserved patient dignity in perioperative practice. The findings show different aspects of caring in perioperative practice. OTNs wanted to be more involved in patient care and follow the patient throughout the perioperative nursing process. Although OTNs have the ambition to make the care in perioperative practice visible, there is today a medical technical approach which promotes OTNs continuing to offer care in secret. © 2014 Nordic College of Caring Science.

  18. Fast-track surgery: Toward comprehensive peri-operative care.

    Science.gov (United States)

    Nanavati, Aditya J; Prabhakar, S

    2014-01-01

    Fast-track surgery is a multimodal approach to patient care using a combination of several evidence-based peri-operative interventions to expedite recovery after surgery. It is an extension of the critical pathway that integrates modalities in surgery, anesthesia, and nutrition, enforces early mobilization and feeding, and emphasizes reduction of the surgical stress response. It entails a great partnership between a surgeon and an anesthesiologist with several other specialists to form a multi-disciplinary team, which may then engage in patient care. The practice of fast-track surgery has yielded excellent results and there has been a significant reduction in hospital stay without a rise in complications or re-admissions. The effective implementation begins with the formulation of a protocol, carrying out each intervention and gathering outcome data. The care of a patient is divided into three phases: Before, during, and after surgery. Each stage needs active participation of few or all the members of the multi-disciplinary team. Other than surgical technique, anesthetic drugs, and techniques form the cornerstone in the ability of the surgeon to carry out a fast-track surgery safely. It is also the role of this team to keep abreast with the latest development in fast-track methodology and make appropriate changes to policy. In the Indian healthcare system, there is a huge benefit that may be achieved by the successful implementation of a fast-track surgery program at an institutional level. The lack of awareness regarding this concept, fear and apprehension regarding its implementation are the main barriers that need to be overcome.

  19. Perioperative care of a pregnant trauma victim: a review of ...

    African Journals Online (AJOL)

    Adele

    2004-05-03

    May 3, 2004 ... (until proven otherwise) in any female trauma patient of child- ... The perioperative management of pregnant trauma victims re- ... trauma, abdominal trauma, head injury, cervical spine injury, fetal injury, gun shot wounds, blunt.

  20. The perspective of children on factors influencing their participation in perioperative care.

    Science.gov (United States)

    Sjöberg, Carina; Amhliden, Helene; Nygren, Jens M; Arvidsson, Susann; Svedberg, Petra

    2015-10-01

    To describe the experiences of participation in perioperative care of 8- to 11-year-old children. All children have the right to participate in decisions that affect them and have the right to express their views in all matters that concern them. Allowing children to be involved in their perioperative care can make a major difference in terms of their well-being by decreasing fear and anxiety and having more positive experiences. Taking the views of children into account and facilitating their participation could thus increase the quality of care. Descriptive qualitative design. The study was conducted in 2013 and data were collected by narrative interviews with 10 children with experience from perioperative care in Sweden. Qualitative content analysis was chosen to describe the variations, differences and similarities in children's experiences of participation in perioperative care. The result showed that receiving preparatory information, lack of information regarding postoperative care and wanting to have detailed information are important factors for influencing children's participation. Interaction with healthcare professionals, in terms of being listened to, being a part of the decision-making and feeling trust, is important for children's participation in the decision-making process. Poor adaptation of the care environment to the children's needs, feeling uncomfortable while waiting and needs for distraction are examples of how the environment and the care in the operating theatre influence the children's experiences of participation. Efforts should be made to improve children's opportunities for participation in the context of perioperative care and further research is needed to establish international standards for information strategies and care environment that promotes children's participation in perioperative care. Nurse anaesthetists need to acquire knowledge and develop strategies for providing preparatory visits and information to children prior to

  1. Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

    OpenAIRE

    Segelman, Josefin; Nygren, Jonas

    2014-01-01

    Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioper...

  2. [The geriatric perioperative unit, a high performance care department for elderly surgical patients].

    Science.gov (United States)

    Papas, Anne; Caillard, Laurence; Nion, Nathalie

    2011-01-01

    For over a year Professor Marc Verny's geriatric department at Pitié-Salpêtrière hospital in Paris has had ten beds set aside for the perioperative care of elderly people. This geriatric perioperative unit (UPOG) offers patients the skills of a multidisciplinary team trained in the specificities of caring for elderly patients often suffering from polypathology. The team works closely together around a common goal: the rapid return of the patient's autonomy during the postoperative period, crucial for the future of elderly people. So far UPOG's results have been very positive, as more than 90% of patients regain their autonomy after a short and uncomplicated period of postoperative care.

  3. Perioperative Care of the Patient With the Total Artificial Heart.

    Science.gov (United States)

    Yaung, Jill; Arabia, Francisco A; Nurok, Michael

    2017-05-01

    Advanced heart failure continues to be a leading cause of morbidity and mortality despite improvements in pharmacologic therapy. High demand for cardiac transplantation and shortage of donor organs have led to an increase in the utilization of mechanical circulatory support devices. The total artificial heart is an effective biventricular assist device that may be used as a bridge to transplant and that is being studied for destination therapy. This review discusses the history, indications, and perioperative management of the total artificial heart with emphasis on the postoperative concerns.

  4. The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement.

    Science.gov (United States)

    Chimento, George F; Thomas, Leslie C

    2017-09-01

    The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

  5. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  6. Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study.

    Science.gov (United States)

    Alito, Miguel Aprelino; de Aguilar-Nascimento, José Eduardo

    2016-04-02

    Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty. Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12.5 % maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of crystalloid fluid after surgery) and preoperative immune nutrition (600 mL/day of Impact - Nestlé, Brazil) for five days prior to surgery, or traditional care (n = 17; control group), which consisted of 6-8 h preoperative fasting, intravenous hydration until the 1(st) postoperative day and no preoperative immune supplementation. The main endpoint was LOS. C-reactive protein (CRP) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2. Neither deaths nor postoperative complications occurred. The median LOS was 3 (2-5) days in the ACERTO group and 6 (3-8) days in controls (P care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty. NCT02580214.

  7. Optimising perioperative care for hip and knee arthroplasty in South Africa: a Delphi consensus study.

    Science.gov (United States)

    Plenge, U; Nortje, M B; Marais, L C; Jordaan, J D; Parker, R; van der Westhuizen, N; van der Merwe, J F; Marais, J; September, W V; Davies, G L; Pretorius, T; Solomon, C; Ryan, P; Torborg, A M; Farina, Z; Smit, R; Cairns, C; Shanahan, H; Sombili, S; Mazibuko, A; Hobbs, H R; Porrill, O S; Timothy, N E; Siebritz, R E; van der Westhuizen, C; Troskie, A J; Blake, C A; Gray, L A; Munting, T W; Steinhaus, H K S; Rowe, P; van der Walt, J G; Isaacs Noordien, R; Theron, A; Biccard, B M

    2018-05-09

    A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.

  8. Perioperative management of obstructive sleep apnea: a survey of Veterans Affairs health care providers.

    Science.gov (United States)

    Dhanda Patil, Reena; Patil, Yash J

    2012-01-01

    (1) To determine the presence of Veterans Affairs (VA) institutional guidelines for the perioperative management of obstructive sleep apnea (OSA); (2) to examine current use of preoperative screening tools for OSA in the VA; and (3) to understand current VA practice patterns regarding postoperative disposition of patients with OSA. Survey study. Veterans Affairs hospitals with surgical services; sample size 102 facilities. Veterans Affairs health care providers. The authors surveyed health care providers at VA hospitals using a survey tool developed by the authors. The response rate was 80%. A variety of preoperative screening tools for OSA were used by respondents, most commonly American Society of Anesthesiologists guidelines (53%). A policy for postoperative disposition of known and presumed OSA was present in 26% and 19% of responses, respectively. Of those respondents reporting a formal postoperative care policy, 48% and 30% admitted patients to a monitored ward bed and surgical intensive care unit, respectively. Of the 74% of respondents unaware of an institutional policy, Anesthesia and Surgery worked together to dictate postoperative disposition of patients with known OSA 73% of the time. The degree of OSA was ranked as the most important factor (58%) influencing postoperative disposition. Ten percent of respondents reported a major perioperative complication attributable to OSA in the past year. This survey study elucidates the heterogeneity of preoperative screening for and postoperative care of veterans with OSA. Future investigators may use these data to formalize institutional policies with regard to patients with OSA, with potentially significant impacts on patient care and usage of financial resources.

  9. Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

    Science.gov (United States)

    Tetteh, Hassan A

    2012-01-01

    Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. Published by Elsevier Inc.

  10. Student nurses' experiences of undignified caring in perioperative practice - Part II.

    Science.gov (United States)

    Willassen, Elin; Blomberg, Ann-Catrin; von Post, Iréne; Lindwall, Lillemor

    2015-09-01

    In recent years, operating theatre nurse students' education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery. The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice. The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique. Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. The study was approved by the Karlstad University's Research Ethics Committee. The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient's worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient's body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient's dignity in perioperative practice. In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed. © The Author(s) 2014.

  11. Results of a national survey about perioperative care in gastric resection surgery.

    Science.gov (United States)

    Bruna, Marcos; Navarro, Carla; Báez, Celia; Ramírez, José Manuel; Ortiz, María Ángeles

    2018-04-23

    Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids greater than 6hours and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically; 56.8% use epidural analgesia and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48hours by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24hours; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. A Structured Transfer of Care Process Reduces Perioperative Complications in Cardiac Surgery Patients.

    Science.gov (United States)

    Hall, Michael; Robertson, Jamie; Merkel, Matthias; Aziz, Michael; Hutchens, Michael

    2017-08-01

    Serious complications are common during the intensive care of postoperative cardiac surgery patients. Some of these complications may be influenced by communication during the process of handover of care from the operating room to the intensive care unit (ICU) team. A structured transfer of care process may reduce the rate of communication errors and perioperative complications. We hypothesized that a collaborative, comprehensive, structured handover of care from the intraoperative team to the ICU team would reduce a specific set of postoperative complications. We tested this hypothesis by developing and introducing a comprehensive multidisciplinary transfer of care process. We measured patient outcomes before and after the intervention using a linkage between 2 care databases: an Anesthesia Information Management System and a critical care complication registry database. There were 1127 total postoperative cardiac surgery admissions during the study period, 550 before and 577 after the intervention. There was no statistical difference between overall complications before and after the intervention (P = .154). However, there was a statistically significant reduction in preventable complications after the intervention (P = .023). The main finding of this investigation is that the introduction of a collaborative, comprehensive transfer of care process from the operating room to the ICU was associated with patients suffering fewer preventable complications.

  13. Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use.

    Science.gov (United States)

    Ukawa, Naoto; Tanaka, Masayuki; Morishima, Toshitaka; Imanaka, Yuichi

    2015-02-01

    The objective of this work was to elucidate aspects of organizational culture associated with hospital performance in perioperative antibiotic prophylaxis using quantitative data in a multicenter and multidimensional study. Cross-sectional retrospective study using a survey data and administrative data. Eighty-three acute hospitals in Japan. A total of 4856 respondents in the organizational culture study, and 23 172 patients for the quality indicator analysis. Multilevel models of various cultural dimensions were used to analyze the association between hospital organizational culture and guideline adherence. The dependent variable was adherence or non-adherence to Japanese and CDC guidelines at the patient level and main independent variable was hospital groups categorized according to organizational culture score. Other control variables included hospital characteristics such as ownership, bed capacity, region and urbanization level of location. The multilevel analysis showed that hospitals with a high score in organizational culture were more likely to adhere to the Japanese and CDC guidelines when compared with lower scoring hospitals. In particular, the hospital group with high scores in the 'collaboration' and 'professional growth' dimensions had three times the odds for Japanese guideline adherence in comparison with low-scoring hospitals. Our study revealed that various aspects of organizational culture were associated with adherence to guidelines for perioperative antibiotic use. Hospital managers aiming to improve quality of care may benefit from improving hospital organizational culture. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  14. Evidence or eminence in abdominal surgery: Recent improvements in perioperative care

    Science.gov (United States)

    Segelman, Josefin; Nygren, Jonas

    2014-01-01

    Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies. PMID:25469030

  15. A Hospital Is Not Just a Factory, but a Complex Adaptive System-Implications for Perioperative Care.

    Science.gov (United States)

    Mahajan, Aman; Islam, Salim D; Schwartz, Michael J; Cannesson, Maxime

    2017-07-01

    Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated. In this article, we argue that applying only factory approaches such as lean methodologies or process standardization to complex systems such as perioperative care could account for difficulties and/or failures in improving performance in care delivery. Within perioperative services, only noncomplex/low-variance surgical episodes are amenable to manufacturing-based redesign. On the other hand, complex surgery/high-variance cases and preoperative segmentation (the process of distinguishing between normal and complex cases) can be viewed as CAS-like. These systems tend to self-organize, often resist or react unpredictably to attempts at control, and therefore require application of CAS principles to modify system behavior. We describe 2 examples of perioperative redesign to illustrate the concepts outlined above. These examples present complementary and contrasting cases from 2 leading delivery systems. The Mayo Clinic example illustrates the application of manufacturing-based redesign principles to a factory-like (high-volume, low-risk, and mature practice) clinical program, while the Kaiser Permanente example illustrates the application of both manufacturing-based and self-organization-based approaches to programs and processes that are not factory-like but CAS-like. In this article, we describe how factory-like processes and CAS can coexist within a hospital and how

  16. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review

    Science.gov (United States)

    Jones, Emma L.; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary

    2016-01-01

    Abstract Background Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. Methods Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) checklist, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e.g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. Results The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). Conclusions The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved. PMID:27066922

  17. Medical tourism in plastic surgery: ethical guidelines and practice standards for perioperative care.

    Science.gov (United States)

    Iorio, Matthew L; Verma, Kapil; Ashktorab, Samaneh; Davison, Steven P

    2014-06-01

    The goal of this review was to identify the safety and medical care issues that surround the management of patients who had previously undergone medical care through tourism medicine. Medical tourism in plastic surgery occurs via three main referral patterns: macrotourism, in which a patient receives treatments abroad; microtourism, in which a patient undergoes a procedure by a distant plastic surgeon but requires postoperative and/or long-term management by a local plastic surgeon; and specialty tourism, in which a patient receives plastic surgery from a non-plastic surgeon. The ethical practice guidelines of the American Medical Association, International Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and American Board of Plastic Surgeons were reviewed with respect to patient care and the practice of medical tourism. Safe and responsible care should start prior to surgery, with communication and postoperative planning between the treating physician and the accepting physician. Complications can arise at any time; however, it is the duty and ethical responsibility of plastic surgeons to prevent unnecessary complications following tourism medicine by adequately counseling patients, defining perioperative treatment protocols, and reporting complications to regional and specialty-specific governing bodies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  18. Defining Value-Based Care in Cardiac and Vascular Anesthesiology: The Past, Present, and Future of Perioperative Cardiovascular Care.

    Science.gov (United States)

    Kolarczyk, Lavinia M; Arora, Harendra; Manning, Michael W; Zvara, David A; Isaak, Robert S

    2018-02-01

    Health care reimbursement models are transitioning from volume-based to value-based models. Value-based models focus on patient outcomes both during the hospital admission and postdischarge. These models place emphasis on cost, quality of care, and coordination of multidisciplinary services. Perioperative physicians are challenged to evaluate traditional practices to ensure coordinated, cost-effective, and evidence-based care. With the Centers for Medicare and Medicaid Services planned introduction of bundled payments for coronary artery bypass graft surgery, cardiovascular anesthesiologists are financially responsible for postdischarge outcomes. In order to meet these patient outcomes, multidisciplinary care pathways must be designed, implemented, and sustained, a process that is challenging at best. This review (1) provides a historical perspective of health care reimbursement; (2) defines value as it pertains to quality, service, and cost; (3) reviews the history of value-based care for cardiac surgery; (4) describes the drive toward optimization for vascular surgery patients; and (5) discusses how programs like Enhanced Recovery After Surgery assist with the delivery of value-based care. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Referrral Systems Development and Survey of Perioperative and Critical Care Referral to Anesthetists.

    Science.gov (United States)

    Narendra, P L; Hegde, Harihar V; Khan, Maroof Ahmad; Talikoti, Dayanand G; Nallamilli, Samson

    2017-01-01

    Anesthetists come in contact with more than two-third of hospital patients. Timely referral to anesthetists is vital in perioperative and remote site settings. Delayed referrals, improper referrals, and referrals at inappropriate levels can result in inadequate preparation, perioperative complications, and poor outcome. The self administered paper survey to delegates attending anesthesia conferences. Questions were asked on how high-risk, emergency surgical cases remote site and critical care patients were referred to anesthetists and presence of rapid response teams. The response rate was 43.8%. Sixty percent (55.3-64.8, P - 0.001) reported high-risk elective cases were referred after admission. Sixty-eight percent (63.42-72.45, P - 0.001) opined preoperative resting echocardiographs were useful. Six percent (4.16-8.98, P - 0.001) reported emergency room referral before arrival of the patient. Twenty-five percent (20.92-29.42, P - 0.001) indicated high-risk obstetric cases were referred immediately after admission. Consultants practiced preoperative stabilization more commonly than residents (32% vs. 22%) ( P - 0.004). For emergency surgery, resident referrals occurred after surgery time was fixed (40% vs. 28%) ( P - 0.012). Residents dealt with more cases without full investigations in obstetrics (28% vs. 15) ( P = 0.002). Remote site patients were commonly referred to residents after sedation attempts (32% vs. 20%) ( P = 0.036). Only 34.8 said hosptals where tbey practiced had dedicated cardiac arrest team in place. Anesthetic departments must periodically assess whether subgroups of patients are being referred in line with current guidelines. Cancellations, critical incidents and complications arising out of referral delays, and improper referrals must be recorded as referral incidents and a separate referral incident registry must be maintained in each department. Regular referral audits must be encouraged.

  20. The perioperative nursing care of patients with malignant obstructive jaundice treated with interventional therapy: clinical experience in 71 cases

    International Nuclear Information System (INIS)

    Zhang Huaping; Tao Ran; Zhang Liqin; Zheng Wenping; Jiang Lei

    2011-01-01

    Objective: To summarize the clinical experience of perioperative nursing for patients with malignant obstructive jaundice who were treated with percutaneous transhepatic biliary drainage. Methods: Sufficient preoperative preparation,careful psychological nursing, serious postoperative observation of vital signs, enhancement of the nutritional support,care of the puncture site and drainage tube, maintenance of the electrolyte balance, correct evaluation of the jaundice, etc. were strictly carried out in all 71 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary drainage. Results: Because the sufficient preoperative preparation and postoperative nursing work were seriously carried out,the obstructive jaundice was well relieved in all patients, the liver function and the living quality were markedly improved and the survival time was prolonged. Conclusion: It is of great clinical significance to intensify the perioperative nursing care for patients with malignant obstructive jaundice who are receiving interventional therapy. (authors)

  1. CARE07 Coordinated Accelerator Research in Europe

    CERN Multimedia

    2007-01-01

    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting takes place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments on s...

  2. CARE07 Coordinated Accelerator Research in Europe

    CERN Multimedia

    2007-01-01

    Annual Meeting, at CERN, 29-31 October 2007 The CARE project started on 1st January 2004 and will end on 31st December 2008. At the end of each year, the progress and status of its activities are reported in a general meeting. This year, the meeting is taking place at CERN. The CARE objective is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The programme includes the most advanced scientific and technological developments, relevant to accelerator research for particle physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe’s ability to produce intense and high-energy particle beams (electrons and positrons, muons and neutrinos, protons and ions, respectively). The Joint Activities, SRF, PHIN, HIPPI and NED, aim at technical developments ...

  3. Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Gattis Katherine G

    2009-08-01

    Full Text Available Abstract Background Given the complexity of surgical care, perioperative patients are at high risk of opioid-related adverse drug events. Existing methods of detection, such as trigger tools and manual chart review, are time-intensive which makes sustainability challenging. Using strategic rule design, computerized surveillance may be an efficient, pharmacist-driven model for event detection that leverages existing staff resources. Methods Computerized adverse drug event surveillance uses a logic-based rules engine to identify potential adverse drug events or evolving unsafe clinical conditions. We extended an inpatient rule (administration of naloxone to detect opioid-related oversedation and respiratory depression to perioperative care at a large academic medical center. Our primary endpoint was the adverse drug event rate. For all patients with a naloxone alert, manual chart review was performed by a perioperative clinical pharmacist to assess patient harm. In patients with confirmed oversedation, other patient safety event databases were queried to determine if they could detect duplicate, prior, or subsequent opioid-related events. Results We identified 419 cases of perioperative naloxone administration. Of these, 101 were given postoperatively and 69 were confirmed as adverse drug events after chart review yielding a rate of 1.89 adverse drug events/1000 surgical encounters across both the inpatient and ambulatory settings. Our ability to detect inpatient opioid adverse drug events increased 22.7% by expanding surveillance into perioperative care. Analysis of historical surveillance data as well as a voluntary reporting database revealed that 11 of our perioperative patients had prior or subsequent harmful oversedation. Nine of these cases received intraoperative naloxone, and 2 had received naloxone in the post-anesthesia care unit. Pharmacist effort was approximately 3 hours per week to evaluate naloxone alerts and confirm adverse drug

  4. Perioperative lipid-enriched enteral nutrition versus standard care in patients undergoing elective colorectal surgery (SANICS II): a multicentre, double-blind, randomised controlled trial

    NARCIS (Netherlands)

    Peters, Emmeline G.; Smeets, Boudewijn J. J.; Nors, Jesper; Back, Christian M.; Funder, Jonas A.; Sommer, Thorbjørn; Laurberg, Søren; Løve, Uffe S.; Leclercq, Wouter K. G.; Slooter, Gerrit D.; de Vries Reilingh, Tammo S.; Wegdam, Johannes A.; Nieuwenhuijzen, Grard A. P.; Hiligsmann, Mickaël; Buise, Marc P.; Buurman, Willem A.; de Jonge, Wouter J.; Rutten, Harm J. T.; Luyer, Misha D. P.

    2018-01-01

    Postoperative ileus and anastomotic leakage severely impair recovery after colorectal resection. We investigated the effect of perioperative lipid-enriched enteral nutrition versus standard care on the risk of postoperative ileus, anastomotic leakage, and other clinical outcomes. We did an

  5. Randomized trial of aromatherapy versus conventional care for breast cancer patients during perioperative periods.

    Science.gov (United States)

    Tamaki, Kentaro; Fukuyama, Akiko Komatsu; Terukina, Shigeharu; Kamada, Yoshihiko; Uehara, Kano; Arakaki, Miwa; Yamashiro, Kazuko; Miyashita, Minoru; Ishida, Takanori; McNamara, Keely May; Ohuchi, Noriaki; Tamaki, Nobumitsu; Sasano, Hironobu

    2017-04-01

    Several studies focused on the effect of aromatherapy on mood, quality of life (QOL), and physical symptoms in patients with cancer. We compared the effects on QOL, vital signs, and sleep quality between aromatherapy and conventional therapy during perioperative periods of the breast cancer patients in this study. Patients were randomly assigned in a 2:1 ratio to receive aromatherapy or usual care. The primary endpoint was QOL, which was assessed using the quality of life questionnaire QLQ-C30, Version 3.0 of the European Organization for Research and Treatment of Cancer (EORTC) Study Group on quality of life. Secondary endpoints included the necessity of hypnotics, vital signs including blood pressure and heart rate and adverse events. In addition, we also summarized the patients' perception of the experience from a free description-type questionnaire. A total of 249 patients had breast cancer surgery and 162 patients gave physician consent and were recruited; 110 were randomly assigned to aromatherapy group (eight patients showed incomplete EORTC QLQ-C30) and 52 to control group (one patient showed incomplete EORTC QLQ-C30). There were no statistically significant differences between the aromatherapy group and control group in the EORTC QLQ-C30 at the surgery day. As for the results of the post-operation day 1, trends for differentiations of physical functioning and role functioning were detected between aromatherapy group and control group, but the differences did not reach statistical significance (p = 0.08 and 0.09). There were no significant differences of systolic and diastolic blood pressures between aromatherapy group and control group (p = 0.82 and 0.68). There was no statistically significant difference in heart rates between aromatherapy group (70.6 ± 11.0 bpm) and control group (71.2 ± 9.8 bpm) (p = 0.73). Likewise, the rate of hypnotic use was not statistically significant (p = 0.10). No adverse events were reported after aromatherapy

  6. CARE05 coordinated accelerator research in Europe

    CERN Multimedia

    2005-01-01

    Annual Meeting at CERN, 23-25 November 2005 CARE started on 1st January 2004 and will last for five years. At the end of each year it holds a general meeting to report on the progress and status of its activities. This year, the CARE annual meeting is taking place at CERN The objective of the CARE project is to generate structured and integrated European cooperation in the field of accelerator research and related R&D. The program includes the most advanced scientific and technological developments, relevant to accelerator research for Particle Physics. It is articulated around three Networking Activities and four Joint Activities. The Networking Activities ELAN, BENE and HHH aim to better coordinate R&D efforts at the European level and to strengthen Europe's ability to evaluate and develop methods of producing intense and high energy beams of electrons, protons, muons and neutrinos. These activities are embedded in world-wide efforts towards future e+e- linear colliders, superior neutrino beam fa...

  7. Effects of using WeChat-assisted perioperative care instructions for parents of pediatric patients undergoing day surgery for herniorrhaphy.

    Science.gov (United States)

    Liu, Jun; Zheng, Xin; Chai, Shouxia; Lei, Meirong; Feng, Zehui; Zhang, Xuelin; Lopez, Violeta

    2018-02-19

    This study examined the effects of WeChat-assisted perioperative instructions for parents whose children were to undergo herniorrhaphy. A randomized controlled trial was conducted in a day surgery center in China. Participants were randomly assigned to the intervention (WeChat) group (n = 209) and the control (Leaflet) group (n = 209). The primary outcomes of this study were parents' knowledge regarding hernia and rate of cancellation of children's surgery. The secondary outcomes were the rate of lost-to-follow-up and the rate of complications and adverse events during the seventh postoperative follow-up day. There was a significant difference in the rate of cancelling the surgery and the mean knowledge score between the WeChat group and leaflet groups. The lost-to-follow-up rate was significantly lower in the WeChat group (0.54%) than in the leaflet group (3.66%). The incidence of postoperative complications were higher in the control group. WeChat-assisted perioperative care instructions enhanced parents' knowledge on perioperative instructions and promoted the preparation of their children for day surgery resulting in lower rate of cancelling the surgery. WeChat has the ability to expand health services outside the hospital confines and could be used as an important low-cost health educational medium in China. Copyright © 2018 Elsevier B.V. All rights reserved.

  8. Perioperative anaphylaxis

    Directory of Open Access Journals (Sweden)

    Marta Inés Berrío Valencia

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  9. A standardized perioperative surgical site infection care process among children with stoma closure: a before-after study.

    Science.gov (United States)

    Porras-Hernandez, Juan; Bracho-Blanchet, Eduardo; Tovilla-Mercado, Jose; Vilar-Compte, Diana; Nieto-Zermeño, Jaime; Davila-Perez, Roberto; Teyssier-Morales, Gustavo; Lule-Dominguez, Martha

    2008-10-01

    We report on the effectiveness of a standardized perioperative care process for lowering surgical site infection (SSI) rates among children with stoma closure at a tertiary-care public pediatric teaching hospital in Mexico City. All consecutive children with stoma closure operated on between November 2003 and October 2005 were prospectively followed for 30 days postoperatively. We conducted a before-after study to evaluate standardized perioperative bowel- and abdominal-wall care process results on SSI rates. Seventy-one patients were operated on, and all completed follow-up. SSI rates declined from 42.8% (12/28) before to 13.9% (6/43) after the standardization procedure (relative risk (RR) = 3.1; 95% confidence interval (CI) = 1.3-7.2; p = 0.006). SSI independently associated risk factors comprised peristomal skin inflammation >3 mm (odds ratio (OR) = 9.6; 95% CI = 1.8-49.6; p = 0.007) and intraoperative complications (OR = 13.3; 95% CI = 1.4-127.2; p = 0.02). Being operated on during the after-study period was shown to be a protective factor against SSI (OR = 0.2; 95% CI = 0.4-0.97; p = 0.04). Standardization was able to reduce SSI rates threefold in children with stoma closure in a short period of time.

  10. Enhanced Recovery After Surgery as an auditing framework for identifying improvements to perioperative nutrition care of older surgical patients.

    Science.gov (United States)

    Byrnes, Angela; Banks, Merrilyn; Mudge, Alison; Young, Adrienne; Bauer, Judy

    2018-06-01

    Older patients are at increased risk of malnutrition and reduced physical function. Using Enhanced Recovery After Surgery (ERAS) guidelines as an auditing framework, this study aimed to determine adherence of nutrition care to perioperative best practice in older patients. A single researcher retrieved data via chart review. Seventy-five consenting patients ≥65 years (median 72 (range 65-95) years, 61% male) admitted postoperatively to general surgical wards were recruited. Sixty per cent had a primary diagnosis of cancer and 51% underwent colorectal resection. Seventeen per cent and 4% of patients met fasting targets of 2-4 h for fluid and 6-8 h for food, respectively. Fifty-five per cent were upgraded to full diet by first postoperative day. Nil received preoperative carbohydrate loading. Minimally invasive surgery (p = 0.01) and no anastomosis formation (p = 0.05) were associated with receiving ERAS-concordant nutrition care. This study highlights areas for improvement in perioperative nutrition care of older patients at our facility.

  11. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial

    Directory of Open Access Journals (Sweden)

    Swart Annemiek

    2006-11-01

    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

  12. Perioperative Colonic Evaluation in Patients with Rectal Cancer; MR Colonography Versus Standard Care

    DEFF Research Database (Denmark)

    Achiam, Michael Patrick; Løgager, Vibeke; Lund Rasmussen, Vera

    2015-01-01

    RATIONALE AND OBJECTIVES: Preoperative colonic evaluation is often inadequate because of cancer stenosis making a full conventional colonoscopy (CC) impossible. In several studies, cancer stenosis has been shown in up to 16%-34% of patients with colorectal cancer. The purpose of this study...... was to prospectively evaluate the completion rate of preoperative colonic evaluation and the quality of perioperative colonic evaluation using magnetic resonance colonography (MRC) in patients with rectal cancer. MATERIALS AND METHODS: Patients diagnosed with rectal cancer were randomized to either group A: standard...... preoperative diagnostic work-up or group B: preoperative MR diagnostic work-up (standard preoperative diagnostic work-up + MRC). A complete and adequate perioperative clean-colon evaluation (PCE) was defined as either a complete preoperative colonic evaluation or a complete colonic evaluation within 3 months...

  13. Coping and caring: support resources integral to perioperative nurses during the process of organ procurement surgery.

    Science.gov (United States)

    Smith, Zaneta; Leslie, Gavin; Wynaden, Dianne

    2017-11-01

    To discuss and explore the levels of support provided to perioperative nurses when participating in multi-organ procurement surgery and the impact to their overall well-being. Assisting within multi-organ procurement surgical procedures has been recognised to impact on the well-being of perioperative nurses leaving little opportunity for them to recover from their participation or to seek available support resources. To date, this area has remained largely unexplored with limited evidence of how nurses manage and cope with these procedures, in addition to the support received in the workplace. A qualitative grounded theory method. The study was informed by perioperative nurses (n = 35) who had previous participatory experience in these surgical procedures from two Australian states. Theoretical sampling directed the collection of data via semistructured in-depth interviews. Data were analysed using the constant comparative method. Three components of levels of support were identified from the data: lacking support within the operating room organisation; surgical team support and access to external professional support. These findings offer new insights into how nurses manage and cope with their participation in organ procurement surgical procedures and what types of support resources can be seen as barriers or enablers to their overall experiences. The need for timely and adequate support is vital to their overall well-being and future participation in organ procurement surgery. These findings have the potential to guide further research with implications for clinical initiatives and practices, looking at new ways of supporting perioperative nurses within the clinical environment both locally and internationally. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health and well-being of nurses impacted by these surgical procedures and provide appropriate and timely clinical support within the work environment. © 2016

  14. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings.

    Science.gov (United States)

    Stoicea, Nicoleta; Baddigam, Ramya; Wajahn, Jennifer; Sipes, Angela C; Arias-Morales, Carlos E; Gastaldo, Nicholas; Bergese, Sergio D

    2016-01-01

    The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

  15. The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea

    2016-07-01

    Full Text Available The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and therefore the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

  16. Peculiarities of the Perioperative Care of Elderly Patients Undergoing Endoscopic Transsphenoidal Removal of Tumors in the Chiasmatic-Sellar Area

    Directory of Open Access Journals (Sweden)

    Alexey B. Kurnosov

    2017-01-01

    Full Text Available Nowadays, in the age of rapid introduction of digital and fiber-optic technologies in neurosurgery, a technique for removal of tumors in the chiasmatic-sellar area via an endoscopic transsphenoidal endonasal approach is actively developed; this technique is considered less invasive and is well tolerated by patients, thus permitting to operate patients with somatic complications, as well as the elderly. Taking into account these facts, as well as world statistic data indicating a continuous trend of population aging in developed countries, including Russia, optimization of the perioperative care of elderly patients with a tumor of the chiasmatic-sellar area becomes the problem of highest priority. In order to solve it, this review discusses the basic peculiarities of the perioperative management of elderly patients (characteristics of their somatic status and possible variants of the pre-operational state with a pathology in the chiasmatic-sellar region; it also presents the modern and most acceptable alternative solutions of this difficult problem (introduction of modern methods of anesthesia, management of the postoperative cognitive dysfunction, postoperative pain syndrome, and postoperative nausea and vomiting. 

  17. Perioperative Management of Neurological Conditions

    Directory of Open Access Journals (Sweden)

    Manjeet Singh Dhallu

    2017-06-01

    Full Text Available Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease. In this article, we emphasize on early diagnosis and management strategies of neurological disorders in the perioperative period to minimize morbidity and mortality of patients.

  18. Digital mobile technology facilitates HIPAA-sensitive perioperative messaging, improves physician-patient communication, and streamlines patient care.

    Science.gov (United States)

    Gordon, Chad R; Rezzadeh, Kameron S; Li, Andrew; Vardanian, Andrew; Zelken, Jonathan; Shores, Jamie T; Sacks, Justin M; Segovia, Andres L; Jarrahy, Reza

    2015-01-01

    Mobile device technology has revolutionized interpersonal communication, but the application of this technology to the physician-patient relationship remains limited due to concerns over patient confidentiality and the security of digital information. Nevertheless, there is a continued focus on improving communication between doctors and patients in all fields of medicine as a means of improving patient care. In this study, we implement a novel communications platform to demonstrate that instantaneously sharing perioperative information with surgical patients and members of their support networks can improve patient care and strengthen the physician-patient relationship. 423 consecutive patients scheduled to undergo elective surgical procedures were offered complimentary registration to a secure, web-based service designed to distribute perioperative updates to a group of recipients designated by each patient via Short Message Service (SMS) and/or email. Messages were created by attending surgeons and delivered instantaneously through the web-based platform. In the postoperative period, patients and their designated message recipients, as well as participating healthcare providers, were asked to complete a survey designed to assess their experience with the messaging system. Survey results were statistically analyzed to determine satisfaction rates. Of the qualifying 423 patients, 313 opted to enroll in the study. On average, patients selected a total of 3.5 recipients to receive perioperative updates. A total of 1,195 electronic messages were generated for distribution to designated recipients during the study period and delivered to recipients located around the world. There were no documented errors or failures in message delivery. Satisfaction surveys were completed by 190 users of the service (73 %). Respondents identified themselves as either patients (n = 48, 25.5 %), family/friends (n = 120, 63.8 %), or healthcare providers (n = 15, 12

  19. Surgical Stress Response and Postoperative Immune Function After Laparoscopy or Open Surgery With Fast Track or Standard Perioperative Care A Randomized Trial

    NARCIS (Netherlands)

    Veenhof, A. A. F. A.; Vlug, M. S.; van der Pas, M. H. G. M.; Sietses, C.; van der Peet, D. L.; de Lange-de Klerk, E. S. M.; Bonjer, H. J.; Bemelman, W. A.; Cuesta, M. A.

    2012-01-01

    Objective: To evaluate the effect of laparoscopic or open colectomy with fast track or standard perioperative care on patient's immune status and stress response after surgery. Methods: Patients with nonmetastasized colon cancer were randomized to laparoscopic or open colectomy with fast track or

  20. Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

    Science.gov (United States)

    Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia

    2015-01-01

    Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pimproved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Conclusion Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach. PMID:26327392

  1. Perioperative care of patients with epidermolysis bullosa: proceedings of the 5th international symposium on epidermolysis bullosa, Santiago Chile, December 4-6, 2008.

    Science.gov (United States)

    Goldschneider, Kenneth; Lucky, Anne W; Mellerio, Jemima E; Palisson, Francis; del Carmen Viñuela Miranda, Maria; Azizkhan, Richard G

    2010-09-01

    Epidermolysis bullosa (EB) has become recognized as a multisystem disorder that poses a number of pre-, intra-, and postoperative challenges. While anesthesiologists have long appreciated the potential difficult intubation in patients with EB, other systems can be affected by this disorder. Hematologic, cardiac, skeletal, gastrointestinal, nutritional, and metabolic deficiencies are foci of preoperative medical care, in addition to the airway concerns. Therefore, multidisciplinary planning for operative care is imperative. A multinational, interdisciplinary panel of experts assembled in Santiagio, Chile to review the best practices for perioperative care of patients with EB. This paper presents guidelines that represent a synthesis of evidence-based approaches and the expert consensus of this panel and are intended to aid physicians new to caring for patients with EB when operative management is indicated. With proper medical optimization and attention to detail in the operating room, patients with EB can have an uneventful perioperative course.

  2. Comparative evaluation of two methods care of the perioperative period after laparoscopic operations on uterine appendages

    Directory of Open Access Journals (Sweden)

    О. S. Lashkul

    2017-10-01

    Full Text Available Aim – тo assess the impact of the early multimodal rehabilitation concept on postoperative period after laparoscopic operations on uterine appendages. Маterials and methods. The study involved 79 patients who were randomized by envelope method in two groups. In the main group (26 patients, a protocol of early multimodal rehabilitation (ERAS was used. In the control group (53 patients, the traditional perioperative regimen was used. In both groups, laparoscopic operations were performed under general anesthesia with mechanical ventilation (propofol + fentanyl. In perioperative anesthesia NSAIDs (dexketoprofen, ketorolac, paracetamol were included. Non-invasive monitoring was performed by the «Leon» monitor (StO2, blood pressure, heart rate, capnogram, hourly diuresis was taken into account, thermometry was performed. In the postoperative period analgesia with combination with systemic administration of dexketoprofen (100–150 mg/day + ketorolac (60 mg/day + paracetamol (3000 mg/day was used. Results. The groups were homogeneous according to anamnestic (the beginning of menstruation, the number of pregnancies, childbirth, abortions, miscarriages, anthropometric and demographic characteristics, the duration of operations, blood loss and baseline values of systolic, diastolic, mean arterial pressures and heart rate. In groups the volumes of diuresis did not differ significantly (p < 0.05. Positive intraoperative hemohydrate balance in the FTS group was almost half that in the control group. When assessing pain at rest by VAS, a statistically significant difference was found at the 6 and 24 hours study stages. Nevertheless, at the study stages the pain level in the control group did not exceed 30 mm, which indicates adequate analgesia at rest. The level of cough pain in the control group exceeded the level of pain in the main group, the statistical difference was determined after 6 hours and 24 hours, but was above 30 mm, which required

  3. Differences between patients' and clinicians' research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership.

    Science.gov (United States)

    Boney, O; Nathanson, M H; Grocott, M P W; Metcalf, L

    2017-09-01

    The James Lind Alliance Anaesthesia and Peri-operative Care Priority Setting Partnership was a recent collaborative venture bringing approximately 2000 patients, carers and clinicians together to agree priorities for future research into anaesthesia and critical care. This secondary analysis compares the research priorities of 303 service users, 1068 clinicians and 325 clinicians with experience as service users. All three groups prioritised research to improve patient safety. Service users prioritised research about improving patient experience, whereas clinicians prioritised research about clinical effectiveness. Clinicians who had experience as service users consistently prioritised research more like clinicians than like service users. Individual research questions about patient experience were more popular with patients and carers than with clinicians in all but one case. We conclude that patients, carers and clinicians prioritise research questions differently. All groups prioritise research into patient safety, but service users also favour research into patient experience, whereas clinicians favour research into clinical effectiveness. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  4. Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

    Science.gov (United States)

    Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

    2015-01-01

    Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, pcontrol group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (pcontrol group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

  5. Implementing a Perioperative Nursing Student Summer Internship.

    Science.gov (United States)

    Nash, Janice; Kamel, Teya C; Sherer, Joanne; Nauer, Kathleen

    2018-01-01

    Using qualitative research and a collaborative academic service partnership, we created an innovative 120-hour perioperative nursing summer internship for eight undergraduate nursing students in 2016. Recognizing that perioperative exposure is limited in the traditional baccalaureate program, this unpaid internship served to clarify student perceptions of perioperative nursing care and encourage graduates to meet perioperative workforce demands. We based the theoretical and practical student learning experiences on the AORN Periop 101 learning modules and included faculty-led discussions, student journaling, and onsite precepted clinical activities. Evaluation data revealed that students achieved an enhanced awareness of perioperative nursing, and a majority of the participants expressed a desire to enter the perioperative field after graduation. We suggest that stakeholders continue to strategize ways to maximize educational preparation to address the evolving health care market supply and demand. © AORN, Inc, 2018.

  6. 76 FR 66931 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-10-28

    ...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... Services (CMS). This two-day training session is the third and final Accelerated Development Learning... the quality of care for beneficiaries. Through Accelerated Development Learning Sessions (ADLS), the...

  7. [Nursing care in perioperative period in patients with intenstinal stomia exposure].

    Science.gov (United States)

    Szewczyk, Joanna; Bajon, Anna

    2009-05-01

    Despite of enormous advance in minimally invasive surgery which is almost scarless nowadays, there is still very important emotional issue for patients connected with each surgical procedure. One of the most stressful surgical procedures for patients is the one which ends up with stomia exposure. The main objective of this article is to point out very the important factor which leads to decrease the number of complications, speeds up recovery and acceptation of the stomia by patients. This factor is known as a professional nursing care. It consists of physical and psychical preoperative preparation and postoperative care for patients. Special care in early postoperative 24h is crucial for preventing from development of any complications. That is why the nursing personnel is obliged to monitor vital signs very carefully. Complex preparation and postoperative care leads to diminish significantly the number of complications, facilitates cooperation with patients and also influences the increase of sense of safety and trust to medical personnel. Patients with stomia who were under professional nursing staff supervision achieve full recovery and higher quality of life considerably earlier.

  8. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  9. The CARE accelerator R&D programme in Europe

    CERN Document Server

    Napoly, Olivier; den Ouden, Andres; Devred, Arnaud; Garoby, Roland; Garvey, Terence; Ghigo, Andrea; Gschwendtner, Edda; Losito, Roberto; Mais, Helmut; Palladino, V; Proch, Dieter; Richard, F; Rinolfi, Louis; Ruggiero, Francesco; Scandale, Walter; Schulte, Daniel; Vretenar, Maurizio

    2005-01-01

    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to future projects such as linear colliders, upgrades of hadron colliders and high intensity proton drivers. We describe the CARE R&D plans, mostly devoted to advancing the performance of the superconducting technology, both in the fields of RF cavities for electron or proton acceleration and of high field magnets, as well as to developing high intensity electron and proton injectors. We highlight some results and progress obtained so far.

  10. Evidence-based medicine: A survey among perioperative health care professionals in India

    Directory of Open Access Journals (Sweden)

    Reshma Ambulkar

    2017-01-01

    Conclusion: Although most respondents agreed that practicing EBM improved patient care, many of them showed a low level of awareness regarding fundamental aspects of EBM. In addition to encouraging implementation of EBM, there should be increased focus on training in EBM methods.

  11. Improving the Quality of Care for Patients Diagnosed With Glioma During the Perioperative Period

    Science.gov (United States)

    Riblet, Natalie B.V.; Schlosser, Evelyn M.; Homa, Karen; Snide, Jennifer A.; Jarvis, Lesley A.; Simmons, Nathan E.; Sargent, David H.; Mason, Linda P.; Cooney, Tobi J.; Kennedy, Nancy L.; Fadul, Camilo E.

    2014-01-01

    Purpose: Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting. Results: The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P sustaining process improvements. PMID:25294392

  12. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Ahmed, Aamer B; Afshari, Arash

    2017-01-01

    : The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia...... and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide...

  13. A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs.

    Science.gov (United States)

    Miralpeix, Ester; Nick, Alpa M; Meyer, Larissa A; Cata, Juan; Lasala, Javier; Mena, Gabriel E; Gottumukkala, Vijaya; Iniesta-Donate, Maria; Salvo, Gloria; Ramirez, Pedro T

    2016-05-01

    Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT). Copyright © 2016 Elsevier Inc. All rights reserved.

  14. The Care Accelerator R&D Programme in Europe

    NARCIS (Netherlands)

    Napoly, O.; Aleksan, A.; Devred, A.; den Ouden, A.

    CARE, an ambitious and coordinated programme of accelerator research and developments oriented towards high energy physics projects, has been launched in January 2004 by the main European laboratories and the European Commission. This project aims at improving existing infrastructures dedicated to

  15. Identifying research priorities in anaesthesia and perioperative care: final report of the joint National Institute of Academic Anaesthesia/James Lind Alliance Research Priority Setting Partnership.

    Science.gov (United States)

    Boney, Oliver; Bell, Madeline; Bell, Natalie; Conquest, Ann; Cumbers, Marion; Drake, Sharon; Galsworthy, Mike; Gath, Jacqui; Grocott, Michael P W; Harris, Emma; Howell, Simon; Ingold, Anthony; Nathanson, Michael H; Pinkney, Thomas; Metcalf, Leanne

    2015-12-16

    To identify research priorities for Anaesthesia and Perioperative Medicine. Prospective surveys and consensus meetings guided by an independent adviser. UK. 45 stakeholder organisations (25 professional, 20 patient/carer) affiliated as James Lind Alliance partners. First 'ideas-gathering' survey: Free text research ideas and suggestions. Second 'prioritisation' survey: Shortlist of 'summary' research questions (derived from the first survey) ranked by respondents in order of priority. Final 'top ten': Agreed by consensus at a final prioritisation workshop. First survey: 1420 suggestions received from 623 respondents (49% patients/public) were refined into a shortlist of 92 'summary' questions. Second survey: 1718 respondents each nominated up to 10 questions as research priorities. Top ten: The 25 highest-ranked questions advanced to the final workshop, where 23 stakeholders (13 professional, 10 patient/carer) agreed the 10 most important questions: ▸ What can we do to stop patients developing chronic pain after surgery? ▸ How can patient care around the time of emergency surgery be improved? ▸ What long-term harm may result from anaesthesia, particularly following repeated anaesthetics?▸ What outcomes should we use to measure the 'success' of anaesthesia and perioperative care? ▸ How can we improve recovery from surgery for elderly patients? ▸ For which patients does regional anaesthesia give better outcomes than general anaesthesia? ▸ What are the effects of anaesthesia on the developing brain? ▸ Do enhanced recovery programmes improve short and long-term outcomes? ▸ How can preoperative exercise or fitness training, including physiotherapy, improve outcomes after surgery? ▸ How can we improve communication between the teams looking after patients throughout their surgical journey? Almost 2000 stakeholders contributed their views regarding anaesthetic and perioperative research priorities. This is the largest example of patient and public

  16. Influence of multi-level anaesthesia care and patient profile on perioperative patient satisfaction in short-stay surgical inpatients: A preliminary study

    Directory of Open Access Journals (Sweden)

    Amarjeet Singh

    2007-01-01

    Full Text Available Background and goals of study: Patient satisfaction in relation to perioperative anesthesia care represents essential aspect of quality health-care management. We analyzed the influence of multi-level anesthesia care exposure and patient profile on perioperative patient satisfaction in short-stay surgical inpatients. Methods : 120 short-stay surgical inpatients who underwent laparoscopic surgery have been included in this prospective study. Pertaining to demographic parameters (age, gender, education, profession, duration of stay (preoperative room, recovery room, various patient problems and patient satisfaction (various levels, overall were recorded by an independent observer and analyzed. Overall, adults, male and uneducated patients experienced more problems. Conversely, elderly, females and educated patients were more dissatisfied. Female patients suffered more during immediate postoperative recovery room stay and were more dissatisfied than their male counterparts (p< 0.05. However, patient′s professional status had no bearing on the problems encountered and dissatisfaction levels. Preoperative and early postoperative period accounted for majority of the problems encountered among the study population. There was a positive correlation between problems faced and dissatisfaction experienced at respective levels of anesthesia care (p< 0.05. Conclusion(s : Patient′s demographic profile and problems faced during respective level of anesthesia care has a correlation with dissatisfaction. Interestingly, none of the above stated factors had any effect on overall satisfaction level.

  17. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

    Science.gov (United States)

    Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Yamada, Shin-Ichi; Kurita, Hiroshi; Yamauchi, Chika; Shibuya, Yasuyuki; Kojima, Yuka; Nakahara, Hirokazu; Oho, Takahiko; Umeda, Masahiro

    2017-08-01

    The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

  18. Controversies in perioperative anesthetic management of the morbidly obese: I am a surgeon, why should I care?

    Science.gov (United States)

    Sinha, Ashish C; Singh, Preet Mohinder

    2015-05-01

    Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.

  19. 76 FR 50224 - Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center...

    Science.gov (United States)

    2011-08-12

    ...] Medicare Program; Accountable Care Organization Accelerated Development Learning Sessions; Center for... (CMS). This two-day training session is the second Accelerated Development Learning Session (ADLS.... Through Accelerated Development Learning Sessions (ADLS), the Innovation Center will test whether...

  20. THE CARE PROJECT - Coordinated Accelerator Research in Europe

    CERN Multimedia

    2003-01-01

    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend. Presentation of the CARE project (Coordinated Accelerator Research in Europe) to be submitted within FP6 February 10th, at CERN in the council room Agenda Chair : C. Wyss 9:00 General presentation of FP6 and introduction of IA proposal (R. Aleksan) 9:45 Networking activities on e ...

  1. Habits in perioperative nursing culture.

    Science.gov (United States)

    Lindwall, Lillemor; von Post, Iréne

    2008-09-01

    This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time).

  2. A survey of contemporary opinions and practices of surgical and intensive care specialists towards peri-operative venous thromboembolism prophylaxis in Asia.

    Science.gov (United States)

    Lee, L; Liew, N C; Gee, T

    2012-12-01

    This survey was conducted to determine the opinions and practices of peri-operative venous thromboembolism (VTE) prophylaxis among surgical and intensive care specialists in Asia. A set of questionnaire was distributed to surgeons and intensivists from different countries in Asia. The specialties included were general surgery and its sub-specialties, orthopaedic surgery, gynaecological surgery and intensive care unit. This survey involved teaching institutions, general hospitals and private hospitals. To gauge if the respondents were from hospitals that would likely encounter VTE cases, the hospital's bed-strength, intensive care facility and sub-specialty services were recorded. Over a period of six months, questionnaires and feedbacks were collected and analyzed. One hundred and ninety-one responses were received from 8 countries throughout Asia. Fifty-six percent of these were from large hospitals (800 bedded or more) and 62% of these hospitals have large intensive care facility (20 or more beds). Only half of the respondents practice routine thromboprophylaxis in moderate and high risk surgeries. Thirty six percent of them practices selective thromboprophylaxis and only 3% do not believe in any thromboprophylaxis. A third prescribed thromboprophylaxis for 3 to 5 days; another third extended it until patient is mobile. About 48.6% of the respondents do not have VTE guidelines in their institutions. Majority of the respondents agreed that more evidence is needed in the form of multi-centre randomized controlled trials to influence their decision on thromboprophylaxis. Despite the availability of strong epidemiological data, randomized controlled trials and multicentre case-controlled studies, perioperative VTE prophylactic practices are still suboptimal in Asia.

  3. Poor performances of EuroSCORE and CARE score for prediction of perioperative mortality in octogenarians undergoing aortic valve replacement for aortic stenosis.

    Science.gov (United States)

    Chhor, Vibol; Merceron, Sybille; Ricome, Sylvie; Baron, Gabriel; Daoud, Omar; Dilly, Marie-Pierre; Aubier, Benjamin; Provenchere, Sophie; Philip, Ivan

    2010-08-01

    Although results of cardiac surgery are improving, octogenarians have a higher procedure-related mortality and more complications with increased length of stay in ICU. Consequently, careful evaluation of perioperative risk seems necessary. The aims of our study were to assess and compare the performances of EuroSCORE and CARE score in the prediction of perioperative mortality among octogenarians undergoing aortic valve replacement for aortic stenosis and to compare these predictive performances with those obtained in younger patients. This retrospective study included all consecutive patients undergoing cardiac surgery in our institution between November 2005 and December 2007. For each patient, risk assessment for mortality was performed using logistic EuroSCORE, additive EuroSCORE and CARE score. The main outcome measure was early postoperative mortality. Predictive performances of these scores were assessed by calibration and discrimination using goodness-of-fit test and area under the receiver operating characteristic curve, respectively. During this 2-year period, we studied 2117 patients, among whom 134/211 octogenarians and 335/1906 nonoctogenarians underwent an aortic valve replacement for aortic stenosis. When considering patients with aortic stenosis, discrimination was poor in octogenarians and the difference from nonoctogenarians was significant for each score (0.58, 0.59 and 0.56 vs. 0.82, 0.81 and 0.77 for additive EuroSCORE, logistic EuroSCORE and CARE score in octogenarians and nonoctogenarians, respectively, P performances of these scores are poor in octogenarians undergoing cardiac surgery, especially aortic valve replacement. Risk assessment and therapeutic decisions in octogenarians should not be made with these scoring systems alone.

  4. The CARE project (Coordinated Accelerator Research in Europe)

    International Nuclear Information System (INIS)

    Napoly, Olivier

    2006-01-01

    CARE, an ambitious and coordinated project of accelerator research and developments oriented towards High Energy Physics projects, has been launched in January 2004 by the main European laboratories and the European Commission with the 6th Framework Programme. This project aims at improving existing infrastructures dedicated to future projects such as linear colliders, upgrades of hadron colliders and high intensity proton drivers An important part of this programme is devoted to advancing the performance of the superconducting technology, both in the fields of RF cavities for electron and proton acceleration and of high field magnets, as well as to developing high intensity electron and proton injectors. We describe the plans of the four main Joint Research Activities and report on the results and progress obtained so far. The CARE project also includes three adjacent Networking Activities whose main goal is to organize a forum of discussions and to provide the strategic plans in the fields of the Linear Collider, intense Neutrino Beams, and future Hadron Colliders

  5. Transitioning From Perioperative Staff Nurse to Perioperative Educator.

    Science.gov (United States)

    Mower, Juliana

    2017-08-01

    Perioperative nurses who enjoy teaching may wish to become staff development educators. The shift to this new role requires a transition period during which the new educator acquires the knowledge, skills, and attitudes integral to mastering the job. A systematic approach to achieving baseline competencies in the educator role helps to ensure a successful conversion from providing direct patient care to supporting the educational needs of staff members. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  6. Service Dogs in the Perioperative Setting.

    Science.gov (United States)

    Levey, Janet A; Chappy, Sharon L

    2017-04-01

    Service dogs are critical for the independence of individuals with disabilities because they assist with daily living activities and help these individuals navigate society. Perioperative nurses need a working knowledge of disability laws pertaining to service dogs to provide patient-centered care for individuals using service dogs. This article provides information on the Americans With Disabilities Act regulations regarding service dogs, makes recommendations for the care of patients with service dogs across the perioperative continuum, and offers policy directives to ensure that safe, high-quality care is delivered to patients using service dogs. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Danish Perioperative Nurses' Documentation

    DEFF Research Database (Denmark)

    Søndergaard, Susanne Friis; Lorentzen, Vibeke; Sørensen, Erik E

    2017-01-01

    of 2015 to 2016, six participants tested an EHR containing a Danish edition of a selected section of the Perioperative Nursing Data Set. This study relied on realistic evaluation and participant observations to generate data. We found that nursing leadership was essential for improving perioperative...

  8. Perioperative Rosuvastatin in Cardiac Surgery.

    Science.gov (United States)

    Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

    2016-05-05

    Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

  9. The CARE project - Coordinated Accelerator Research in Europe

    CERN Multimedia

    2003-01-01

    A one-day presentation of the project will take place on Monday February 10th in the CERN Council Chamber. The meeting will start a 9am and is expected to end at 4:30pm. The meeting, which is open to the whole community, will present an initiative on accelerator R&D in Europe, supported by ECFA, with the aim to bid for European Union support through the Framework 6 scheme. This initiative is coordinated by a steering group (ESGARD - European Steering Group on Accelerator Research and Development), which has been set up to coordinate European efforts on accelerator R&D and the submission of such bids. The initial bids have to be submitted by April 15th. All those interested in accelerator R&D are welcome to attend.

  10. Understanding Value as a Key Concept in Sustaining the Perioperative Nursing Workforce.

    Science.gov (United States)

    Kapaale, Chaluza C

    2018-03-01

    Perioperative nursing is faced with a staffing crisis attributed in part to minimal numbers of newly graduated nurses choosing a career in this specialty. This article analyzes and applies the concept of value to explore how to maintain an adequate perioperative nursing workforce; recruit newly graduated nurses; and encourage career professional, nurse educator, and student collaboration to generate meaningful value for perioperative nursing. This analysis revealed that value co-creation for perioperative nursing could lead to newly graduated nurses increasingly choosing perioperative nursing as a career, and enjoying satisfying perioperative nursing careers while providing high-quality patient care. © AORN, Inc, 2018.

  11. Critical Elements for the Pediatric Perioperative Anesthesia Environment.

    Science.gov (United States)

    Polaner, David M; Houck, Constance S

    2015-12-01

    The American Academy of Pediatrics proposes guidance for the pediatric perioperative anesthesia environment. Essential components are identified to optimize the perioperative environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events. Copyright © 2015 by the American Academy of Pediatrics.

  12. Reduce--recycle--reuse: guidelines for promoting perioperative waste management.

    Science.gov (United States)

    Laustsen, Gary

    2007-04-01

    The perioperative environment generates large amounts of waste, which negatively affects local and global ecosystems. To manage this waste health care facility leaders must focus on identifying correctable issues, work with relevant stakeholders to promote solutions, and adopt systematic procedural changes. Nurses and managers can moderate negative environmental effects by promoting reduction, recycling, and reuse of materials in the perioperative setting.

  13. Japanese-style intensive medical care improves prognosis for acute liver failure and the perioperative management of liver transplantation.

    Science.gov (United States)

    Inoue, K; Watanabe, T; Maruoka, N; Kuroki, Y; Takahashi, H; Yoshiba, M

    2010-12-01

    The Japanese style of intensive medical care for acute liver failure has yielded high survival rates. The care system comprises artificial liver support (ALS) together with treatment for the underlying disease. Plasma exchange in combination with high-volume hemodiafiltration using an high performance membrane has become the standard ALS system. It is safe, efficiently removing more low and middle molecular weight toxic substances than other methods because of the large volumes of buffer (more than 200 L per session), resulting in recovery from coma in patients with severe fulminant hepatitis, a status comparable with the ahepatic state. This ALS is therefore an effective tool to sustain patients with fulminant hepatitis in a favorable condition until liver function recovers or liver transplantation becomes available. The accompanying treatment for underlying disease serves to limit the liver destruction that hampers regeneration. The treatment has remarkably improved the prognosis for patients with subacute types of fulminant hepatitis, which generally carry a less favorable prognosis than the acute type. This treatment system thus provides more time for physicians to assess the indications for liver transplantation as well as giving the patient a greater chance of undergoing transplantation. Copyright © 2010 Elsevier Inc. All rights reserved.

  14. Accelerating delivery of trauma-sensitive care: Using multilevel stakeholder engagement to improve care for women veterans.

    Science.gov (United States)

    Yano, Elizabeth M; Hamilton, Alison B

    2017-09-01

    Engaging women Veterans with trauma histories in the design of innovations for their own care in partnership with providers and staff and other multilevel stakeholders holds promise for accelerating delivery of trauma-sensitive care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Immediate outcome indicators in perioperative care: a controlled intervention study on quality improvement in hospitals in Tanzania.

    Science.gov (United States)

    Bosse, Goetz; Mtatifikolo, Ferdinand; Abels, Wiltrud; Strosing, Christian; Breuer, Jan-Philipp; Spies, Claudia

    2013-01-01

    Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators. Surgical care quality in six hospitals in Tanzania was assessed from 2006-2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates. In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n = 12,530) in 2006, 3.5% (n = 21,114) in 2009 and 4.6% (n = 18,840) in 2011. In the control group it was 3.1% (n = 17,827) in 2006, 4.2% (n = 13,632) in 2009 and 3.8% (n = 17,059) in 2011. Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care. Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome

  16. Utilising advance care planning videos to empower perioperative cancer patients and families: a study protocol of a randomised controlled trial.

    Science.gov (United States)

    Aslakson, Rebecca A; Isenberg, Sarina R; Crossnohere, Norah L; Conca-Cheng, Alison M; Yang, Ting; Weiss, Matthew; Volandes, Angelo E; Bridges, John F P; Roter, Debra L

    2017-06-06

    Despite positive health outcomes associated with advance care planning (ACP), little research has investigated the impact of ACP in surgical populations. Our goal is to evaluate how an ACP intervention video impacts the patient centredness and ACP of the patient-surgeon conversation during the presurgical consent visit. We hypothesise that patients who view the intervention will engage in a more patient-centred communication with their surgeons compared with patients who view a control video. Randomised controlled superiority trial of an ACP video with two study arms (intervention ACP video and control video) and four visits (baseline, presurgical consent, postoperative 1 week and postoperative 1 month). Surgeons, patients, principal investigator and analysts are blinded to the randomisation assignment. Single, academic, inner city and tertiary care hospital. Data collection began July 16, 2015 and continues to March 2017. Patients recruited from nine surgical oncology clinics who are undergoing major cancer surgery. In the intervention arm, patients view a patient preparedness video developed through extensive engagement with patients, surgeons and other stakeholders. Patients randomised to the control arm viewed an informational video about the hospital surgical programme. Primary Outcome: Patient centredness and ACP of patient-surgeon conversations during the presurgical consent visit as measured through the Roter Interaction Analysis System. patient Hospital Anxiety and Depression Scale score; patient goals of care; patient, companion and surgeon satisfaction; video helpfulness; medical decision maker designation; and the frequency patients watch the video. Intent-to-treat analysis will be used to assess the impact of video assignment on outcomes. Sensitivity analyses will assess whether there are differential effects contingent on patient or surgeon characteristics. This study has been approved by the Johns Hopkins School of Medicine institutional review

  17. Accelerators

    CERN Multimedia

    CERN. Geneva

    2001-01-01

    The talk summarizes the principles of particle acceleration and addresses problems related to storage rings like LEP and LHC. Special emphasis will be given to orbit stability, long term stability of the particle motion, collective effects and synchrotron radiation.

  18. Care for the Caregiver: Evaluation of Mind-Body Self-Care for Accelerated Nursing Students.

    Science.gov (United States)

    Drew, Barbara L; Motter, Tracey; Ross, Ratchneewan; Goliat, Laura M; Sharpnack, Patricia A; Govoni, Amy L; Bozeman, Michelle C; Rababah, Jehad

    2016-01-01

    Stress affects the well-being of both nursing students and the individuals with whom they work. With the theory of cognitive appraisal as a framework for this study, it is proposed that mind-body self-care strategies promote stress management by stabilization of emotions. Outcomes will be a perception of less stress and more mindful engagement with the environment. Objective of the study was to describe an evaluation of student perceived stress and mindfulness to 1-hour per week of class time dedicated to mind-body self-care (yoga, mindful breathing, Reiki, and essential oil therapy). It was a quasi-experimental study; data collection took place at 4 time points. Participants were entry-level accelerated nursing students from 3 US universities: 50 in the treatment group, 64 in the comparison group. Data included health-promoting practices using Health-Promoting Promotion Lifestyle Profile II as a control variable, stress and mindfulness (Perceived Stress Scale [PSS] and Mindful Attention Awareness Scale [MAAS]), and demographic information; analysis using mixed-design repeated-measures analysis of variances. There was a statistically significant interaction between intervention and time on PSS scores, F(3, 264) = 3.95, P = .009, partial η(2) = 0.043, with PSS scores of the intervention group decreasing from baseline to T3 when intervention ended whereas PSS scores of the comparison group increased from baseline. The average scores on the MAAS did not differ significantly. Evaluation of an embedded mind-body self-care module in the first nursing course demonstrated promising improvements in stress management. The findings support the appropriateness of integrating mind-body self-care content into nursing curricula to enhance students' ability to regulate stress.

  19. anaesthetic registrars' experiences of perioperative death

    African Journals Online (AJOL)

    Death on the table: anaesthetic registrars' experiences of perioperative ... aDepartment of Anaesthesiology and Critical Care, University of KwaZulu-Natal, Durban, South Africa ... Results: Themes expressed by participants fell into three broad categories: ... number (up to 70%) of anaesthetists report experiencing adverse.

  20. Patient Education May Improve Perioperative Safety.

    NARCIS (Netherlands)

    de Haan, L.S.; Calsbeek, H; Wolff, André

    2016-01-01

    Importance: There is a growing interest in enabling ways for patients to participate in their own care to improve perioperative safety, but little is known about the effectiveness of interventions enhancing an active patient role. Objective: To evaluate the effect of patient participation on

  1. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Perioperative care of infants with diaphragmatic hernias can be a challenge because of pulmonary hypertension and systemic hypotension. The objective of this study was to report the usefulness of vasopressin infusion in improving pulmonary and systemic haemodynamics in an infant with congenital diaphragmatic hernia.

  2. Ethics in perioperative practice--patient advocacy.

    Science.gov (United States)

    Schroeter, Kathryn

    2002-05-01

    Though often difficult, ethical decision making is necessary when caring for surgical patients. Perioperative nurses have to recognize ethical dilemmas and be prepared to take action based on the ethical code outlined in the American Nurses Association's (ANA's) Code of Ethics for Nurses with Interpretive Statements. In this second of a nine-part series that will help perioperative nurses relate the ANA code to their own area of practice, the author looks at the third provision statement, which addresses nurses' position as patient advocates.

  3. Perioperative Management of Patients with Rheumatic Diseases

    Science.gov (United States)

    Bissar, Lina; Almoallim, Hani; Albazli, Khaled; Alotaibi, Manal; Alwafi, Samar

    2013-01-01

    This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education. Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care. The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation PMID:24062860

  4. Perioperative nursing in public university hospitals

    DEFF Research Database (Denmark)

    Sørensen, Erik Elgaard; Olsen, Ida Østrup; Tewes, Marianne

    2014-01-01

    BACKGROUND: In recent years, perioperative nursing has received ongoing attention as part of an interprofessional collaboration. Perioperative nursing is constantly faced with new challenges and opportunities that necessitate continual updates of nursing knowledge and technical skills. In light...... of the longstanding relationship between nursing and technology, it is interesting that few studies with this focus have been performed. Therefore, our research question was: What is the content of perioperative nursing and how do nurses facilitate the interaction between nursing care and technology in highly...... specialized operating rooms in public university hospitals? METHODS: An ethnography involving participant observations and interviews was conducted during a 9-month study period. The participants comprised 24 nurses from 9 different operating wards at 2 university hospitals in different regions of Denmark...

  5. New 'patent accelerated care environment' aims to facilitate work flow, free up ED for acute care needs.

    Science.gov (United States)

    2012-02-01

    Faced with rising acuity levels and surging demand, Virginia Mason Medical Center modified the Clinical Decision Unit concept used in many EDs, and developed a new Patient Accelerated Care Environment (PACE) to care for observation patients, process patients for discharge, and to prepare patients for admission.The approach is designed to utilize ED beds for initial processing of patients, allowing resuscitative care if needed, and treating and releasing the patients with quick care needs. Using the Virginia Mason Production System, a methodology that is modeled after Toyota production techniques, developers designed an optimal work flow pattern and then built infrastructure to facilitate that process. All patients who present to the ED for care are seen by the ED team through a "team greet" approach. Approximately 35% to 40% of patients who come to the ED for care are transferred to the PACE unit. Patients assigned to the PACE unit typically remain there for 4 to 48 hours, depending on their care needs.

  6. Nitrous oxide and perioperative outcomes.

    Science.gov (United States)

    Ko, Hanjo; Kaye, Alan David; Urman, Richard D

    2014-06-01

    There is emerging evidence related to the effects of nitrous oxide on important perioperative patient outcomes. Proposed mechanisms include metabolic effects linked to elevated homocysteine levels and endothelial dysfunction, inhibition of deoxyribonucleic acid and protein formation, and depression of chemotactic migration by monocytes. Newer large studies point to possible risks associated with the use of nitrous oxide, although data are often equivocal and inconclusive. Cardiovascular outcomes such as stroke or myocardial infarction were shown to be unchanged in previous studies, but the more recent Evaluation of Nitrous Oxide in the Gas Mixture for Anesthesia I trial shows possible associations between nitrous oxide and increased cardiovascular and pulmonary complications. There are also possible effects on postoperative wound infections and neuropsychological function, although the multifactorial nature of these complications should be considered. Teratogenicity linked to nitrous oxide use has not been firmly established. The use of nitrous oxide for routine anesthetic care may be associated with significant costs if complications such as nausea, vomiting, and wound infections are taken into consideration. Overall, definitive data regarding the effect of nitrous oxide on major perioperative outcomes are lacking. There are ongoing prospective studies that may further elucidate its role. The use of nitrous oxide in daily practice should be individualized to each patient's medical conditions and risk factors.

  7. Identifying research priorities in anaesthesia and perioperative care: final report of the joint National Institute of Academic Anaesthesia/James Lind Alliance Research Priority Setting Partnership

    OpenAIRE

    Boney, O.; Bell, M.; Bell, N.; Conquest, A.; Cumbers, M.; Drake, S.; Galsworthy, M.; Gath, J.; Grocott, M. P.; Harris, E.; Howell, S.; Ingold, A.; Nathanson, M. H.; Pinkney, T.; Metcalf, L.

    2015-01-01

    Objective To identify research priorities for Anaesthesia and Perioperative Medicine. Design Prospective surveys and consensus meetings guided by an independent adviser. Setting UK. Participants 45 stakeholder organisations (25 professional, 20 patient/carer) affiliated as James Lind Alliance partners. Outcomes First ?ideas-gathering? survey: Free text research ideas and suggestions. Second ?prioritisation? survey: Shortlist of ?summary? research questions (derived from the first survey) rank...

  8. Application of fast-track surgery concept in perioperative patients with biliary calculi and liver cirrhosis: a prospective study

    Directory of Open Access Journals (Sweden)

    WANG Hua

    2014-11-01

    Full Text Available ObjectiveTo investigate the advantage and safety of the concept of fast-track surgery (FTS applied in perioperative patients with biliary calculi and liver cirrhosis. MethodsFifty-two patients undergoing operation for biliary calculi and liver cirrhosis from January 2011 to September 2013 were included in this study. These patients were randomly divided into FTS group (n = 30 and control group (n = 22. Patients in the FTS group received perioperative care measures guided by FTS concept, while patients in the control group received traditional perioperative management measures. The intraoperative situation of patients, time to postoperative recovery of intestinal function, length of postoperative hospital stay, total medical expenses during hospitalization, and postoperative complications were compared between the two groups. Continuous data and categorical data were compared by t-test and χ2 test, respectively. ResultsAs compared with the control group, the FTS group had significantly time to postoperative recovery of intestinal function (t = 2.239, P = 0.045, a significantly shortened length of postoperative stay (t = 4.246, P = 0.038, and significantly reduced total medical expenses during hospitalization (t = 3.045, P = 0.033. No significant difference in postoperative complications was observed between the two groups (P>0.05. ConclusionThe concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrhosis, which can accelerate rehabilitation without increasing the risk of surgery.

  9. Introducing a music program in the perioperative area.

    Science.gov (United States)

    Cunningham, M F; Monson, B; Bookbinder, M

    1997-10-01

    Music can touch patients deeply and thus transform their anxiety and stress into relaxation and healing. Patients with cancer who undergo surgical procedures are highly stressed. To help alleviate these patients' stress and improve their comfort, perioperative nurses at Memorial Sloan-Kettering Cancer Center (MSKCC), New York, surveyed surgical patients and staff members about introducing a perioperative music program. This article reviews the literature on the use of music in perioperative care settings and describes MSKCC's decision to evaluate and then implement a music program.

  10. Risk reduction: perioperative smoking intervention

    DEFF Research Database (Denmark)

    Møller, Ann; Tønnesen, Hanne

    2006-01-01

    Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk...... of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual...... approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation...

  11. Perioperative nutritional support.

    Science.gov (United States)

    Morán López, Jesús Manuel; Piedra León, María; García Unzueta, María Teresa; Ortiz Espejo, María; Hernández González, Miriam; Morán López, Ruth; Amado Señaris, José Antonio

    2014-01-01

    The relationship between preoperative malnutrition and morbi-mortality has been documented for years. Despite the existence of tools that allow its detection, and therefore treat this entity, their introduction into clinical practice is not wide-spread. Both perioperative insulin resistance and hyperglycemia are associated with increased perioperative morbidity and length of hospital stay. The intake of carbohydrate-rich drinks 2-4h prior to surgery reduces insulin resistance. In the immediate postoperative period, the enteral route is safe and well tolerated and its early use reduces hospital stay and postoperative complications compared with parenteral nutritional support. Inmunonutrition has been proven effective to decrease postoperative complications and hospital stay. In view of these data we opted for the adoption of these measures replacing bowel rest and the indiscriminate use of postoperative parenteral nutrition. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  12. Burnout in perioperative context

    OpenAIRE

    Galvão, Ana Maria; Gonçalves, Ana Rita Veloso; Certo, Ana

    2014-01-01

    Companies in a global context are going through moments of great development of information and technologies. In these environments Burnout is highly prevalent, this syndrome is considered as one of physical and emotional stress that leads to a lack of motivation to work, leading to a progressive sense of inadequacy and failure. Objectives: What level of stress Perioperative nurses for nurses in the Region of Tras-os-Montes and Alto Douro. Methods: Non-experimental study,...

  13. Perioperative registered nurses knowledge, attitudes, behaviors, and barriers regarding pressure ulcer prevention in perioperative patients.

    Science.gov (United States)

    Tallier, Peggy C; Reineke, Patricia R; Asadoorian, Kathy; Choonoo, John G; Campo, Marc; Malmgreen-Wallen, Christine

    2017-08-01

    Hospital acquired pressure ulcers have a detrimental effect on patient quality of life, morbidity, mortality, and cost to the healthcare industry. Little is known about pressure ulcer prevention in perioperative services. The objectives of this study were to describe perioperative registered nurses (RNs) knowledge, attitudes, behaviors, and barriers about pressure ulcer prevention and to determine if knowledge and the availability of a pressure ulcer staging tool are predictors of pressure ulcer prevention behavior. A cross-sectional descriptive pilot study was conducted. Sixty-two perioperative RNs from 10 acute care hospitals participated. Perioperative nurses believed carrying out pressure ulcer prevention strategies is essential to nursing practice but only two-thirds reported conducting pressure ulcer risk assessment on all patients and daily assessment on at risk patients. Results indicated a knowledge deficit regarding assessment and prevention of pressure ulcers as performance on the PUKT (72%) fell below the recommended score of 90%. Results of binary logistic regression indicated that knowledge as measured by the PUKT and availability of a pressure ulcer staging tool were statistically significant (p=0.03) predictors of pressure ulcer prevention behavior. The initial model without the predictor variables, indicated an overall success rate of correct predictions of 64% which increase to 73% when the predictor variables were added to the initial model. Although perioperative nurses believe that pressure ulcer prevention is important, a knowledge deficit exists and there is a need for pressure ulcer prevention education. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. I need to know! Timely accessing of perioperative user manuals.

    Science.gov (United States)

    Landreneau, Raphael

    2010-12-01

    Ready access to equipment or product information is essential for the safe operation of the many items that a perioperative nurse is asked to use, troubleshoot, or maintain. One institution's solution for making manufacturer information available in the practice setting was to create a facility intranet site dedicated to OR equipment manuals. This site provides information access to perioperative nurses and support staff members and, ultimately, helps improve patient care. Published by Elsevier Inc. All rights reserved.

  15. Acceleration in the care of older adults: new demands as predictors of employee burnout and engagement.

    Science.gov (United States)

    Kubicek, Bettina; Korunka, Christian; Ulferts, Heike

    2013-07-01

    This paper introduces the concept of acceleration-related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well-being. Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration-related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job-related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well-being of employees. Survey. Between March-June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration-related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication). Hierarchical regression analyses show that acceleration-related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration-related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration-related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion. Results illustrate that new demands resulting from social acceleration generate potential challenges for on-the-job learning and potential risks to employees' health and well-being. © 2012 Blackwell Publishing Ltd.

  16. Accelerating a Network Model of Care: Taking a Social Innovation to Scale

    Directory of Open Access Journals (Sweden)

    Kerry Byrne

    2012-07-01

    Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

  17. Perioperative nursing for patients with diabetic foot receiving endovascular interventional therapy

    International Nuclear Information System (INIS)

    Yang Yang; Wang Feng; Li Ke; Li Cheng; Ji Donghua

    2010-01-01

    Objective: To study the effect of perioperative nursing on the living quality of patients with diabetic foot who are treated with endovascular interventional therapy. Methods: Specific perioperative nursing care plan was accordingly designed for 43 patients with diabetic foot. Endovascular balloon angioplasty and stent implantation were formed in these patients to treat their diabetic foot. The clinical results were observed. Results: Perioperative nursing effectively improved patient's limb blood supply, enhanced the healing of diabetic foot ulceration and increased the possibility of limb preservation. Conclusion: Endovascular therapy combined with corresponding perioperative nursing care can benefit more patients with diabetic foot. (authors)

  18. Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting.

    Science.gov (United States)

    O'Brien, Brid; Andrews, Tom; Savage, Eileen

    2018-01-01

    To explore and explain how nurses minimise risk in the perioperative setting. Perioperative nurses care for patients who are having surgery or other invasive explorative procedures. Perioperative care is increasingly focused on how to improve patient safety. Safety and risk management is a global priority for health services in reducing risk. Many studies have explored safety within the healthcare settings. However, little is known about how nurses minimise risk in the perioperative setting. Classic grounded theory. Ethical approval was granted for all aspects of the study. Thirty-seven nurses working in 11 different perioperative settings in Ireland were interviewed and 33 hr of nonparticipant observation was undertaken. Concurrent data collection and analysis was undertaken using theoretical sampling. Constant comparative method, coding and memoing and were used to analyse the data. Participants' main concern was how to minimise risk. Participants resolved this through engaging in anticipatory vigilance (core category). This strategy consisted of orchestrating, routinising and momentary adapting. Understanding the strategies of anticipatory vigilance extends and provides an in-depth explanation of how nurses' behaviour ensures that risk is minimised in a complex high-risk perioperative setting. This is the first theory situated in the perioperative area for nurses. This theory provides a guide and understanding for nurses working in the perioperative setting on how to minimise risk. It makes perioperative nursing visible enabling positive patient outcomes. This research suggests the need for training and education in maintaining safety and minimising risk in the perioperative setting. © 2017 John Wiley & Sons Ltd.

  19. Perioperative Management of Diabetes: A Review

    Directory of Open Access Journals (Sweden)

    Md Nazmul Kayes

    2014-07-01

    Full Text Available Diabetes increases the requirements of surgery as well as perioperative morbidity and mortality. Careful preoperative evaluation and treatment of cardiac and renal diseases, intensive intraoperative and postoperative management are essential to optimize the best outcome. Stress hyperglycemia in response to surgery, osmotic diuresis and hypoinsulinemia can lead to life threatening complications like ketoacidosis or hyperglycemic hyperosmolar syndrome. Wound healing is impaired by hyperglycemia and chance of postoperative wound infection is more in diabetics. Therefore aseptic precautions must be taken. Adequate insulin, glucose, fluid and electrolytes should be provided for good metabolic control. Though some current study reveals that oral hypoglycemic agents can be used for the effective management of perioperative diabetes; the adverse effects of newly introduced agents need more clinical observations. Subcutaneous administration of insulin as in Sliding Scale may be a less preferable method, because of unreliable absorption and unpredictable blood glucose. Intravenous administration of rapid onset soluble (short acting insulin as in Alberti (GIK regimen, is safe and effective method controlling perioperative hyperglycemia. Patient with type 1 diabetes needs frequent monitoring of glucose, electrolytes and acid-base balance as chance of high hyperglycemia and ketoacidosis is more. In case of emergency surgery assessment for diabetic ketoacidosis (DKA and meticulous management is essential. Postoperative pain and hyperglycemia should be treated carefully to avoid complications.

  20. Accelerated telomere shortening: Tracking the lasting impact of early institutional care at the cellular level.

    Science.gov (United States)

    Humphreys, Kathryn L; Esteves, Kyle; Zeanah, Charles H; Fox, Nathan A; Nelson, Charles A; Drury, Stacy S

    2016-12-30

    Studies examining the association between early adversity and longitudinal changes in telomere length within the same individual are rare, yet are likely to provide novel insight into the subsequent lasting effects of negative early experiences. We sought to examine the association between institutional care history and telomere shortening longitudinally across middle childhood and into adolescence. Buccal DNA was collected 2-4 times, between the ages of 6 and 15 years, in 79 children enrolled in the Bucharest Early Intervention Project (BEIP), a longitudinal study exploring the impact of early institutional rearing on child health and development. Children with a history of early institutional care (n=50) demonstrated significantly greater telomere shortening across middle childhood and adolescence compared to never institutionalized children (n=29). Among children with a history of institutional care, randomization to high quality foster care was not associated with differential telomere attrition across development. Cross-sectional analysis of children randomized to the care as usual group indicated shorter telomere length was associated with greater percent of the child's life spent in institutional care up to age 8. These results suggest that early adverse care from severe psychosocial deprivation may be embedded at the molecular genetic level through accelerated telomere shortening. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. The Ebola Spatial Care Path™: Accelerating point-of-care diagnosis, decision making, and community resilience in outbreaks.

    Science.gov (United States)

    Kost, Gerald J; Ferguson, William J; Hoe, Jackie; Truong, Anh-Thu; Banpavichit, Arirat; Kongpila, Surin

    2015-01-01

    To present a vision where point-of-care testing (POCT) accelerates an Ebola Spatial Care Path™ (SCP) and future molecular diagnostics enable facilitated-access self-testing (FAST POC); to design an alternate care facility (ACF) for the SCP; to innovate an Ebola diagnostic center (DC); and to propel rapid POCT to the frontline to create resilience that stops future outbreaks. PubMed, literature, and web searches. Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Medicine Without Frontiers, and World Health Organization (WHO) document analyses. Investigations in China, the Philippines, Thailand, and the United States. Review of SE Asia, US, and West Africa isolation-treatment centers. Innovation of a SCP, ACF, and DC suitable for American and other communities. The authors designed an ACF and DC to integrate SCP principles for urgent Ebola care. FDA emergency use authorizations for Ebola molecular diagnostics were discovered, but no portable, handheld, or self-contained molecular POC instruments are yet available, although feasible. The WHO initiated design criteria and an acceptance protocol for testing. Financial investment in POCT will downsize Ebola outbreaks. POCT is facilitating global health. Now, global health problems are elevating POCT to new levels of importance for accelerating diagnosis and evidence-based decision making during disease outbreaks. Authorities concur that rapid diagnosis has potential to stop disease spread. With embedded POCT, strategic SCPs planned by communities fulfill CDC recommendations. POC devices should consolidate multiplex test clusters supporting patients with Ebola in isolation. The ultimate future solution is FAST POC. New technologies offer minimally significant risks. Diagnostic centers in ACFs and transportable formats also will optimize Ebola SCPs.

  2. A 10-year review of perioperative complications in pharyngeal flap surgery

    NARCIS (Netherlands)

    Hofer, SOP; Dhar, BK; Robinson, PH; Goorhuis-Brouwer, SM; Nicolai, JPA

    2002-01-01

    A 10-year retrospective study was undertaken to investigate perioperative complications in pharyngeal flap surgery in one institution using inferiorly and superiorly based flaps. In this fashion the current practice of surgical technique based on local findings and perioperative care, through

  3. Optimizing perioperative decision making: improved information for clinical workflow planning.

    Science.gov (United States)

    Doebbeling, Bradley N; Burton, Matthew M; Wiebke, Eric A; Miller, Spencer; Baxter, Laurence; Miller, Donald; Alvarez, Jorge; Pekny, Joseph

    2012-01-01

    Perioperative care is complex and involves multiple interconnected subsystems. Delayed starts, prolonged cases and overtime are common. Surgical procedures account for 40-70% of hospital revenues and 30-40% of total costs. Most planning and scheduling in healthcare is done without modern planning tools, which have potential for improving access by assisting in operations planning support. We identified key planning scenarios of interest to perioperative leaders, in order to examine the feasibility of applying combinatorial optimization software solving some of those planning issues in the operative setting. Perioperative leaders desire a broad range of tools for planning and assessing alternate solutions. Our modeled solutions generated feasible solutions that varied as expected, based on resource and policy assumptions and found better utilization of scarce resources. Combinatorial optimization modeling can effectively evaluate alternatives to support key decisions for planning clinical workflow and improving care efficiency and satisfaction.

  4. Perioperative management of children with obstructive sleep apnea.

    Science.gov (United States)

    Schwengel, Deborah A; Sterni, Laura M; Tunkel, David E; Heitmiller, Eugenie S

    2009-07-01

    Obstructive sleep apnea syndrome (OSA) affects 1%-3% of children. Children with OSA can present for all types of surgical and diagnostic procedures requiring anesthesia, with adenotonsillectomy being the most common surgical treatment for OSA in the pediatric age group. Thus, it is imperative that the anesthesiologist be familiar with the potential anesthetic complications and immediate postoperative problems associated with OSA. The significant implications that the presence of OSA imposes on perioperative care have been recognized by national medical professional societies. The American Academy of Pediatrics published a clinical practice guideline for pediatric OSA in 2002, and cited an increased risk of anesthetic complications, though specific anesthetic issues were not addressed. In 2006, the American Society of Anesthesiologists published a practice guideline for perioperative management of patients with OSA that noted the pediatric-related risk factor of obesity, and the increased perioperative risk associated with adenotonsillectomy in children younger than 3 yr. However, management of OSA in children younger than 1 yr-of-age was excluded from the guideline, as were other issues related specifically to the pediatric patient. Hence, many questions remain regarding the perioperative care of the child with OSA. In this review, we examine the literature on pediatric OSA, discuss its pathophysiology, current treatment options, and recognized approaches to perioperative management of these young and potentially high-risk patients.

  5. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  6. Melatonin in perioperative medicine: Current perspective

    Directory of Open Access Journals (Sweden)

    Souvik Maitra

    2013-01-01

    Full Text Available Melatonin, a new addition to the armamentarium of anesthesiologist, has some unique properties that are highly desirable in routine peri-operative care. Available clinical data show that preoperative melatonin is as effective as benzodiazepines in reducing preoperative anxiety with minimal action on psychomotor performance and sleep wake cycle. It may be considered as a safe and effective alternative of benzodiazepines as preoperative anxiolytic. It may have opioid sparing effect, may reduce intraocular pressure, and have role in prevention of postoperative delirium. The short-term administration of melatonin is free from significant adverse effects also.

  7. Patient satisfaction with the perioperative surgical services and ...

    African Journals Online (AJOL)

    Introduction: Globally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients' ...

  8. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    Science.gov (United States)

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  9. Perioperative Management of a Patient with Cold Urticaria

    Directory of Open Access Journals (Sweden)

    Priscilla Agbenyefia

    2017-12-01

    Full Text Available Cold urticaria consists of an allergic immune response to cold temperatures with symptoms ranging from pruritic wheals to life-threatening angioedema, bronchospasm, or anaphylactic shock. Adequate planning to maintain normothermia perioperatively is vital due to impaired hypothalamic thermoregulation and overall depression of sympathetic outflow during deep sedation and general anesthesia. This case report describes the successful perioperative management of a 45-year-old female with a history of cold urticaria undergoing a laparoscopic Nissen fundoplication for refractory gastroesophageal reflux disease and discusses how to appropriately optimize the care of these patients.

  10. A Novel Process Audit for Standardized Perioperative Handoff Protocols.

    Science.gov (United States)

    Pallekonda, Vinay; Scholl, Adam T; McKelvey, George M; Amhaz, Hassan; Essa, Deanna; Narreddy, Spurthy; Tan, Jens; Templonuevo, Mark; Ramirez, Sasha; Petrovic, Michelle A

    2017-11-01

    A perioperative handoff protocol provides a standardized delivery of communication during a handoff that occurs from the operating room to the postanestheisa care unit or ICU. The protocol's success is dependent, in part, on its continued proper use over time. A novel process audit was developed to help ensure that a perioperative handoff protocol is used accurately and appropriately over time. The Audit Observation Form is used for the Audit Phase of the process audit, while the Audit Averages Form is used for the Data Analysis Phase. Employing minimal resources and using quantitative methods, the process audit provides the necessary means to evaluate the proper execution of any perioperative handoff protocol. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  11. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries

    DEFF Research Database (Denmark)

    Lassen, K; Hannemann, P; Ljungqvist, O

    2005-01-01

    Evidence for optimal perioperative care in colorectal surgery is abundant. By avoiding fasting, intravenous fluid overload, and activation of the neuroendocrine stress response, postoperative catabolism is reduced and recovery enhanced. The specific measures that can be used routinely include no ...

  12. Perioperative nurses' attitudes toward the electronic health record.

    Science.gov (United States)

    Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

    2015-02-01

    The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  13. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial.

    NARCIS (Netherlands)

    Meij, E.; Huirne, J.A.F.; Bouwsma, E.V.A.; van Dongen, J.M.; Terwee, Caroline B; van de Ven, P.M.; Bakker, C.M.; van der Meij, S.; van Baal, W.M.; Leclercq, W.K.G.; Geomini, P.M.; Consten, E.C.; Schraffordt Koops, S.E.; van Kesteren, P.J.; Stockmann, H.B.; Ten Cate, A.D.; Davids, P.H.P.; Scholten, P.C.; van den Heuvel, B.; Schaafsma, Frederieke G.; Meijerink, W.J.; Bonjer, H.J.; Anema, J.R.

    2016-01-01

    BACKGROUND: Due to the strong reduction in the length of hospital stays in the last decade, the period of in-hospital postoperative care is limited. After discharge from the hospital, guidance and monitoring on recovery and resumption of (work) activities are usually not provided. As a consequence,

  14. Perioperative lung protective ventilation in obese patients.

    Science.gov (United States)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-05-06

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity.

  15. Levosimendan for Perioperative Cardioprotection: Myth or Reality?

    Science.gov (United States)

    Santillo, Elpidio; Migale, Monica; Massini, Carlo; Incalzi, Raffaele Antonelli

    2018-03-21

    Levosimendan is a calcium sensitizer drug causing increased contractility in the myocardium and vasodilation in the vascular system. It is mainly used for the therapy of acute decompensated heart failure. Several studies on animals and humans provided evidence of the cardioprotective properties of levosimendan including preconditioning and anti-apoptotic. In view of these favorable effects, levosimendan has been tested in patients undergoing cardiac surgery for the prevention or treatment of low cardiac output syndrome. However, initial positive results from small studies have not been confirmed in three recent large trials. To summarize levosimendan mechanisms of action and clinical use and to review available evidence on its perioperative use in cardiac surgery setting. We searched two electronic medical databases for randomized controlled trials studying levosimendan in cardiac surgery patients, ranging from January 2000 to August 2017. Meta-analyses, consensus documents and retrospective studies were also reviewed. In the selected interval of time, 54 studies on the use of levosimendan in heart surgery have been performed. Early small size studies and meta-analyses have suggested that perioperative levosimendan infusion could diminish mortality and other adverse outcomes (i.e. intensive care unit stay and need for inotropic support). Instead, three recent large randomized controlled trials (LEVO-CTS, CHEETAH and LICORN) showed no significant survival benefits from levosimendan. However, in LEVO-CTS trial, prophylactic levosimendan administration significantly reduced the incidence of low cardiac output syndrome. Based on most recent randomized controlled trials, levosimendan, although effective for the treatment of acute heart failure, can't be recommended as standard therapy for the management of heart surgery patients. Further studies are needed to clarify whether selected subgroups of heart surgery patients may benefit from perioperative levosimendan

  16. Perioperative pharmacokinetics of methadone in adolescents.

    Science.gov (United States)

    Sharma, Anshuman; Tallchief, Danielle; Blood, Jane; Kim, Thomas; London, Amy; Kharasch, Evan D

    2011-12-01

    Methadone is frequently administered to adults experiencing anesthesia and receiving pain treatment. Methadone pharmacokinetics in adults are well characterized, including the perioperative period. Methadone is also used in children. There is, however, no information on methadone pharmacokinetics in children of any age. The purpose of this investigation was to determine the pharmacokinetics of intravenous methadone in children undergoing surgery. Perioperative opioid-sparing effects were also assessed. Eligible subjects were children 5-18 yr undergoing general anesthesia and surgery, with an anticipated postoperative inpatient stay exceeding 3 days. Three groups of 10 to 11 patients each received intravenous methadone hydrochloride after anesthetic induction in ascending dose groups of 0.1, 0.2, and 0.3 mg/kg (up to 20 mg). Anesthetic care was not otherwise changed. Venous blood was obtained for 4 days, for stereoselective determination of methadone and metabolites. Pain assessments were made each morning. Daily and total opioid consumption was determined. Perioperative opioid consumption and pain was determined in a second cohort, which was matched to age, sex, race, ethnicity, surgical procedure, and length of stay, but not receiving methadone. The final methadone study cohort was 31 adolescents (14 ± 2 yr, range 10-18) undergoing major spine surgery for a diagnosis of scoliosis. Methadone pharmacokinetics were linear over the dose range 0.1-0.3 mg/kg. Disposition was stereoselective. Methadone administration did not dose-dependently affect postoperative pain scores, and did not dose-dependently decrease daily or total postoperative opioid consumption in spinal fusion patients. Methadone enantiomer disposition in adolescents undergoing surgery was similar to that in healthy adults.

  17. Multicentre trial of a perioperative protocol to reduce mortality in patients with peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, M H; Adamsen, S; Thomsen, R W

    2011-01-01

    Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU.......Morbidity and mortality rates in patients with perforated peptic ulcer (PPU) remain substantial. The aim of the present study was to evaluate the effect of a multimodal and multidisciplinary perioperative care protocol on mortality in patients with PPU....

  18. Perioperative management of facial bipartition surgery

    Directory of Open Access Journals (Sweden)

    Caruselli M

    2015-11-01

    Full Text Available Marco Caruselli,1 Michael Tsapis,1,2 Fabrice Ughetto,1 Gregoire Pech-Gourg,3 Dario Galante,4 Olivier Paut1 1Anesthesia and Intensive Care Unit, La Timone Children’s Hospital, 2Pediatric Transport Team, SAMU 13, La Timone Hospital, 3Pediatric Neurosurgery Unit, La Timone Children’s Hospital, Marseille, France; 4Anesthesia and Intensive Care Unit, University Hospital Ospedali Riuniti of Foggia, Foggia, Italy Abstract: Severe craniofacial malformations, such as Crouzon, Apert, Saethre-Chotzen, and Pfeiffer syndromes, are very rare conditions (one in 50,000/100,000 live births that often require corrective surgery. Facial bipartition is the more radical corrective surgery. It is a high-risk intervention and needs complex perioperative management and a multidisciplinary approach. Keywords: craniofacial surgery, facial bipartition surgery, craniofacial malformations, pediatric anesthesia

  19. Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

    Science.gov (United States)

    Rudolfsson, Gudrun

    2014-08-01

    The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study. © 2013 Wiley Publishing Asia Pty Ltd.

  20. The Role of Emotional Intelligence in Perioperative Nursing and Leadership: Developing Skills for Improved Performance.

    Science.gov (United States)

    Beydler, Kathy Williams

    2017-10-01

    Many responsibilities of perioperative professionals involve concrete tasks that require high technical competence. Emotional intelligence, referred to as EQ, which involves the ability to relate to and influence others, may also be important for perioperative professionals. High EQ has been linked to higher performance in the workplace, higher job satisfaction, lower turnover intentions, and less burnout. Perioperative professionals who demonstrate a combination of technical skills and EQ could be more attuned to the humanity of health care (ie, providing more holistic care for the patient). Perioperative nurses who value providing holistic care for their patients may possess many of the elements of EQ. Leaders who recognize the importance of their own EQ and actively assist staff members to enhance and develop their EQ competency may help to create a competitive advantage by establishing a workforce of nurses who possess strong technical skills and high EQ. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  1. Avaliação perioperatória de pacientes em unidade de terapia intensiva Perioperative assessment of the patients in intensive care unit

    Directory of Open Access Journals (Sweden)

    Stelma Regina Sodré Pontes

    2013-04-01

    Full Text Available OBJETIVO: Avaliar as condições pré-operatórias e o procedimento cirúrgico relacionando-os à morbidade e mortalidade de pacientes cirúrgicos em uma unidade de terapia intensiva geral de um hospital universitário. MÉTODOS: Foram estudados os prontuários de pacientes submetidos a procedimentos cirúrgicos de médio e grande porte, admitidos na unidade de terapia intensiva geral. Foram analisados: dados demográficos, quadro clínico, registros de antecedentes pessoais e exames laboratoriais pré-operatórios e de admissão na unidade de terapia intensiva, exames de imagem, relato operatório, boletim anestésico e antibioticoprofilaxia. Após a admissão, as variáveis estudadas foram: tempo de internação, tipo de suporte nutricional, utilização de tromboprofilaxia, necessidade de ventilação mecânica, descrição de complicações e mortalidade. RESULTADOS: Foram analisados 130 prontuários. A mortalidade foi 23,8% (31 pacientes; Apache II maior do que 40 foi observado em 57 pacientes submetidos à operação de grande porte (64%; a classificação ASA e" II foi observada em 16 pacientes que morreram (51,6%; o tempo de permanência na unidade de terapia intensiva variou de um a nove dias e foi observado em 70 pacientes submetidos à cirurgia de grande porte (78,5%; a utilização da ventilação mecânica por até cinco dias foi observada em 36 pacientes (27,7%; hipertensão arterial sistêmica foi observada em 47 pacientes (47,4%; a complicação mais frequente foi a sepse. CONCLUSÃO: a correta estratificação do paciente cirúrgico determina sua alta precoce e menor exposição a riscos aleatóriosOBJECTIVE: To evaluate the preoperative condition and the surgical procedure of surgical patients in a general intensive care unit of a university hospital, relating them to morbidity and mortality. METHODS: We studied the medical records of patients undergoing medium and large surgical procedures, admitted to the general intensive

  2. "Leading Better Care": An evaluation of an accelerated coaching intervention for clinical nursing leadership development.

    Science.gov (United States)

    Cable, Stuart; Graham, Edith

    2018-03-30

    Outcomes of an accelerated co-active coaching intervention for senior clinical nursing leadership development. Co-active coaching is characterized by a whole person approach, commitment to deep learning and conscious action through supportive compassionate and courageous coach-coachee partnership. The national leadership capabilities framework, "Step into Leadership", was used for development and evaluation. 116 senior clinical nurse leaders attended one face-to-face induction day and received a total of 3 hours of one-to-one telephone coaching and two virtual peer group facilitated sessions. Evaluation used primarily qualitative descriptive methods with iterative review of emerging themes. Capability mapping indicated self-leadership development as the most frequently cited need. Improvements in self-confidence, capacity for reflection and bringing whole self into the work were reported to deliver enhancement in team and service performance. Co-active coaching supported deep analysis by individuals. Focus on self, rather than behaviours provoked reflection on perspectives, mindsets, beliefs and approaches which can lead to more sustainable behaviour and support service change. Investment in a co-active coaching approach offers bespoke support for clinical leaders to develop self-leadership capability, a precursor to delivering positive impacts on care. © 2018 John Wiley & Sons Ltd.

  3. Perioperative Management of Sickle Cell Disease.

    Science.gov (United States)

    Adjepong, Kwame Ofori; Otegbeye, Folashade; Adjepong, Yaw Amoateng

    2018-01-01

    Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  4. Supply chain optimization for pediatric perioperative departments.

    Science.gov (United States)

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  5. Effectiveness of combined laser-puncture and conventional wound care to accelerate diabetic foot ulcer healing

    Directory of Open Access Journals (Sweden)

    Adiningsih Srilestari

    2017-05-01

    Full Text Available Background: Impaired wound healing is a common complication of diabetes. It has complex pathophysiologic mechanisms and often necessitates amputation. Our study aimed to evaluate the effectiveness of combined laser-puncture and conventional wound care in the treatment of diabetic foot ulcers.Methods: This was a double-blind controlled randomized clinical trial on 36 patients, conducted at the Metabolic Endocrine Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, between May and August 2015. Stimulation by laser-puncture (the treatment group or sham stimulation (the control group were performed on top of the standard wound care. Laser-puncture or sham were done on several acupuncture points i.e. LI4 Hegu, ST36 Zusanli, SP6 Sanyinjiao and KI3 Taixi bilaterally, combined with irradiation on the ulcers itself twice a week for four weeks. The mean reduction in ulcer sizes (week 2–1, week 3–1, week 4–1 were measured every week and compared between the two groups and analyzed by Mann-Whitney test.Results: The initial median ulcer size were 4.75 (0.10–9.94 cm2 and 2.33 (0.90–9.88 cm2 in laser-puncture and sham groups, respectively (p=0.027. The median reduction of ulcer size at week 2–1 was -1.079 (-3.25 to -0.09 vs -0.36 (-0.81 to -1.47 cm2, (p=0.000; at week 3–1 was -1.70 (-3.15 to -0.01 vs -0.36 (-0.80 to -0.28 cm2, (p=0.000; and at week 4–1 was -1.22 (-2.72 to 0.00 vs -0.38 (-0.74 to -0.57 cm2, (p=0.012.Conclusion: Combined laser-puncture and conventional wound care treatment are effective in accelerating the healing of diabetic foot ulcer.

  6. Born Too Soon: Accelerating actions for prevention and care of 15 million newborns born too soon

    Science.gov (United States)

    2013-01-01

    Preterm birth complication is the leading cause of neonatal death resulting in over one million deaths each year of the 15 million babies born preterm. To accelerate change, we provide an overview of the comprehensive strategy required, the tools available for context-specific health system implementation now, and the priorities for research and innovation. There is an urgent need for action on a dual track: (1) through strategic research to advance the prevention of preterm birth and (2) improved implementation and innovation for care of the premature neonate. We highlight evidence-based interventions along the continuum of care, noting gaps in coverage, quality, equity and implications for integration and scale up. Improved metrics are critical for both burden and tracking programmatic change. Linked to the United Nation's Every Women Every Child strategy, a target was set for 50% reduction in preterm deaths by 2025. Three analyses informed this target: historical change in high income countries, recent progress in best performing countries, and modelling of mortality reduction with high coverage of existing interventions. If universal coverage of selected interventions were to be achieved, then 84% or more than 921,000 preterm neonatal deaths could be prevented annually, with antenatal corticosteroids and Kangaroo Mother Care having the highest impact. Everyone has a role to play in reaching this target including government leaders, professionals, private sector, and of course families who are affected the most and whose voices have been critical for change in many of the countries with the most progress. Declaration This article is part of a supplement jointly funded by Save the Children's Saving Newborn Lives programme through a grant from The Bill & Melinda Gates Foundation and March of Dimes Foundation and published in collaboration with the Partnership for Maternal, Newborn and Child Health and the World Health Organization (WHO). The original article was

  7. Rhinoplasty perioperative database using a personal digital assistant.

    Science.gov (United States)

    Kotler, Howard S

    2004-01-01

    To construct a reliable, accurate, and easy-to-use handheld computer database that facilitates the point-of-care acquisition of perioperative text and image data specific to rhinoplasty. A user-modified database (Pendragon Forms [v.3.2]; Pendragon Software Corporation, Libertyville, Ill) and graphic image program (Tealpaint [v.4.87]; Tealpaint Software, San Rafael, Calif) were used to capture text and image data, respectively, on a Palm OS (v.4.11) handheld operating with 8 megabytes of memory. The handheld and desktop databases were maintained secure using PDASecure (v.2.0) and GoldSecure (v.3.0) (Trust Digital LLC, Fairfax, Va). The handheld data were then uploaded to a desktop database of either FileMaker Pro 5.0 (v.1) (FileMaker Inc, Santa Clara, Calif) or Microsoft Access 2000 (Microsoft Corp, Redmond, Wash). Patient data were collected from 15 patients undergoing rhinoplasty in a private practice outpatient ambulatory setting. Data integrity was assessed after 6 months' disk and hard drive storage. The handheld database was able to facilitate data collection and accurately record, transfer, and reliably maintain perioperative rhinoplasty data. Query capability allowed rapid search using a multitude of keyword search terms specific to the operative maneuvers performed in rhinoplasty. Handheld computer technology provides a method of reliably recording and storing perioperative rhinoplasty information. The handheld computer facilitates the reliable and accurate storage and query of perioperative data, assisting the retrospective review of one's own results and enhancement of surgical skills.

  8. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

    Directory of Open Access Journals (Sweden)

    Polderman JAW

    2016-05-01

    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  9. Vasopressin in perioperative management of congenital ...

    African Journals Online (AJOL)

    Annals of Pediatric Surgery ... Oxygenation failure, pulmonary hypertension and refractory systemic hypotension in infants with ... managing pulmonary and systemic perioperative haemodynamic instability in infants with diaphragmatic hernia.

  10. Universal definition of perioperative bleeding in adult cardiac surgery

    NARCIS (Netherlands)

    Dyke, Cornelius; Aronson, Solomon; Dietrich, Wulf; Hofmann, Axel; Karkouti, Keyvan; Levi, Marcel; Murphy, Gavin J.; Sellke, Frank W.; Shore-Lesserson, Linda; von Heymann, Christian; Ranucci, Marco

    2014-01-01

    Perioperative bleeding is common among patients undergoing cardiac surgery; however, the definition of perioperative bleeding is variable and lacks standardization. We propose a universal definition for perioperative bleeding (UDPB) in adult cardiac surgery in an attempt to precisely describe and

  11. Effects of perioperative briefing and debriefing on patient safety: a prospective intervention study.

    Science.gov (United States)

    Leong, Katharina Brigitte Margarethe Siew Lan; Hanskamp-Sebregts, Mirelle; van der Wal, Raymond A; Wolff, Andre P

    2017-12-14

    This study was carried out to improve patient safety in the operating theatre by the introduction of perioperative briefing and debriefing, which focused on an optimal collaboration between surgical team members. A prospective intervention study with one pretest and two post-test measurements: 1 month before and 4 months and 2.5 years after the implementation of perioperative briefing and debriefing, respectively. Operating theatres of a tertiary care hospital with 875 beds in the Netherlands. All members of five surgical teams participated in the perioperative briefing and debriefing. The implementation of perioperative briefing and debriefing from July 2012 to January 2014. The primary outcome was changes in the team climate, measured by the Team Climate Inventory. Secondary outcomes were the experiences of surgical teams with perioperative briefing and debriefing, measured with a structured questionnaire, and the duration of the briefings, measured by an independent observer. Two and a half years after the introduction of perioperative briefing and debriefing, the team climate increased statistically significant (p≤0.05). Members of the five surgical teams strongly agreed with the positive influence of perioperative briefing and debriefing on clear agreements and reminding one another of the agreements of the day. They perceived a higher efficiency of the surgical programme with more operations starting on time and less unexpectedly long operation time. The perioperative briefing took less than 4 min to conduct. Perioperative briefing and debriefing improved the team climate of surgical teams and the efficiency of their work within the operating theatre with acceptable duration per briefing. Surgical teams with alternating team compositions have the most benefit of briefing and debriefing. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise

  12. Innovative care models for high-cost Medicare beneficiaries: delivery system and payment reform to accelerate adoption.

    Science.gov (United States)

    Davis, Karen; Buttorff, Christine; Leff, Bruce; Samus, Quincy M; Szanton, Sarah; Wolff, Jennifer L; Bandeali, Farhan

    2015-05-01

    About a third of Medicare beneficiaries are covered by Medicare Advantage (MA) plans or accountable care organizations (ACOs). As a result of assuming financial risk for Medicare services and/or being eligible for shared savings, these organizations have an incentive to adopt models of delivering care that contribute to better care, improved health outcomes, and lower cost. This paper identifies innovative care models across the care continuum for high-cost Medicare beneficiaries that MA plans and ACOs could adopt to improve care while potentially achieving savings. It suggests policy changes that would accelerate testing and spread of promising care delivery model innovations. Targeted review of the literature to identify care delivery models focused on high-cost or high-risk Medicare beneficiaries. This paper presents select delivery models for high-risk Medicare beneficiaries across the care continuum that show promise of yielding better care at lower cost that could be considered for adoption by MA plans and ACOs. Common to these models are elements of the Wagner Chronic Care Model, including practice redesign to incorporate a team approach to care, the inclusion of nonmedical personnel, efforts to promote patient engagement, supporting provider education on innovations,and information systems allowing feedback of information to providers. The goal of these models is to slow the progression to long-term care, reduce health risks, and minimize adverse health impacts, all while achieving savings.These models attempt to maintain the ability of high-risk individuals to live in the home or a community-based setting, thereby avoiding costly institutional care. Identifying and implementing promising care delivery models will become increasingly important in launching successful population health initiatives. MA plans and ACOs stand to benefit financially from adopting care delivery models for high-risk Medicare beneficiaries that reduce hospitalization. Spreading

  13. Perioperative management of gastrostomy tube placement in Duchenne muscular dystrophy adolescent and young adult patients: A role for a perioperative surgical home.

    Science.gov (United States)

    Boivin, Ariane; Antonelli, Richard; Sethna, Navil F

    2018-02-01

    In past decades, Duchenne muscular dystrophy patients have been living longer and as the disease advances, patients experience multisystemic deterioration. Older patients often require gastrostomy tube placement for nutritional support. For optimizing the perioperative care, a practice of multidisciplinary team can better anticipate, prevent, and manage possible complications and reduce the overall perioperative morbidity and mortality. The aim of this study was to review our experience with perioperative care of adolescent and young adults with Duchenne muscular dystrophy undergoing gastrostomy by various surgical approaches in order to identify challenges and improve future perioperative care coordination to reduce morbidity. We retrospectively examined cases of gastrostomy tube placement in patients of ages 15 years and older between 2005 and 2016. We reviewed preoperative evaluation, anesthetic and surgical management, and postoperative complications. Twelve patients were identified; 1 had open gastrostomy, 3 laparoscopic gastrostomies, 5 percutaneous endoscopic guided, and 3 radiologically inserted gastrostomy tubes. All patients had preoperative cardiac evaluation with 6 patients demonstrating cardiomyopathy. Nine patients had preoperative pulmonary consultations and the pulmonary function tests reported forced vital capacity of ≤36% of predicted. Eight patients were noninvasive positive pressure ventilation dependent. General anesthesia with tracheal intubation was administered in 8 patients, and intravenous sedation in 4 patients; 1 received sedation supplemented with regional anesthesia and 3 received deep sedation. One patient had a difficult intubation that resulted in trauma and prolonged tracheal intubation. Three patients developed postoperative respiratory complications. Two patients' procedures were postponed due to inadequate preoperative evaluation and 1 because of disagreement between anesthesia and procedural services as to the optimal

  14. Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital.

    Science.gov (United States)

    Walters, Tessa L; Howard, Steven K; Kou, Alex; Bertaccini, Edward J; Harrison, T Kyle; Kim, T Edward; Shafer, Audrey; Brun, Carlos; Funck, Natasha; Siegel, Lawrence C; Stary, Erica; Mariano, Edward R

    2016-06-01

    The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement. © The Author(s) 2015.

  15. Perioperative corticosteroids for intermittent and mild persistent asthma

    Directory of Open Access Journals (Sweden)

    Hiroto Matsuse

    2002-01-01

    Conclusions: Our results suggest that perioperative corticosteroids are effective in preventing perioperative bronchospasm in stable asthmatics during surgery under general anesthesia by suppressing airway hyperresponsiveness.

  16. Statins and perioperative myocardial infarction. | Levin | Southern ...

    African Journals Online (AJOL)

    The growing prevalence of atherosclerosis means that perioperative myocardial infarction (PMI) is of significant concern to anesthesiologists. Perioperative revascularization (if indicated medically), beta blockade (in high risk patients) and statin therapy are therapeutic modalities that are currently employed to reduce PMI.

  17. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

    Science.gov (United States)

    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (pdiagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (pdiagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (pdiagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), pdiagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  18. Perioperative aspirin and clonidine and risk of acute kidney injury

    DEFF Research Database (Denmark)

    Garg, Amit X; Kurz, Andrea; Sessler, Daniel I

    2014-01-01

    IMPORTANCE: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain...... and each intervention has the potential for harm. OBJECTIVE: To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. DESIGN, SETTING, AND PARTICIPANTS: A 2 × 2 factorial randomized, blinded, clinical trial of 6905...... patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. INTERVENTIONS: Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days...

  19. Emerging Risk Factors and Prevention of Perioperative Pulmonary Complications

    Directory of Open Access Journals (Sweden)

    Priyanka Bhateja

    2014-01-01

    Full Text Available Modern surgery is faced with the emergence of newer “risk factors” and the challenges associated with identifying and managing these risks in the perioperative period. Obstructive sleep apnea and obesity hypoventilation syndrome pose unique challenges in the perioperative setting. Recent studies have identified some of the specific risks arising from caring for such patients in the surgical setting. While all possible postoperative complications are not yet fully established or understood, the prevention and management of these complications pose even greater challenges. Pulmonary hypertension with its changing epidemiology and novel management strategies is another new disease for the surgeon and the anesthesiologist in the noncardiac surgical setting. Traditionally most such patients were not considered surgical candidates for any required elective surgery. Our review discusses these disease entities which are often undiagnosed before elective noncardiac surgery.

  20. Innovating in Health Care Management Education: Development of an Accelerated MBA and MPH Degree Program at Yale

    Science.gov (United States)

    Forman, Howard P.; Pistell, Anne F.; Nembhard, Ingrid M.

    2015-01-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges. PMID:25706023

  1. Innovating in health care management education: development of an accelerated MBA and MPH degree program at Yale.

    Science.gov (United States)

    Pettigrew, Melinda M; Forman, Howard P; Pistell, Anne F; Nembhard, Ingrid M

    2015-03-01

    Increasingly, there is recognition of the need for individuals with expertise in both management and public health to help health care organizations deliver high-quality and cost-effective care. The Yale School of Public Health and Yale School of Management began offering an accelerated Master of Business Administration (MBA) and Master of Public Health (MPH) joint degree program in the summer of 2014. This new program enables students to earn MBA and MPH degrees simultaneously from 2 fully accredited schools in 22 months. Students will graduate with the knowledge and skills needed to become innovative leaders of health care organizations. We discuss the rationale for the program, the developmental process, the curriculum, benefits of the program, and potential challenges.

  2. Multidisciplinary Point-of-Care Testing in South African Primary Health Care Clinics Accelerates HIV ART Initiation but Does Not Alter Retention in Care.

    Science.gov (United States)

    Stevens, Wendy S; Gous, Natasha M; MacLeod, William B; Long, Lawrence C; Variava, Ebrahim; Martinson, Neil A; Sanne, Ian; Osih, Regina; Scott, Lesley E

    2017-09-01

    Lack of accessible laboratory infrastructure limits HIV antiretroviral therapy (ART) initiation, monitoring, and retention in many resource-limited settings. Point-of-care testing (POCT) is advocated as a mechanism to overcome these limitations. We executed a pragmatic, prospective, randomized, controlled trial comparing the impact of POCT vs. standard of care (SOC) on treatment initiation and retention in care. Selected POC technologies were embedded at 3 primary health clinics in South Africa. Confirmed HIV-positive participants were randomized to either SOC or POC: SOC participants were venesected and specimens referred to the laboratory with patient follow-up as per algorithm (∼3 visits); POC participants had phlebotomy and POCT immediately on-site using Pima CD4 to assess ART eligibility followed by hematology, chemistry, and tuberculosis screening with the goal of receiving same-day adherence counseling and treatment initiation. Participant outcomes measured at recruitment 6 and 12 months after initiation. Four hundred thirty-two of 717 treatment eligible participants enrolled between May 2012 and September 2013: 198 (56.7%) SOC; 234 (63.6%) POC. Mean age was 37.4 years; 60.5% were female. Significantly more participants were initiated using POC [adjusted prevalence ratio (aPR) 0.83; 95% confidence interval (CI): 0.74 to 0.93; P ART was similar for both arms at 6 months (47 vs. 50%) (aPR 0.96; 95% CI: 0.79 to 1.16) and 12 months (32 vs. 32%) (aPR 1.05; 95% CI: 0.80 to 1.38), with similar mortality rates. Loss to follow-up at 12 months was higher for POC (36% vs. 51%) (aPR 0.82; 95% CI: 0.65 to 1.04). Adoption of POCT accelerated ART initiation but once on treatment, there was unexpectedly higher loss to follow-up on POC and no improvement in outcomes at 12 months over SOC.

  3. Perioperative drug management. Reduction of potential drug-related problems in patients undergoing orthopaedic surgery by perioperative participation of a hospital pharmacist

    NARCIS (Netherlands)

    Duyvendak, M.; Bosman, J.; Klopotowska, J.; Kuiper-Herder, A.J.; Van Roon, E.N.; Brouwers, J.R.B.J.

    2007-01-01

    Objective: Drug management in the perioperative period is complex. Only little is known about the effects of clinical pharmaceutical care in this setting. The aim of this study was to determine the effect of a clinical pharmacy-based intervention on the number of potential drug-related problems in

  4. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  5. Update on perioperative management of the child with asthma

    Directory of Open Access Journals (Sweden)

    Francesco Dones

    2012-04-01

    Full Text Available Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

  6. Optimal glucose management in the perioperative period.

    Science.gov (United States)

    Evans, Charity H; Lee, Jane; Ruhlman, Melissa K

    2015-04-01

    Hyperglycemia is a common finding in surgical patients during the perioperative period. Factors contributing to poor glycemic control include counterregulatory hormones, hepatic insulin resistance, decreased insulin-stimulated glucose uptake, use of dextrose-containing intravenous fluids, and enteral and parenteral nutrition. Hyperglycemia in the perioperative period is associated with increased morbidity, decreased survival, and increased resource utilization. Optimal glucose management in the perioperative period contributes to reduced morbidity and mortality. To readily identify hyperglycemia, blood glucose monitoring should be instituted for all hospitalized patients. Published by Elsevier Inc.

  7. Development of free electron laser and accelerator technology in Poland (CARE and EuCARD projects)

    CERN Document Server

    Romaniuk, Ryszard

    2009-01-01

    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financing solution has to be implemented in Poland, where a scientific and political campaign is underway on behalf of building two big machines, a Polish Synchrotron in Kraków and a Polish FEL in Świerk. Around these two projects, there are realized a dozen or so smaller ones.

  8. Development of accelerator technology in Poland, Impact of European CARE and EuCARD projects

    CERN Document Server

    Romaniuk, R

    2008-01-01

    The development of accelerator technology in Poland is strictly combined with the cooperation with specialist accelerator centers of global character, where the relevant knowledge is generated, allowing to build big and modern machines. These are relatively costly undertakings of interdisciplinary character. Most of them are financed from the local resources. Only the biggest machines are financed commonly by many nations like: LHC in CERN, ILC in Fermi Lab, E-XFEL in DESY. A similar financing solution has to be implemented in Poland, where a scientific and political campaign is underway on behalf of building two big machines, a Polish Synchrotron in Kraków and a Polish FEL in Świerk. Around these two projects, there are realized a dozen or so smaller ones.

  9. Evidence utilisation project: Management of inadvertent perioperative hypothermia. The challenges of implementing best practice recommendations in the perioperative environment.

    Science.gov (United States)

    Munday, Judy; Hines, Sonia Jane; Chang, Anne M

    2013-12-01

    The prevention of inadvertent perioperative hypothermia (IPH) remains an important issue in perioperative healthcare. The aims of this project were to: (i) assess current clinical practice in the management of IPH and (ii) promote best practice in the management of IPH in adult operating theatres. This project from August 2010 to March 2012 utilised a system of audit and feedback to implement best practice recommendations. Data were collected via chart audits against criteria developed from best practice recommendations for managing IPH. Evidence-based best practices, such as consistent temperature monitoring and patient warming, were implemented using multifaceted interventions. Perioperative records for 73 patients (baseline) and 72 patients (post-implementation) were audited. Post-implementation audit showed an increase in patients with temperatures >36°C admitted to the post-anaesthetic care unit (PACU) (8%) and discharged from PACU (28%). The percentage of patients receiving preoperative temperature monitoring increased (38%); however, low levels of intraoperative monitoring remained (31% of patients with surgery of 30 min or longer duration). Small increases were found in patient warming of 5% intraoperatively and 8% postoperatively. Preoperative warming was not successfully implemented during this phase of the project. Temperature monitoring, warming and rates of normothermia improved; however, barriers to best practice of IPH management were experienced, which negatively impacted on the project. Further stages of implementation and audit were added to further address IPH management in this department. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

  10. Usage of perioperative anxiety neuromarker for improving the quality of life of a patient operated on for critical stenosis of the internal carotid artery

    Directory of Open Access Journals (Sweden)

    Mariusz Trystuła

    2016-09-01

    Significant changes were observed on the Hospital Anxiety and Depression Scale (HAD. Modern neurotechnologies measures are necessary to capture all the changes in the symptoms of anxiety before and after the operation for a carotid stenosis. ERPs might be used to select patients with neuromarker of perioperative anxiety, and subsequently to serve in proper psychological care and minimalize the perioperative risk of complications.

  11. Perioperative lung protective ventilation in obese patients

    NARCIS (Netherlands)

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F.; Repine, John E.

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent

  12. The IOM report on the future of nursing: what perioperative nurses need to know.

    Science.gov (United States)

    Battié, Renae N

    2013-09-01

    The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, continues to be the most-viewed report in IOM history. Nearly three years after its publication, there are action coalitions of nursing and non-nursing agencies in 50 states and the District of Columbia collaborating to move the eight recommendations for action forward. There is much work to do to reshape health care delivery in the United States, and the IOM has identified nurses as key leaders in driving the reform. Every nurse must be educated on the key messages of the IOM report and become involved in moving these recommendations forward as well as in educating others on what needs to be done. AORN and perioperative nurses have a key role in voicing the unique needs of perioperative patients and in ensuring that perioperative patient care is represented in reform activities. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  13. Respiratory Management of Perioperative Obese Patients.

    Science.gov (United States)

    Imber, David Ae; Pirrone, Massimiliano; Zhang, Changsheng; Fisher, Daniel F; Kacmarek, Robert M; Berra, Lorenzo

    2016-12-01

    With a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia. Copyright © 2016 by Daedalus Enterprises.

  14. Perioperative factors associated with pressure ulcer development after major surgery

    Science.gov (United States)

    2018-01-01

    Background Postoperative pressure ulcers are important indicators of perioperative care quality, and are serious and expensive complications during critical care. This study aimed to identify perioperative risk factors for postoperative pressure ulcers. Methods This retrospective case-control study evaluated 2,498 patients who underwent major surgery. Forty-three patients developed postoperative pressure ulcers and were matched to 86 control patients based on age, sex, surgery, and comorbidities. Results The pressure ulcer group had lower baseline hemoglobin and albumin levels, compared to the control group. The pressure ulcer group also had higher values for lactate levels, blood loss, and number of packed red blood cell (pRBC) units. Univariate analysis revealed that pressure ulcer development was associated with preoperative hemoglobin levels, albumin levels, lactate levels, intraoperative blood loss, number of pRBC units, Acute Physiologic and Chronic Health Evaluation II score, Braden scale score, postoperative ventilator care, and patient restraint. In the multiple logistic regression analysis, only preoperative low albumin levels (odds ratio [OR]: 0.21, 95% CI: 0.05–0.82; P pressure ulcer development. A receiver operating characteristic curve was used to assess the predictive power of the logistic regression model, and the area under the curve was 0.88 (95% CI: 0.79–0.97; P pressure ulcer development after surgery. PMID:29441175

  15. Importance of Perioperative Glycemic Control in General Surgery

    Science.gov (United States)

    Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David

    2014-01-01

    Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best adverse outcomes. Conclusions Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than

  16. 76 FR 28988 - Medicare Program; Accelerated Development Sessions for Accountable Care Organizations-June 20, 21...

    Science.gov (United States)

    2011-05-19

    ... 1115A of the Social Security Act (the Act), as added by section 3021 the Affordable Care Act... participating team should consist of two to four senior-level leaders (including at least one executive with financial/management responsibility and one with clinical responsibility). Participants are also asked to...

  17. Perioperative anaesthetic adverse events in Thailand (PAAd THAI) study: Incident report of perioperative convulsion.

    Science.gov (United States)

    Eiamcharoenwit, Jatuporn; Akavipat, Phuping; Ariyanuchitkul, Thidarat; Wirachpisit, Nichawan; Pulnitiporn, Aksorn; Pongraweewan, Orawan

    2018-01-01

    The aim of this study was to identify the characteristics of perioperative convulsion and to suggest possible correcting strategies. The multi-centre study was conducted prospectively in 22 hospitals across Thailand in 2015. The occurrences of perioperative adverse events were collected. The data was collated by site manager and forwarded to the data management unit. All perioperative convulsion incidences were enrolled and analysed. The consensus was documented for the relevant factors and the corrective strategies. Descriptive statistics were used. From 2,000 incident reports, perioperative convulsions were found in 16 patients. Six episodes (37.5%) were related to anaesthesia, 31.3% to patients, 18.8% to surgery, and 12.5% to systemic processes. The contributing factor was an inexperienced anaesthesia performer (25%), while the corrective strategy was improvements to supervision (43.8%). Incidents of perioperative convulsion were found to be higher than during the last decade. The initiation and maintenance of safe anaesthesia should be continued.

  18. Status of the Next European Dipole (NED) Activity of the Collaborated Accelerator Research in Europe (CARE) Project

    CERN Document Server

    Devred, Arnaud; Baynham, D Elwyn; Boutboul, T; Canfer, S; Chorowski, M; den Ouden, A; Fabbricatore, P; Farinon, S; Fessia, P; Fydrych, J; Félice, H; Greco, Michela; Greenhalgh, J; Leroy, D; Loveridge, P W; Michel, F; Oberli, L R; Pedrini, D; Polinski, J; Previtali, V; Quettier, L; Rifflet, J M; Rochford, J; Rondeaux, F; Sanz, S; Sgobba, Stefano; Sorbi, M; Toral-Fernandez, F; Van Weelderen, R; Vincent-Viry, O; Volpini, G; Védrine, P

    2005-01-01

    Plans for LHC upgrade and for the final focalization of linear colliders call for large aperture and/or high-performance dipole and quadrupole magnets that may be beyond the reach of conventional NbTi magnet technology. The Next European Dipole (NED) activity was launched on January 1st, 2004 to promote the development of high-performance, Nb$_{3}$Sn wires in collaboration with European industry (aiming at a non-copper critical current density of 1500 A/mm2 at 4.2 K and 15 T) and to assess the suitability of Nb$_{3}$Sn technology to the next generation of accelerator magnets (aiming at an aperture of 88 mm and a conductor peak field of 15 T). It is integrated within the Collaborated Accelerator Research in Europe (CARE) project, involves seven collaborators, and is partly funded by the European Union. We present here an overview of the NED activity and we report on the status of the various work packages it encompasses.

  19. Patterns in current perioperative practice: survey of colorectal surgeons in five northern European countries

    DEFF Research Database (Denmark)

    Lassen, K; Hannemann, P; Ljungqvist, O

    2005-01-01

    Evidence for optimal perioperative care in colorectal surgery is abundant. By avoiding fasting, intravenous fluid overload, and activation of the neuroendocrine stress response, postoperative catabolism is reduced and recovery enhanced. The specific measures that can be used routinely include...... in colorectal cancer surgery in five northern European countries: Scotland, the Netherlands, Denmark, Sweden, and Norway....

  20. Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury A Randomized Clinical Trial

    NARCIS (Netherlands)

    Garg, Amit X.; Kurz, Andrea; Sessler, Daniel I.; Cuerden, Meaghan; Robinson, Andrea; Mrkobrada, Marko; Parikh, Chirag R.; Mizera, Richard; Jones, Philip M.; Tiboni, Maria; Font, Adrià; Cegarra, Virginia; Gomez, Maria Fernanda Rojas; Meyhoff, Christian S.; VanHelder, Tomas; Chan, Matthew T. V.; Torres, David; Parlow, Joel; de Nadal Clanchet, Miriam; Amir, Mohammed; Bidgoli, Seyed Javad; Pasin, Laura; Martinsen, Kristian; Malaga, German; Myles, Paul; Acedillo, Rey; Roshanov, Pavel S.; Walsh, Michael; Dresser, George; Kumar, Priya; Fleischmann, Edith; Villar, Juan Carlos; Painter, Thomas; Biccard, Bruce; Bergese, Sergio; Srinathan, Sadeesh; Cata, Juan P.; Chan, Vincent; Mehra, Bhupendra; Wijeysundera, Duminda N.; Leslie, Kate; Forget, Patrice; Whitlock, Richard; Yusuf, Salim; Devereaux, P. J.; Alvarez, A.; Bulach, R.; Hannon, S.; Ives, K.; de Hert, S.

    2014-01-01

    IMPORTANCE Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury; however, these effects are uncertain and each

  1. Perioperative Intravascular Fluid Assessment and Monitoring: A Narrative Review of Established and Emerging Techniques

    Directory of Open Access Journals (Sweden)

    Sumit Singh

    2011-01-01

    Full Text Available Accurate assessments of intravascular fluid status are an essential part of perioperative care and necessary in the management of the hemodynamically unstable patient. Goal-directed fluid management can facilitate resuscitation of the hypovolemic patient, reduce the risk of fluid overload, reduce the risk of the injudicious use of vasopressors and inotropes, and improve clinical outcomes. In this paper, we discuss the strengths and limitations of a spectrum of noninvasive and invasive techniques for assessing and monitoring intravascular volume status and fluid responsiveness in the perioperative and critically ill patient.

  2. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1).

    Science.gov (United States)

    Patel, Santosh; Lutz, Jan M; Panchagnula, Umakanth; Bansal, Sujesh

    2012-04-01

    Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

  3. Perioperative death: Its implications and management

    Directory of Open Access Journals (Sweden)

    J P Attri

    2016-01-01

    Full Text Available Death to most people is a major life event. Nothing in this world prepares us to face and manage the perioperative death although the majority of anesthesiologists will be involved in an intraoperative death during the course of their careers. Whether death on the table was expected or occurred when least expected or may be even later, the anesthesiologist is most likely to be affected emotionally, physically in his personal life, and as well as will have an influence on his professional career. Anesthesiologists as perioperative physicians are likely to experience death on the operating table at some time in their careers. In case of perioperative death, meticulous record keeping including time of occurrence of event and methods and medications used during resuscitation, nature of the problem, and all sequence of events should be adopted to breaking bad news with relatives and blame game should be avoided. The anesthesiologist and the relatives of the patient should also be given emotional support to come out of this untoward event. In this article, we have highlighted the various factors and causes leading on to perioperative death and if in case such an event occurs, what are the protocols to be followed, including medicolegal aspects, giving emotional support to the concerned anesthesiologist, dealing with the relatives of the patient sympathetically, etc. We have also enumerated the various precautions to be taken to prevent perioperative mortality in this article.

  4. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  5. The challenge of perioperative pain management in opioid-tolerant patients

    Science.gov (United States)

    Coluzzi, Flaminia; Bifulco, Francesca; Cuomo, Arturo; Dauri, Mario; Leonardi, Claudio; Melotti, Rita Maria; Natoli, Silvia; Romualdi, Patrizia; Savoia, Gennaro; Corcione, Antonio

    2017-01-01

    The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone. PMID:28919771

  6. The Science And Art Of Delivery: Accelerating The Diffusion Of Health Care Innovation.

    Science.gov (United States)

    Parston, Greg; McQueen, Julie; Patel, Hannah; Keown, Oliver P; Fontana, Gianluca; Al Kuwari, Hanan; Al Kuwari, Hannan; Darzi, Ara

    2015-12-01

    There is a widely acknowledged time lag in health care between an invention or innovation and its widespread use across a health system. Much is known about the factors that can aid the uptake of innovations within discrete organizations. Less is known about what needs to be done to enable innovations to transform large systems of health care. This article describes the results of in-depth case studies aimed at assessing the role of key agents and agencies that facilitate the rapid adoption of innovations. The case studies-from Argentina, England, Nepal, Singapore, Sweden, the United States, and Zambia-represent widely varying health systems and economies. The implications of the findings for policy makers are discussed in terms of key factors within a phased approach for creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. Purposeful and directed change management is needed to drive system transformation. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Less noise, more hacking: how to deploy principles from MIT's hacking medicine to accelerate health care.

    Science.gov (United States)

    DePasse, Jacqueline W; Carroll, Ryan; Ippolito, Andrea; Yost, Allison; Santorino, Data; Chu, Zen; Olson, Kristian R

    2014-07-01

    Medical technology offers enormous potential for scalable medicine--to improve the quality and access in health care while simultaneously reducing cost. However, current medical device innovation within companies often only offers incremental advances on existing products, or originates from engineers with limited knowledge of the clinical complexities. We describe how the Hacking Medicine Initiative, based at Massachusetts Institute of Technology has developed an innovative "healthcare hackathon" approach, bringing diverse teams together to rapidly validate clinical needs and develop solutions. Hackathons are based on three core principles; emphasis on a problem-based approach, cross-pollination of disciplines, and "pivoting" on or rapidly iterating on ideas. Hackathons also offer enormous potential for innovation in global health by focusing on local needs and resources as well as addressing feasibility and cultural contextualization. Although relatively new, the success of this approach is clear, as evidenced by the development of successful startup companies, pioneering product design, and the incorporation of creative people from outside traditional life science backgrounds who are working with clinicians and other scientists to create transformative innovation in health care.

  8. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  9. Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.

    Science.gov (United States)

    Lakhey, Paleswan Joshi; Bhandari, Ramesh Singh; Ghimire, Bikal; Khakurel, Mahesh

    2010-08-01

    Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital. A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed. Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place. Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.

  10. Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study)

    NARCIS (Netherlands)

    Vlug, Malaika S.; Wind, Jan; Hollmann, Markus W.; Ubbink, Dirk T.; Cense, Huib A.; Engel, Alexander F.; Gerhards, Michael F.; van Wagensveld, Bart A.; van der Zaag, Edwin S.; van Geloven, Anna A. W.; Sprangers, Mirjam A. G.; Cuesta, Miguel A.; Bemelman, Willem A.; Preckel, Benedikt; Bossuyt, Patrick; Gouma, Dirk; van Berge Henegouwen, Mark; Fuhring, Jan; van Lenthe, Ineke Picard; Bakker, Chris; King-Kalimanis, Bellinda; Hofland, Jan; Dejong, Cornelis; van Dam, Ronald; van der Peet, Donald; van Zalingen, Edith; Noordhuis, Astrid; de Jong, Dick; Goei, T. Hauwy; de Stoppelaar, Erica; van den Dongen, Marjon; van Tets, Willem; van den Elsen, Maarten; Swart, Annemiek; deWit, Laurens; Siepel, Muriel; Molly, Glaresa; Juttmann, Jan; Clevers, Wilfred; Bieleman, Andrea; Coenen, Ludo; Bonekamp, Elly; van Abeelen, Jacobus; van Iterson-de Jong, Diana; Krombeen, Margriet

    2011-01-01

    To investigate which perioperative treatment, ie, laparoscopic or open surgery combined with fast track (FT) or standard care, is the optimal approach for patients undergoing segmental resection for colon cancer. Important developments in elective colorectal surgery are the introduction of

  11. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidence...... to assess the use of perioperative beta blockers in patients having non-cardiac surgery....

  12. The treatment of perioperative myocardial infarctions following ...

    African Journals Online (AJOL)

    Background: Perioperative myocardial infarction (PMI) is a common complication following noncardiac surgery, with a 30-day mortality of 10-20%. Effective therapeutic interventions are of public health importance. Method: This is a systematic review, aimed to determine the evidence for therapies following PMI. Results: A ...

  13. Perioperative Anesthesiological Management of Patients with Pulmonary Hypertension

    Directory of Open Access Journals (Sweden)

    Jochen Gille

    2012-01-01

    Full Text Available Pulmonary hypertension is a major reason for elevated perioperative morbidity and mortality, even in noncardiac surgical procedures. Patients should be thoroughly prepared for the intervention and allowed plenty of time for consideration. All specialty units involved in treatment should play a role in these preparations. After selecting each of the suitable individual anesthetic and surgical procedures, intraoperative management should focus on avoiding all circumstances that could contribute to exacerbating pulmonary hypertension (hypoxemia, hypercapnia, acidosis, hypothermia, hypervolemia, and insufficient anesthesia and analgesia. Due to possible induction of hypotonic blood circulation, intravenous vasodilators (milrinone, dobutamine, prostacyclin, Na-nitroprusside, and nitroglycerine should be administered with the greatest care. A method of treating elevations in pulmonary pressure with selective pulmonary vasodilation by inhalation should be available intraoperatively (iloprost, nitrogen monoxide, prostacyclin, and milrinone in addition to invasive hemodynamic monitoring. During the postoperative phase, patients must be monitored continuously and receive sufficient analgesic therapy over an adequate period of time. All in all, perioperative management of patients with pulmonary hypertension presents an interdisciplinary challenge that requires the adequate involvement of anesthetists, surgeons, pulmonologists, and cardiologists alike.

  14. [Perioperative fibrinogen concentrations in cardiac surgery with cardiopulmonary bypass].

    Science.gov (United States)

    Uji, Makiko; Terada, Yuki; Noguchi, Teruo; Nishida, Takaya; Hasuwa, Kyoko; Shinohara, Kozue; Kumano, Hotaka; Ishimura, Naoko; Nishiwada, Makoto

    2012-08-01

    Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) need many blood products due to deficiency of coagulation factors. Blood transfusion therapy in patients with excessive bleeding after CPB is generally empiric. We checked and studied the fibrinogen concentration and transfusion, as well as bleeding amount in the perioperative period. The study was approved by our institutional ethics committee. Thirty patients were studied. Blood samples were obtained at the induction of anesthesia (before CPB), at the end of CPB, at the end of operation, and on the next morning, or before the patient was given fresh frozen plasma in the intensive care unit. For all cases, fibrinogen concentration and platelet concentration were lowest at the end of CPB. Fibrinogen concentration rose up to before CPB level on the next morning. The group in which fibrinogen concentration was less than 150 mg x dl(-1) at the end of CPB consumed more blood products than the group with fibrinogen concentration of over 150 mg x dl(-1). Blood transfusion therapy based on fibrinogen concentration is needed to maintain adequacy of the perioperative blood transfusion and blood conservation in cardiac surgery.

  15. Pattern of perioperative cardiac arrests at University of Maiduguri Teaching Hospital.

    Science.gov (United States)

    Kwari, Y D; Bello, M R; Eni, U E

    2010-01-01

    Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern, causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes, anaesthetic chart and ICU records. Study variables which include demographic data, ASA score, anaesthetic technique, causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia, while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults. ASA class III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2 (14%) out of 14 cardiac arrests recovered to home discharge, one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early There is need to improve on patient monitoring, knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest.

  16. Experience of anaesthesia nurses of perioperative communication in hip fracture patients with dementia.

    Science.gov (United States)

    Krupic, Ferid; Eisler, Thomas; Sköldenberg, Olof; Fatahi, Nabi

    2016-03-01

    Perioperative care in hip fracture patients with dementia can be complex. There is currently little scientific evidence on how care should be undertaken. The aim of the study was to describe the experience of anaesthesia nurses of the difficulties that emerge in care situations and how communication with patients can be maintained in the perioperative setting of hip fracture surgery. Individual interviews were conducted with ten anaesthesia nurses (5 men and 5 women). The interviews were carried out at a university hospital in Gothenburg (Sweden), and the data were analysed using qualitative content analysis. Three main response categories were discerned: 'Communication', 'Dementia as a special issue' and 'Practical issues'. Dementia was viewed as one of the most difficult and shifting diseases an individual may suffer from. Time must be allocated to communicate clearly and patiently, to meticulously plan and carry out care while providing distinct information to enable patient participation. Establishing a mental bridgehead by confirming the patients' perceptions/feelings significantly reduced distress in a majority of the patients. A holistic and respectful approach was deemed mandatory at all times. Patients are sometimes dependent on recognition, so that small personal items brought close to the patient during surgery can calm the patient. State-of-the-art analgesia and anxiolytic medications are mandatory. Perioperative problems can be overcome with patience, empathy and profound knowledge of how patients with dementia respond prior to surgery. Our results may serve as a source for future care and provide information about hospital settings for better perioperative care in patients with dementia. © 2015 Nordic College of Caring Science.

  17. CARE-HHH-APD Workshop on Finalizing the Roadmap for the Upgrade of the CERN and GSI Accelerator Complex

    CERN Document Server

    Zimmermann, Frank; BEAM'07; BEAM 2007; Finalizing the Roadmap for the Upgrade of the LHC and GSI Accelerator Complex

    2008-01-01

    This report contains the Proceedings of the CARE-HHH-APD Event BEAM’07, “Finalizing the Roadmap for the Upgrade of the CERN & GSI Accelerator Complex,” which was held at CERN in Geneva, Switzerland, from 1 to 5 October 2007. BEAM’07 was primarily devoted to beam dynamics limitations for the two, or three, alternative baseline scenarios of the LHC luminosity upgrade and to critical design choices for the upgrade of the LHC injector complex at CERN and for the FAIR complex at GSI. It comprised five parts: (1) a Mini-Workshop on LHC+ Beam Performance, (2) a CERN-GSI Meeting on Collective Effects, (3) the Francesco Ruggiero Memorial Symposium, (4) a Mini-Workshop on the LHC Injectors Upgrade, and (5) the BEAM’07 Summaries. Topics addressed in the first mini-workshop of BEAM’07 ranged from the luminosity performance reach of the upgraded LHC in different scenarios, over the generation and stability of the future LHC beams, the turnaround time, beam–beam effects, luminosity levelling methods, and ...

  18. Perioperative modifications of respiratory function.

    LENUS (Irish Health Repository)

    Duggan, Michelle

    2012-01-31

    Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control.

  19. Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

    2018-04-01

    Interhospital competition has been shown to influence the adoption of surgical techniques and approaches, clinical patient outcomes, and health care resource use for select surgical procedures. However, little is known regarding these dynamics as they relate to spine surgery. This investigation sought to examine the relationship between interhospital competitive intensity and perioperative outcomes following lumbar spinal fusion. This study used the Nationwide Inpatient Sample dataset, years 2003, 2006, and 2009. Patients were included based on the presence of the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM) codes corresponding to lumbar spinal fusion, as well as on the presence of data on the Herfindahl-Hirschman Index (HHI). The outcome measures are perioperative complications, defined using an ICD-9-CM coding algorithm. The HHI, a validated measure of competition within a market, was used to assess hospital market competitiveness. The HHI was calculated based on the hospital cachement area. Multiple regression was performed to adjust for confounding variables including patient age, gender, primary payer, severity of illness score, primary versus revision fusion, anterior versus posterior approach, national region, hospital bed size, location or teaching status, ownership, and year. Perioperative clinical outcomes were assessed based on ICD-9-CM codes with modifications. In total, 417,520 weighted patients (87,999 unweighted records) were analyzed. The mean cachement area HHI was 0.31 (range 0.099-0.724). The average patient age was 55.4 years (standard error=0.194), and the majority of patients were female (55.8%, n=232,727). The majority of procedures were primary spinal fusions (92.7%, n=386,998) and fusions with a posterior-only technique (81.5%, n=340,271). Most procedures occurred in the South (42.5%, n=177,509) or the Midwest (27.0%, n=112,758) regions. In the multiple regression analysis, increased hospital

  20. Post-surgical infections and perioperative antibiotics usage in pediatric genitourinary procedures.

    Science.gov (United States)

    Ellett, Justin; Prasad, Michaella M; Purves, J Todd; Stec, Andrew A

    2015-12-01

    Post-surgical infections (PSIs) are a source of preventable perioperative morbidity. No guidelines exist for the use of perioperative antibiotics in pediatric urologic procedures. This study reports the rate of PSIs in non-endoscopic pediatric genitourinary procedures at our institution. Secondary aims evaluate the association of PSI with other perioperative variables, including wound class (WC) and perioperative antibiotic administration. Data from consecutive non-endoscopic pediatric urologic procedures performed between August 2011 and April 2014 were examined retrospectively. The primary outcome was the rate of PSIs. PSIs were classified as superficial skin (SS) and deep/organ site (D/OS) according to Centers for Disease Control and Prevention guidelines, and urinary tract infection (UTI). PSIs were further stratified by WC1 and WC2 and perioperative antibiotic usage. A relative risk and chi-square analysis compared PSI rates between WC1 and WC2 procedures. A total of 1185 unique patients with 1384 surgical sites were reviewed; 1192 surgical sites had follow-up for inclusion into the study. Ten total PSIs were identified, for an overall infection rate of 0.83%. Of these, six were SS, one was D/OS, and three were UTIs. The PSI rate for WC1 (885 sites) and WC2 (307 sites) procedures was 0.34% and 2.28%, respectively, p antibiotics (0.35% vs. 0.33%). All WC2 procedures received antibiotics. Post-surgical infections are associated with significant perioperative morbidity. In some studies, PSI can double hospital costs, and contribute to hospital length of stay, admission to intensive care units, and impact patient mortality. Our study demonstrates that the rate of PSI in WC1 operations is low, irrespective of whether the patient received perioperative antibiotics (0.35%) or no antibiotics (0.33%). WC2 operations were the larger source of morbidity with an infection rate of 2.28% and a 6.7 fold higher increase in relative risk. WC1 procedures have a rate of

  1. PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Kwame Ofori Adjepong

    2018-05-01

    Full Text Available An estimated 30 million people worldwide have sickle cell disease (SCD.  Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.  Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss.  Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

  2. Perioperative complications of sleeve gastrectomy: Review of the literature.

    Science.gov (United States)

    Iannelli, Antonio; Treacy, Patrick; Sebastianelli, Lionel; Schiavo, Luigi; Martini, Francesco

    2018-05-04

    Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.

  3. Perioperative Vision Loss in Cervical Spinal Surgery.

    Science.gov (United States)

    Gabel, Brandon C; Lam, Arthur; Chapman, Jens R; Oskouian, Rod J; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Hamilton, Steven R; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective multicenter case series. To assess the rate of perioperative vision loss following cervical spinal surgery. Medical records for 17 625 patients from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify occurrences of vision loss following surgery. Of the 17 625 patients in the registry, there were 13 946 patients assessed for the complication of blindness. There were 9591 cases that involved only anterior surgical approaches; the remaining 4355 cases were posterior and/or circumferential fusions. There were no cases of blindness or vision loss in the postoperative period reported during the sampling period. Perioperative vision loss following cervical spinal surgery is exceedingly rare.

  4. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  5. Detrimental effects of perioperative blood transfusion

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen

    1995-01-01

    Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red...... cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown...... similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage....

  6. Using games to provide interactive perioperative education.

    Science.gov (United States)

    Carifa, Linda; Janiszewski Goodin, Heather

    2011-10-01

    Perioperative nurses must use critical thinking and sound clinical judgment to meet their patients' needs safely and effectively. This requires the integration and continual updating of large amounts of detailed clinical information. Innovative education strategies are designed to make teaching and learning more interesting and interactive, especially for the presentation of complex subject material. One interactive educational strategy is the use of games. Educational games can foster collaboration and critical thinking among peers and associates. An example of this was the Perioperative QuizBowl: Evidence-Based Practice presented at the annual AORN Congress from 2003 to 2010, which was used to teach and reinforce evidence-based practice in a fun, competitive way. Although AORN no longer presents this offering, the QuizBowl format demonstrates how educational games can support clinical practice. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Management of severe perioperative bleeding

    DEFF Research Database (Denmark)

    Kozek-Langenecker, Sibylle A; Afshari, Arash; Albaladejo, Pierre

    2013-01-01

    -sectional surveys were selected. At the suggestion of the ESA Guideline Committee, the Scottish Intercollegiate Guidelines Network (SIGN) grading system was initially used to assess the level of evidence and to grade recommendations. During the process of guideline development, the official position of the ESA...... with an assessment of the quality of the evidence in order to allow anaesthetists throughout Europe to integrate this knowledge into daily patient care wherever possible. The Guidelines Committee of the European Society of Anaesthesiology (ESA) formed a task force with members of scientific subcommittees...... changed to favour the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This report includes general recommendations as well as specific recommendations in various fields of surgical interventions. The final draft guideline was posted on the ESA website for four weeks...

  8. Perioperative lung protective ventilation in obese patients

    OpenAIRE

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increa...

  9. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  10. Optimizing Perioperative Nutrition in Pediatric Populations.

    Science.gov (United States)

    Canada, Nicki L; Mullins, Lucille; Pearo, Brittany; Spoede, Elizabeth

    2016-02-01

    Nutrition status prior to surgery and nutrition rehabilitation after surgery can affect the morbidity and mortality of pediatric patients. A comprehensive approach to nutrition in pediatric surgical patients is important and includes preoperative assessment, perioperative nutrition considerations, and postoperative recovery. A thorough nutrition assessment to identify patients who are at nutrition risk prior to surgery is important so that the nutrition status can be optimized prior to the procedure to minimize suboptimal outcomes. Preoperative malnutrition is associated with increased complications and mean hospital days following surgery. Enteral and parenteral nutrition can be used in cases where food intake is inadequate to maintain and possibly improve nutrition status, especially in the 7-10 days prior to surgery. In the perioperative period, fasting should be limited to restricting solid foods and non-human milk 6 hours prior to the procedure and allowing clear liquids until 2 hours prior to the procedure. Postoperatively, early feeding has been shown to resolve postoperative ileus earlier, decrease infection rates, promote wound healing, and reduce length of hospital stay. If nutrition cannot be provided orally, then nutrition through either enteral or parenteral means should be initiated within 24-48 hours of surgery. Practitioners should identify those patients who are at the highest nutrition risk for postsurgical complications and provide guidance for optimal nutrition during the perioperative and postoperative period. © 2015 American Society for Parenteral and Enteral Nutrition.

  11. [Perioperative management of long-term medication].

    Science.gov (United States)

    Vogel Kahmann, I; Ruppen, W; Lurati Buse, G; Tsakiris, D A; Bruggisser, M

    2011-01-01

    Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

  12. [Perioperative managment of laparoscopic sleeve gastrectomy].

    Science.gov (United States)

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  13. Management of antiplatelet therapy in patients undergoing elective invasive procedures. Proposals from the French Working Group on perioperative haemostasis (GIHP) and the French Study Group on thrombosis and haemostasis (GFHT). In collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR).

    Science.gov (United States)

    Godier, Anne; Fontana, Pierre; Motte, Serge; Steib, Annick; Bonhomme, Fanny; Schlumberger, Sylvie; Lecompte, Thomas; Rosencher, Nadia; Susen, Sophie; Vincentelli, André; Gruel, Yves; Albaladejo, Pierre; Collet, Jean-Philippe

    2018-01-05

    The French Working Group on Perioperative Haemostasis (GIHP) and the French Study Group on Haemostasis and Thrombosis (GFHT) in collaboration with the French Society for Anaesthesia and Intensive Care Medicine (SFAR) drafted up-to-date proposals for the management of antiplatelet therapy in patients undergoing elective invasive procedures. The proposals were discussed and validated by a vote; all proposals but one could be assigned with a high strength. The management of antiplatelet therapy is based on their indication and the procedure. The risk of bleeding related to the procedure can be divided into high, moderate and low categories depending on the possibility of performing the procedure in patients receiving antiplatelet agents (none, monotherapy and dual antiplatelet therapy respectively). If discontinuation of antiplatelet therapy is indicated before the procedure, a last intake of aspirin, clopidogrel, ticagrelor and prasugrel 3, 5, 5 and 7 days before surgery respectively is proposed. The thrombotic risk associated with discontinuation should be assessed according to each specific indication of antiplatelet therapy and is higher for patients receiving dual therapy for coronary artery disease (with further refinements based on a few well-accepted items) than for those receiving monotherapy for cardiovascular prevention, for secondary stroke prevention or for lower extremity arterial disease. These proposals also address the issue of the potential role of platelet functional tests and consider management of antiplatelet therapy for regional anaesthesia, including central neuraxial anaesthesia and peripheral nerve blocks, and for coronary artery surgery. Copyright © 2018 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

  14. Assistência ao paciente obeso mórbido submetido à cirurgia bariátrica: dificuldades do enfermeiro Asistencia al paciente obeso mórbido sometido a la cirugía bariátrica: dificultades del enfermero Perioperative care for morbid obese patient undergoing bariatric surgery: challenges for nurses

    Directory of Open Access Journals (Sweden)

    Denise Spósito Tanaka

    2009-10-01

    Full Text Available OBJETIVO: Identificar as dificuldades de enfermeiros de centro cirúrgico ao assistir pacientes obesos mórbidos submetidos à cirurgia bariátrica no período transoperatório. MÉTODOS: A amostra constou de 70 enfermeiros com experiência em assistência ao paciente obeso mórbido. Os dados foram coletados durante o 7º Congresso Brasileiro de Enfermeiros de Centro Cirúrgico, Recuperação Anestésica e Centro de Material e Esterilização por meio de um questionário. RESULTADOS: A análise dos resultados apontou como dificuldades aquelas relacionadas ao espaço físico, materiais e equipamentos e à assistência de enfermagem específica ao paciente obeso mórbido. CONCLUSÃO: O conhecimento específico, a especialização e a experiência em Centro Cirúrgico darão o conforto, a segurança física e emocional necessárias a estes pacientes.OBJETIVO: Identificar las dificultades de enfermeros de centro quirúrgico en el cuidado a pacientes obesos mórbidos sometidos a cirugía bariátrica en el período transoperatorio. MÉTODOS: La muestra constó de 70 enfermeros con experiencia en asistencia al paciente obeso mórbido. Los datos fueron recolectados por medio de un cuestionario durante el 7º Congreso Brasileño de Enfermeros de Centro Quirúrgico, Recuperación Anestésica y Centro de Material y Esterilización. RESULTADOS: El análisis de los resultados identificó como dificultades aquellas relacionadas al espacio físico, materiales y equipos y a la asistencia de enfermería específica al paciente obeso mórbido. CONCLUSIÓN: El conocimiento específico, la especialización y la experiencia en Centro Quirúrgico darán el confort, la seguridad física y emocional que necesitan estos pacientes.OBJECTIVE: To identify the challenges for nurses during the perioperative for patients undergoing bariatric surgery. METHODS: The sample consisted of 70 nurses who had experience in providing care for morbid obese patients. Data were collected

  15. TRALI in the perioperative period

    Directory of Open Access Journals (Sweden)

    Berdai MA

    2014-07-01

    Full Text Available Mohamed Adnane Berdai, Smael Labib, Mustapha HarandouChild and Mother Intensive Care Unit, University Hospital Hassan II, Fes, MoroccoBackground: Transfusion-related acute lung injury (TRALI is one of the leading causes of transfusion-related morbidity and mortality. Although it is a serious complication of blood transfusion, it is still underestimated because of underrecognition and misdiagnosis, which can lead to inappropriate management.Case report: We report the case of a 34-year-old female, who presented with hemorrhagic shock during cesarean section and was transfused with packed red blood cells and fresh frozen plasma. Three hours after the end of transfusion, while still intubated, the patient developed acute respiratory failure, with diffuse crackles at auscultation and bilateral lung infiltrations on chest radiography. The ratio of the arterial partial pressure of O2 and the fraction of inspired O2 (PaO2/FiO2 was 51. The diagnosis of TRALI was made after excluding other possible causes of acute lung injury. She was managed symptomatically with ventilatory support and vasopressors. The patient later died secondary to multiple organ failure.Conclusion: The diagnosis of TRALI relies on the exclusion of other causes of acute pulmonary edema following transfusion. All plasma-containing blood products have been involved in the genesis of this syndrome. This is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management. Challenges are ahead as preventive strategies have reduced but not eliminated the onset of TRALI.Keywords: acute lung injury, transfusion related acute lung injury, anti-human leukocyte antigen antibody, pulmonary edema, transfusion accident

  16. Student nurses' experiences of preserved dignity in perioperative practice - Part I.

    Science.gov (United States)

    Blomberg, Ann-Catrin; Willassen, Elin; von Post, Iréne; Lindwall, Lillemor

    2015-09-01

    In recent years, operating theatre nurse students' education focussed on ethical value issues and how the patient's dignity is respected in the perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient's care during surgery. The objective of this study was to present what operating theatre nurse students experienced and interpreted as preserved dignity in perioperative practice. The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan's critical incident technique. Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. The study was conducted accordance with the Declaration of Helsinki and approved by a local University Ethics Research Committee. The findings revealed that students experienced that operating theatre nurses perserved patient's dignity in perioperative practice by being present for each other and making themselves known to the patient. Operating theatre nurses caring for the patient by being compassionate and preserved the patient privacy. The new understanding that emerged was that the operating theatre nurse students understood that the operating theatre nurse wanted to care for the patient like a human being. In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. Preserved dignity is an ethical and caring act. Ethical questions and how to preserve dignity in perioperative practice should be discussed more both in educations of healthcare professionals and in clinical practice. © The Author(s) 2014.

  17. Innovative perioperative role improves patient and organisational outcomes in minimal invasive surgery.

    Science.gov (United States)

    Abraham, Jenny

    2011-05-01

    The drive to improve clinical care and productivity in the NHS has required an innovative approach in the use of the resources and skills of the workforce. With rapidly evolving technology, surgical and anaesthetic techniques, concentration is increasingly being placed on improving patient focused pathways, aiming to return patients back to normal activities as soon as possible. The article highlights the exciting new perioperative role developed at University Hospitals Coventry and Warwickshire (UHCW) NHS Trust in the care of patients undergoing laparoscopic cholecystectomy. It includes the history and development of the post and its current impact in improving the care of patients.

  18. Perioperative coagulation management and blood conservation in cardiac surgery: a Canadian Survey.

    Science.gov (United States)

    Taneja, Ravi; Fernandes, Philip; Marwaha, Gulshan; Cheng, Davy; Bainbridge, Daniel

    2008-10-01

    To determine which strategies are currently used for (anti)coagulation management and blood conservation during cardiac surgery in Canada. Institutional survey. University hospital. All sites performing cardiac surgery in Canada. None. The response rate was 85%. Anticoagulation with heparin is monitored routinely through the activated coagulation time (ACT). Less than 10% of centers use heparin concentrations (Hepcon HMS, Medtronic), thromboelastography, or other point-of-care tests perioperatively. Eighty percent of centers routinely use tranexamic acid as the primary antifibrinolytic agent; however aprotinin until recently, was used more commonly for patients at increased risk for bleeding. Retrograde autologous prime is commonly used (62%); however, cell savers are uncommon for routine patients undergoing cardiac surgery (29%). Although most hospitals use a hematocrit of 20% to 21% for transfusing red blood cells, more than 50% of intensive care units do not have written guidelines for the administration of protamine, fresh frozen plasma, platelets, or factor VIIa. At least one third of centers do not audit their transfusion practices regularly. The majority of Canadian institutions do not use point-of-care tests other than ACT. Most institutions do not have algorithms for management of bleeding following cardiac surgery and at least 30% do not monitor their transfusion practice perioperatively. Cardiac surgery patients in Canada may benefit from a standardized approach to blood conservation in the perioperative period.

  19. Perioperative Variables Contributing to the Rupture of Intracranial Aneurysm: An Update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2013-01-01

    Full Text Available Background. Perioperative aneurysm rupture (PAR is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012 using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history as well as the pathophysiological factors (size, type, location, comorbidities, and procedure. Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better

  20. Perioperative interstitial brachytherapy for recurrent keloid scars

    International Nuclear Information System (INIS)

    Rio, E.; Bardet, E.; Peuvrel, P.; Martinet, L.; Perrot, P.; Baraer, F.; Loirat, Y.; Sartre, J.Y.; Malard, O.; Ferron, C.; Dreno, B.

    2010-01-01

    Purpose: Evaluation of the results of perioperative interstitial brachytherapy with low dose-rate (L.D.R.) Ir-192 in the treatment of keloid scars. Patients and methods: We performed a retrospective analysis of 73 histologically confirmed keloids (from 58 patients) resistant to medico surgical treated by surgical excision plus early perioperative brachytherapy. All lesions were initially symptomatic. Local control was evaluated by clinical evaluation. Functional and cosmetic results were assessed in terms of patient responses to a self-administered questionnaire. Results: Median age was 28 years (range 13-71 years). Scars were located as follows: 37% on the face, 32% on the trunk or abdomen, 16% on the neck, and 15% on the arms or legs. The mean delay before loading was four hours (range, 1-6 h). The median dose was 20 Gy (range, 15-40 Gy). Sixty-four scars (from 53 patients) were evaluated. Local control was 86% (follow-up, 44.5 months; range, 14-150 months). All relapses occurred early within 2 years posttreatment. At 20 months, survival without recurrence was significantly lower when treated lengths were more than 6 cm long. The rate was 100% for treated scars below 4.5 cm in length, 95% (95% CI: 55-96) for those 4.5-6 cm long, and 75% (95% CI: 56-88) beyond 6 cm (p = 0.038). Of the 35 scars (28 patients) whose results were reassessed, six remained symptomatic and the esthetic results were considered to be good in 51% (18/35) and average in 37% (13/35) (median follow-up, 70 months; range, 16-181 months). Conclusion: Early perioperative L.D.R. brachytherapy delivering 20 Gy at 5 mm reduced the rate of recurrent keloids resistant to other treatments and gave good functional results. (authors)

  1. Perioperative Prophylaxis for Total Artificial Heart Transplantation.

    Science.gov (United States)

    Chambers, H E; Pelish, P; Qiu, F; Florescu, D F

    2017-11-01

    Practice variation regarding perioperative antimicrobial prophylaxis in total artificial heart transplantations (TAH-t) across institutions is unknown. The aim of our survey was to assess the current practices for prevention of infection in TAH-t recipients among different programs. An electronic survey was sent to programs that implant Syncardia TAH (Syncardia Systems, Tuscon, Ariz, USA). Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. The majority of centers (80.8%) had a formal surgical infection prophylaxis protocol. For non-penicillin-allergic patients, five (20.1%) institutions reported using a 4-drug regimen, seven (29.2%) used a 3-drug regimen, five (20.1%) used a 2-drug regimen, and seven (29.2%) used a cephalosporin alone. Similar data was seen in the penicillin-allergic patients. Infections were reported to occur postoperatively in 52.2% centers. During the first month after TAH-t, bacteremia represented 27.3%, driveline infections 27.2%, pulmonary infections 9%, and mediastinal infections 18.2%. The most common organisms seen within the first month were Candida spp., Escherichia coli, and Pseudomonas aeruginosa (21.4%). In 65% of centers, the mean rate of death post-TAH-t due to infection was 14.5% (SD, 22.3%). The mean rate of patients surviving until orthotopic heart transplantation was 58.6% (SD, 27.7%). Preventing infections post-TAH-t is key to decreasing morbidity and mortality. All institutions administered perioperative prophylaxis for TAH-t with significant variation among the centers. The majority of the centers have a formal perioperative prophylactic protocol. Copyright © 2017. Published by Elsevier Inc.

  2. Perioperative outcomes following surgery for brain tumors: Objective assessment and risk factor evaluation

    Directory of Open Access Journals (Sweden)

    Aliasgar V Moiyadi

    2012-01-01

    Full Text Available Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.

  3. Peri-operative cognitive dysfunction and protection

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2016-01-01

    Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...... factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can...... reduce the rate of delirium in the elderly, but in spite of promising findings in animal experiments, no intervention reduces postoperative cognitive dysfunction in humans....

  4. Mobile Technology in the Perioperative Arena: Rapid Evolution and Future Disruption.

    Science.gov (United States)

    Rothman, Brian S; Gupta, Rajnish K; McEvoy, Matthew D

    2017-03-01

    Throughout the history of medicine, physicians have relied upon disruptive innovations and technologies to improve the quality of care delivered, patient outcomes, and patient satisfaction. The implementation of mobile technology in health care is quickly becoming the next disruptive technology. We first review the history of mobile technology over the past 3 decades, discuss the impact of hardware and software, explore the rapid expansion of applications (apps), and evaluate the adoption of mobile technology in health care. Next, we discuss how technology serves as the vehicle that can transform traditional didactic learning into one that adapts to the learning behavior of the student by using concepts such as the flipped classroom, just-in-time learning, social media, and Web 2.0/3.0. The focus in this modern education paradigm is shifting from teacher-centric to learner-centric, including providers and patients, and is being delivered as context-sensitive, or semantic, learning. Finally, we present the methods by which connected health systems via mobile devices increase information collection and analysis from patients in both clinical care and research environments. This enhanced patient and provider connection has demonstrated benefits including reducing unnecessary hospital readmissions, improved perioperative health maintenance coordination, and improved care in remote and underserved areas. A significant portion of the future of health care, and specifically perioperative medicine, revolves around mobile technology, nimble learners, patient-specific information and decision-making, and continuous connectivity between patients and health care systems. As such, an understanding of developing or evaluating mobile technology likely will be important for anesthesiologists, particularly with an ever-expanding scope of practice in perioperative medicine.

  5. Perioperative treatment of hemophilia A patients: blood group O patients are at risk of bleeding complications.

    Science.gov (United States)

    Hazendonk, H C A M; Lock, J; Mathôt, R A A; Meijer, K; Peters, M; Laros-van Gorkom, B A P; van der Meer, F J M; Driessens, M H E; Leebeek, F W G; Fijnvandraat, K; Cnossen, M H

    2016-03-01

    ESSENTIALS: Targeting of factor VIII values is a challenge during perioperative replacement therapy in hemophilia. This study aims to identify the extent and predictors of factor VIII underdosing and overdosing. Blood group O predicts underdosing and is associated with perioperative bleeding. To increase quality of care and cost-effectiveness of treatment, refining of dosing is obligatory. Perioperative administration of factor VIII (FVIII) concentrate in hemophilia A may result in both underdosing and overdosing, leading to respectively a risk of bleeding complications and unnecessary costs. This retrospective observational study aims to identify the extent and predictors of underdosing and overdosing in perioperative hemophilia A patients (FVIII levels < 0.05 IU mL(-1)). One hundred nineteen patients undergoing 198 elective, minor, or major surgical procedures were included (median age 40 years, median body weight 75 kg). Perioperative management was evaluated by quantification of perioperative infusion of FVIII concentrate and achieved FVIII levels. Predictors of underdosing and (excessive) overdosing were analyzed by logistic regression analysis. Excessive overdosing was defined as upper target level plus ≥ 0.20 IU mL(-1). Depending on postoperative day, 7-45% of achieved FVIII levels were under and 33-75% were above predefined target ranges as stated by national guidelines. A potential reduction of FVIII consumption of 44% would have been attained if FVIII levels had been maintained within target ranges. Blood group O and major surgery were predictive of underdosing (odds ratio [OR] 6.3, 95% confidence interval [CI] 2.7-14.9; OR 3.3, 95% CI 1.4-7.9). Blood group O patients had more bleeding complications in comparison to patients with blood group non-O (OR 2.02, 95% CI 1.00-4.09). Patients with blood group non-O were at higher risk of overdosing (OR 1.5, 95% CI 1.1-1.9). Additionally, patients treated with bolus infusions were at higher risk of excessive

  6. Variation in Medicare Expenditures for Treating Perioperative Complications: The Cost of Rescue.

    Science.gov (United States)

    Pradarelli, Jason C; Healy, Mark A; Osborne, Nicholas H; Ghaferi, Amir A; Dimick, Justin B; Nathan, Hari

    2016-12-21

    Treating surgical complications presents a major challenge for hospitals striving to deliver high-quality care while reducing costs. Costs associated with rescuing patients from perioperative complications are poorly characterized. To evaluate differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. Retrospective cohort study using claims data from the Medicare Provider Analysis and Review files. We compared payments for patients who died vs patients who survived after perioperative complications occurred. Hospitals were stratified using average payments for patients who survived following complications, and payment components were analyzed across hospitals. Administrative claims database of surgical patients was analyzed at hospitals treating Medicare patients nationwide. This study included Medicare patients aged 65 to 100 years who underwent abdominal aortic aneurysm repair (n = 69 207), colectomy for cancer (n = 107 647), pulmonary resection (n = 91 758), and total hip replacement (n = 307 399) between 2009 and 2012. Data analysis took place between November 2015 and March 2016. Clinical outcome of surgery (eg, no complication, complication and death, or complication and survival) and the individual hospital where a patient received an operation. Risk-adjusted, price-standardized Medicare payments for an episode of surgery. Risk-adjusted perioperative outcomes were also assessed. The mean age for Medicare beneficiaries in this study ranged from 74.1 years (pulmonary resection) to 78.2 years (colectomy). The proportion of male patients ranged from 37% (total hip replacement) to 77% (abdominal aortic aneurysm repair), and most patients were white. Among patients who experienced complications, those who were rescued had higher price-standardized Medicare payments than did those who died for all 4 operations. Assessing variation across hospitals, payments for patients

  7. Best practices in peri-operative management of patients with skeletal dysplasias.

    Science.gov (United States)

    White, Klane K; Bompadre, Viviana; Goldberg, Michael J; Bober, Michael B; Cho, Tae-Joon; Hoover-Fong, Julie E; Irving, Melita; Mackenzie, William G; Kamps, Shawn E; Raggio, Cathleen; Redding, Gregory J; Spencer, Samantha S; Savarirayan, Ravi; Theroux, Mary C

    2017-10-01

    Patients with skeletal dysplasia frequently require surgery. This patient population has an increased risk for peri-operative complications related to the anatomy of their upper airway, abnormalities of tracheal-bronchial morphology and function; deformity of their chest wall; abnormal mobility of their upper cervical spine; and associated issues with general health and body habitus. Utilizing evidence analysis and expert opinion, this study aims to describe best practices regarding the peri-operative management of patients with skeletal dysplasia. A panel of 13 multidisciplinary international experts participated in a Delphi process that included a thorough literature review; a list of 22 possible care recommendations; two rounds of anonymous voting; and a face to face meeting. Those recommendations with more than 80% agreement were considered as consensual. Consensus was reached to support 19 recommendations for best pre-operative management of patients with skeletal dysplasia. These recommendations include pre-operative pulmonary, polysomnography; cardiac, and neurological evaluations; imaging of the cervical spine; and anesthetic management of patients with a difficult airway for intubation and extubation. The goals of this consensus based best practice guideline are to provide a minimum of standardized care, reduce perioperative complications, and improve clinical outcomes for patients with skeletal dysplasia. © 2017 Wiley Periodicals, Inc.

  8. A systematic review of peri-operative melatonin

    DEFF Research Database (Denmark)

    Andersen, L P H; Werner, M U; Rosenberg, J

    2014-01-01

    We systematically reviewed randomised controlled trials of peri-operative melatonin. We included 24 studies of 1794 participants that reported eight peri-operative outcomes: anxiety; analgesia; sleep quality; oxidative stress; emergence behaviour; anaesthetic requirements; steal induction......%, respectively. Qualitative reviews suggested the melatonin improved sleep quality and emergence behaviour, and might be capable of reducing oxidative stress and anaesthetic requirements....

  9. Perioperative nutrition: what do we know? | Kotze | South African ...

    African Journals Online (AJOL)

    Surgery patients are at risk for iatrogenic malnutrition and subsequent deleterious effects. The benefits of nutrition support on patient outcomes have been demonstrated and the possible benefit of perioperative nutrition support thus implied. Enhanced recovery after surgery (ERAS) protocols, including perioperative nutrition ...

  10. Effect of perioperative insulin infusion on surgical morbidity and mortality

    DEFF Research Database (Denmark)

    Gandhi, Gunjan Y; Murad, M Hassan; Flynn, Errol David

    2008-01-01

    To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients.......To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of perioperative insulin infusion on outcomes important to patients....

  11. The impact of acute preoperative beta-blockade on perioperative ...

    African Journals Online (AJOL)

    To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and all- ... Our findings suggest that acute preoperative β-blockade is associated with an increased risk of perioperative cardiac ..... Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE.

  12. Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI).

    Science.gov (United States)

    Alvarez-Nebreda, Maria Loreto; Bentov, Nathalie; Urman, Richard D; Setia, Sabeena; Huang, Joe Chin-Sun; Pfeifer, Kurt; Bennett, Katherine; Ong, Thuan D; Richman, Deborah; Gollapudi, Divya; Alec Rooke, G; Javedan, Houman

    2018-06-01

    Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Anesthesia and perioperative management of colorectal surgical patients - A clinical review (Part 1

    Directory of Open Access Journals (Sweden)

    Santosh Patel

    2012-01-01

    Full Text Available Colorectal surgery is commonly performed for colorectal cancer and other pathology such as diverticular and inflammatory bowel disease. Despite significant advances, such as laparoscopic techniques and multidisciplinary recovery programs, morbidity and mortality remain high and vary among surgical centers. The use of scoring systems and assessment of functional capacity may help in identifying high-risk patients and predicting complications. An understanding of perioperative factors affecting colon blood flow and oxygenation, suppression of stress response, optimal fluid therapy, and multimodal pain management are essential. These fundamental principles are more important than any specific choice of anesthetic agents. Anesthesiologists can significantly contribute to enhance recovery and improve the quality of perioperative care.

  14. Evolution and revision of the Perioperative Nursing Data Set.

    Science.gov (United States)

    Petersen, Carol; Kleiner, Cathy

    2011-01-01

    The Perioperative Nursing Data Set (PNDS) is a nursing language that provides standardized terminology to support perioperative nursing practice. The PNDS represents perioperative nursing knowledge and comprises data elements and definitions that demonstrate the nurse's influence on patient outcomes. Emerging issues and changes in practice associated with the PNDS standardized terminology require ongoing maintenance and periodic in-depth review of its content. Like each new edition of the Perioperative Nursing Data Set, the third edition, published in 2010, underwent content validation by numerous experts in clinical practice, vocabulary development, and informatics. The goal of this most recent edition is to enable the perioperative nurse to use the PNDS in a meaningful manner, as well as to promote standardization of PNDS implementation in practice, both in written documentation and the electronic health record. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. Fast-track surgery: A new concept of perioperative management of surgical patients

    Directory of Open Access Journals (Sweden)

    Gabriel Rodrigues

    2013-01-01

    Full Text Available In the past few decades, surgery has advanced greatly because of an improved understanding of perioperative pathophysiology, development of minimally invasive operative techniques and advanced anaesthetic techniques. Fewer operations are requiring extended periods of hospital stay and a growing number of procedures are performed on an ambulatory basis. The pressure on medical systems is continuously growing as a result of economic constraints, increasing numbers of patients undergoing surgical procedures and greater patient autonomy. Patient awareness is steadily increasing along with their participation in their own care, leading to expectations of a higher standard of care. This has led to the development of a new concept of fast-track surgery.

  16. Can Accelerators Accelerate Learning?

    International Nuclear Information System (INIS)

    Santos, A. C. F.; Fonseca, P.; Coelho, L. F. S.

    2009-01-01

    The 'Young Talented' education program developed by the Brazilian State Funding Agency (FAPERJ)[1] makes it possible for high-schools students from public high schools to perform activities in scientific laboratories. In the Atomic and Molecular Physics Laboratory at Federal University of Rio de Janeiro (UFRJ), the students are confronted with modern research tools like the 1.7 MV ion accelerator. Being a user-friendly machine, the accelerator is easily manageable by the students, who can perform simple hands-on activities, stimulating interest in physics, and getting the students close to modern laboratory techniques.

  17. Can Accelerators Accelerate Learning?

    Science.gov (United States)

    Santos, A. C. F.; Fonseca, P.; Coelho, L. F. S.

    2009-03-01

    The 'Young Talented' education program developed by the Brazilian State Funding Agency (FAPERJ) [1] makes it possible for high-schools students from public high schools to perform activities in scientific laboratories. In the Atomic and Molecular Physics Laboratory at Federal University of Rio de Janeiro (UFRJ), the students are confronted with modern research tools like the 1.7 MV ion accelerator. Being a user-friendly machine, the accelerator is easily manageable by the students, who can perform simple hands-on activities, stimulating interest in physics, and getting the students close to modern laboratory techniques.

  18. Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals.

    Science.gov (United States)

    Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B

    2008-01-01

    Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently.

  19. Plasma accelerators

    International Nuclear Information System (INIS)

    Bingham, R.; Angelis, U. de; Johnston, T.W.

    1991-01-01

    Recently attention has focused on charged particle acceleration in a plasma by a fast, large amplitude, longitudinal electron plasma wave. The plasma beat wave and plasma wakefield accelerators are two efficient ways of producing ultra-high accelerating gradients. Starting with the plasma beat wave accelerator (PBWA) and laser wakefield accelerator (LWFA) schemes and the plasma wakefield accelerator (PWFA) steady progress has been made in theory, simulations and experiments. Computations are presented for the study of LWFA. (author)

  20. Perioperative management of patients with pituitary tumours

    Directory of Open Access Journals (Sweden)

    Mary Abraham

    2016-01-01

    Full Text Available Management of pituitary tumours can be very challenging for the anaesthesiologist. These patients require a thorough pre-operative assessment in view of underlying endocrine disturbances, which could cause anatomic and physiological disturbances. This needs to be optimized prior to surgery and the anaesthetic technique planned accordingly. The main intraoperative problems that could be encountered by the anaesthesiologist are airway problems, haemodynamic disturbances and potential for bleeding during surgery. The postoperative concerns are related to the endocrine system and fluid and water balance and this needs to be monitored closely and managed appropriately. The advent of minimally invasive surgery along with neuroimaging has considerably decreased perioperative morbidity and mortality following pituitary surgery. A team approach and close coordination between the endocrinologist, neurosurgeon and anaesthesiologist is imperative for a favourable outcome in patients undergoing pituitary surgery.

  1. Linear Accelerators

    International Nuclear Information System (INIS)

    Vretenar, M

    2014-01-01

    The main features of radio-frequency linear accelerators are introduced, reviewing the different types of accelerating structures and presenting the main characteristics aspects of linac beam dynamics

  2. Perceptions of perioperative nursing competence: a cross-country comparison.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma B; Falk-Brynhildsen, Karin; Nilsson, Ulrica; Jaensson, Maria

    2018-01-01

    Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room. We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence. Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with > 10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland. Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

  3. Implementation of the Vocera Communication System in a Quaternary Perioperative Environment.

    Science.gov (United States)

    Friend, Tynan H; Jennings, Samantha J; Copenhaver, Martin S; Levine, Wilton C

    2017-01-01

    In the hospital, fast and efficient communication among clinicians and other employees is paramount to ensure optimal patient care, workflow efficiency, patient safety and patient comfort. The implementation of the wireless Vocera® Badge, a hands-free wearable device distributed to perioperative team members, has increased communication efficiency across the perioperative environment at Massachusetts General Hospital (MGH). This quality improvement project, based upon identical pre- and post-implementation surveys, used qualitative and quantitative analysis to determine if and how the Vocera system affected the timeliness of information flow, ease of communication, and operating room noise levels throughout the perioperative environment. Overall, the system increased the speed of information flow and eased communication between coworkers yet was perceived to have raised the overall noise level in and around the operating rooms (ORs). The perceived increase in noise was outweighed by the closed-loop communication between clinicians. Further education of the system's features in regard to speech recognition and privacy along with expected conversation protocol are necessary to ensure hassle-free communication for all staff.

  4. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

    Directory of Open Access Journals (Sweden)

    Miguel L. Tedde

    2012-11-01

    Full Text Available OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results.

  5. Validation of the TRUST tool in a Greek perioperative setting.

    Science.gov (United States)

    Chatzea, Vasiliki-Eirini; Sifaki-Pistolla, Dimitra; Dey, Nilanjan; Melidoniotis, Evangelos

    2017-06-01

    The aim of this study was to translate, culturally adapt and validate the TRUST questionnaire in a Greek perioperative setting. The TRUST questionnaire assesses the relationship between trust and performance. The study assessed the levels of trust and performance in the surgery and anaesthesiology department during a very stressful period for Greece (economic crisis) and offered a user friendly and robust assessment tool. The study concludes that the Greek version of the TRUST questionnaire is a reliable and valid instrument for measuring team performance among Greek perioperative teams. Copyright the Association for Perioperative Practice.

  6. The challenge of perioperative pain management in opioid-tolerant patients

    Directory of Open Access Journals (Sweden)

    Coluzzi F

    2017-09-01

    Full Text Available Flaminia Coluzzi,1 Francesca Bifulco,2 Arturo Cuomo,2 Mario Dauri,3 Claudio Leonardi,4 Rita Maria Melotti,5 Silvia Natoli,3 Patrizia Romualdi,6 Gennaro Savoia,7 Antonio Corcione8 1Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesia, Intensive Care and Pain Medicine, Sapienza University of Rome, Polo Pontino, Latina, 2National Cancer Institute “G Pascale” Foundation, Unit of Anaesthesia, Intensive Care and Pain Medicine, Naples, 3Department of Clinical Science and Translational Medicine, Tor Vergata University of Rome, 4Addiction Disease Department, Local Health Unit (ASL Rome 2, Rome, 5Department of Medical and Surgical Sciences, 6Department of Pharmacy and Biotechnology, Alma Mater Studiorum University of Bologna, Bologna, 7Department Anesthesia, Fatebenefratelli Hospital, Naples, 8Unit of Anaesthesia and Intensive Care, Dei Colli Hospital, V. Monaldi, Naples, Italy Abstract: The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and

  7. The concept of a composite perioperative quality index in kidney transplantation.

    Science.gov (United States)

    Taber, David J; McGillicuddy, John W; Bratton, Charles F; Lin, Angello; Chavin, Kenneth D; Baliga, Prabhakar K

    2014-04-01

    Public reporting of patient and graft outcomes in a national registry and close Centers for Medicare and Medicaid Services oversight has resulted in transplantation being a highly regulated surgical discipline. Despite this, transplantation surgery lacks comprehensive tracking and reporting of perioperative quality measures. Therefore, the aim of this study was to determine the association between a kidney transplantation centers' perioperative quality benchmarking and graft and patient outcomes. This was an analysis of 2011 aggregate data compiled from 2 national datasets that track outcomes from member hospitals and transplantation centers. The transplantation centers included in this study were composed of accredited US kidney transplantation centers that report data through the national registry and are associate members of the University HealthSystem Consortium. A total of 16,811 kidney transplantations were performed at 236 centers in the United States in 2011, of which 10,241 (61%) from 93 centers were included in the analysis. Of the 6 perioperative quality indicators, 3 benchmarked metrics were significantly associated with a kidney transplantation center's underperformance: mean ICU length of stay (C-statistic 0.731; p = 0.002), 30-day readmissions (C-statistic 0.697; p = 0.012) and in-hospital complications (C-statistic 0.785; p = 0.001). The composite quality index strongly correlated with inadequate center performance (C-statistic 0.854; p < 0.001, R(2) = 0.349). The centers in the lowest quartile of the quality index performed 2,400 kidney transplantations in 2011, which led to 2,640 more hospital days, 4,560 more ICU days, 120 more postoperative complications, and 144 more patients with 30-day readmissions, when compared with centers in the 3 higher-quality quartiles. An objective index of a transplantation center's quality of perioperative care is significantly associated with patient and graft survival. Copyright © 2014 American College of

  8. Depth of Anesthesia as a Risk Factor for Perioperative Morbidity

    Directory of Open Access Journals (Sweden)

    Argyro Petsiti

    2015-01-01

    Full Text Available Introduction. The prognostic value of age, physical status, and duration of surgery on perioperative course has been extensively studied. However, the impact of deep hypnotic time (time when Bispectral Index values are less than 40 has not been well evaluated. Methods. We designed an observational study to clarify the relative influence of deep hypnotic time (DHT on outcome. Eligible participants were mentally stable patients over 18 years old scheduled for elective major abdominal surgery. In total, 248 patients enrolled. Data were analyzed using Fisher’s exact test and multiple logistic regression. Results. Five variables (DHT, hypotension, age, comorbidity, and duration of surgery showed statistically significant association with complications, when examined independently. However, when all variables were examined together in a multiple logistic regression model, age and comorbidity were no longer associated with outcome. DHT, hypotension, and duration of surgery were significant predictors of “complications,” and “hypotension” was a significant predictor of prolonged hospital stay (P<0.001.  Conclusion. Deep hypnotic time emerged as a new factor associated with outcome, and its impact compared to other factors such as age, surgery duration, hypotension, and comorbidity is redefined. Monitoring and managing depth of anesthesia during surgery are important and should be part of careful operation planning.

  9. Anesthetic and Perioperative Management of Patients With Brugada Syndrome.

    Science.gov (United States)

    Dendramis, Gregory; Paleologo, Claudia; Sgarito, Giuseppe; Giordano, Umberto; Verlato, Roberto; Baranchuk, Adrian; Brugada, Pedro

    2017-09-15

    Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit. For this reason, in the anesthesia management of patients with BrS, the decision of using each drug must be made after careful consideration and always in controlled conditions, avoiding other factors that are known to have the potential to induce arrhythmias and with a close cooperation between anesthetists and cardiologists, which is essential before and after surgery. In conclusion, given the absence of large studies in literature, we want to focus on some general rules, which resulted from case series and clinical practice, to be followed during the perioperative and anesthetic management of patients with BrS. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Perioperative events influence cancer recurrence risk after surgery.

    Science.gov (United States)

    Hiller, Jonathan G; Perry, Nicholas J; Poulogiannis, George; Riedel, Bernhard; Sloan, Erica K

    2018-04-01

    Surgery is a mainstay treatment for patients with solid tumours. However, despite surgical resection with a curative intent and numerous advances in the effectiveness of (neo)adjuvant therapies, metastatic disease remains common and carries a high risk of mortality. The biological perturbations that accompany the surgical stress response and the pharmacological effects of anaesthetic drugs, paradoxically, might also promote disease recurrence or the progression of metastatic disease. When cancer cells persist after surgery, either locally or at undiagnosed distant sites, neuroendocrine, immune, and metabolic pathways activated in response to surgery and/or anaesthesia might promote their survival and proliferation. A consequence of this effect is that minimal residual disease might then escape equilibrium and progress to metastatic disease. Herein, we discuss the most promising proposals for the refinement of perioperative care that might address these challenges. We outline the rationale and early evidence for the adaptation of anaesthetic techniques and the strategic use of anti-adrenergic, anti-inflammatory, and/or antithrombotic therapies. Many of these strategies are currently under evaluation in large-cohort trials and hold promise as affordable, readily available interventions that will improve the postoperative recurrence-free survival of patients with cancer.

  11. Perioperative management and monitoring of a super-obese patient.

    Science.gov (United States)

    Pellis, Tommaso; Leykin, Yigal; Albano, Giovanni; Zannier, Gianfederico; Di Capua, Gabriella; Marzano, Bernardo; Gullo, Antonino

    2004-01-01

    Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.

  12. Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial

    Directory of Open Access Journals (Sweden)

    Bergman Gert JD

    2010-09-01

    Full Text Available Abstract Background Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy and were allocated at random (yes/no to manipulative therapy (manipulation and mobilization. Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%, but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555. This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard

  13. Accelerator Service

    International Nuclear Information System (INIS)

    Champelovier, Y.; Ferrari, M.; Gardon, A.; Hadinger, G.; Martin, J.; Plantier, A.

    1998-01-01

    Since the cessation of the operation of hydrogen cluster accelerator in July 1996, four electrostatic accelerators were in operation and used by the peri-nuclear teams working in multidisciplinary collaborations. These are the 4 MV Van de Graaff accelerator, 2,5 MV Van de Graaff accelerator, 400 kV ion implanter as well as the 120 kV isotope separator

  14. Making the pediatric perioperative surgical home come to life by leveraging existing health information technology.

    Science.gov (United States)

    Leahy, Izabela C; Borczuk, Rachel; Ferrari, Lynne R

    2017-06-01

    To design a patient data dashboard for the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital that supports care integration across the healthcare system as described by the pediatric perioperative surgical home (PPSH) initiative. By using 360 Technology, patient data was automatically pulled from all available Electronic Health Record sources from 2005 to the present. The PPSH dashboard described in this report provides a guide for implementation of PPSH Clinical Care Pathways. The dashboard integrates several databases to allow for visual longitudinal tracking of patient care, outcomes, and cost. The integration of electronic information provided the ability to display, compare, and analyze selected PPSH metrics in real time. By utilizing the PPSH dashboard format the use of an automated, integrated clinical, and financial health data profile for a specific patient population may improve clinicians' ability to have a comprehensive assessment of all care elements. This more global clinical thinking has the potential to produce bottom-up, evidence-based healthcare reform. The experience with the PPSH dashboard provides solid evidence for the use of integrated Electronic Health Record to improve patient outcomes and decrease cost.

  15. Total joint Perioperative Surgical Home: an observational financial review.

    Science.gov (United States)

    Raphael, Darren R; Cannesson, Maxime; Schwarzkopf, Ran; Garson, Leslie M; Vakharia, Shermeen B; Gupta, Ranjan; Kain, Zeev N

    2014-01-01

    The numbers of people requiring total arthroplasty is expected to increase substantially over the next two decades. However, increasing costs and new payment models in the USA have created a sustainability gap. Ad hoc interventions have reported marginal cost reduction, but it has become clear that sustainability lies only in complete restructuring of care delivery. The Perioperative Surgical Home (PSH) model, a patient-centered and physician-led multidisciplinary system of coordinated care, was implemented at UC Irvine Health in 2012 for patients undergoing primary elective total knee arthroplasty (TKA) or total hip arthroplasty (THA). This observational study examines the costs associated with this initiative. The direct cost of materials and services (excluding professional fees and implants) for a random index sample following the Total Joint-PSH pathway was used to calculate per diem cost. Cost of orthopedic implants was calculated based on audit-verified direct cost data. Operating room and post-anesthesia care unit time-based costs were calculated for each case and analyzed for variation. Benchmark cost data were obtained from literature search. Data are presented as mean ± SD (coefficient of variation) where possible. Total per diem cost was $10,042 ± 1,305 (13%) for TKA and $9,952 ± 1,294 (13%) for THA. Literature-reported benchmark per diem cost was $17,588 for TKA and $16,267 for THA. Implant cost was $7,482 ± 4,050 (54%) for TKA and $9869 ± 1,549 (16%) for THA. Total hospital cost was $17,894 ± 4,270 (24%) for TKA and $20,281 ± 2,057 (10%) for THA. In-room to incision time cost was $1,263 ± 100 (8%) for TKA and $1,341 ± 145 (11%) for THA. Surgery time cost was $1,558 ± 290 (19%) for TKA and $1,930 ± 374 (19%) for THA. Post-anesthesia care unit time cost was $507 ± 187 (36%) for TKA and $557 ± 302 (54%) for THA. Direct hospital costs were driven substantially below USA benchmark levels using the Total Joint-PSH pathway. The incremental

  16. Perioperative leadership: managing change with insights, priorities, and tools.

    Science.gov (United States)

    Taylor, David L

    2014-07-01

    The personal leadership of the perioperative director is a critical factor in the success of any change management initiative. This article presents an approach to perioperative nursing leadership that addresses obstacles that prevent surgical departments from achieving high performance in clinical and financial outcomes. This leadership approach consists of specific insights, priorities, and tools: key insights include self-understanding of personal barriers to leadership and accuracy at understanding economic and strategic considerations related to the OR environment; key priorities include creating a customer-centered organization, focusing on process improvement, and concentrating on culture change; and key tools include using techniques (e.g., direct engagement, collaborative leadership) to align surgical organizations with leadership priorities and mitigate specific perioperative management risks. Included in this article is a leadership development plan for perioperative directors. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  17. Perioperative Evaluation of Pregnant Surgical Patients: A Review

    Directory of Open Access Journals (Sweden)

    Manu Gupta

    2016-06-01

    Full Text Available Pregnant Females require special perioperative consideration as females react differently to treatment from physiologic and behavioural standpoints. Thus a standard perioperative assessment plays a crucial role for successful accomplishment of intraoperative and postoperative phase as well as to resist complications due to pregnancy. Each physiologic system is affected in such a way that may or may not have clinical significance for the surgeons. Thus affect of Pregnancy on cardiovascular, respiratory, gastrointestinal, renal and endocrinal system have been reviewed. Moreover to decrease the hazards to the developing child, impact of surgery/treatment on the fetus has also been discussed. It was concluded that the goal of the perioperative evaluation of pregnant females is to identify its physiological effects on various systems and provide for the best efficacious perioperative treatment algorithm that shall minimize the patient morbidity.

  18. Perioperative Clinical Nurse Specialist Role Delineation: A Systematic Review

    National Research Council Canada - National Science Library

    Cole, Lisa M; Walker, Theodore J; Nader, Kelly C; Glover, Dennis E; Newkirk, Laura E

    2006-01-01

    A clearly defined role of the Perioperative Clinical Nurse Specialist (PONS) is not identified. The purpose of this study was to provide recommendations for a delineated role of the PONS that will provide role clarity and practice guidance...

  19. Risk assessment and perioperative care in perihilar cholangiocarcinoma

    NARCIS (Netherlands)

    Coelen, R.J.S.

    2016-01-01

    Perihilar cholangiocarcinoma is one of the most complex gastrointestinal malignancies due to the many pitfalls encountered at various stages of its management. Despite several techniques to optimize the patient for operation, liver surgery for perihilar cholangiocarcinoma remains a hazardous

  20. Anaesthesia and peri-operative care for laparoscopic donor nephrectomy

    NARCIS (Netherlands)

    I.R.A.M. Mertens Zur Borg (Ingrid)

    2008-01-01

    textabstractA successful renal transplant for patients with kidney failure reduces mortality rate when compared to patients who continue dialysis. Organ donation from living donors has significant better results over organ donation from deceased donors. Traditionally the surgical

  1. Perioperative care of an infant with pyruvate dehydrogenase ...

    African Journals Online (AJOL)

    2011-08-31

    Aug 31, 2011 ... cerebrospinal fluid was obtained, isobaric bupivacaine. (0.5 mg/kg), with an ... cases, blood gas analysis was performed at the start, and conclusion, of surgery. ... included a continuous bicarbonate infusion and mechanical ...

  2. Perioperative corticosteroids for intermittent and mild persistent asthma

    OpenAIRE

    Hiroto Matsuse; Terufumi Shimoda; Ikuko Machida; Yuki Kondo; Tetsuya Kawano; Sachiko Saeki; Shinya Tomari; Kazuko Mitsuta; Chizu Fukushima; Yasushi Obase; Shigeru Kohno

    2002-01-01

    Objectives: Asthmatics are considered to be at high risk for pulmonary complications during general anesthesia with tracheal intubation. The purpose of the present study was to determine the usefulness of perioperative corticosteroids for mild asthmatics in preventing perioperative exacerbation of asthma. Methods: Airway hyperresponsiveness to inhaled methacholine was determined in patients with intermittent (n = 27) and mild persistent (n = 48) asthma before general anesthesia who underwe...

  3. Accelerating Research Impact in a Learning Health Care System: VA's Quality Enhancement Research Initiative in the Choice Act Era.

    Science.gov (United States)

    Kilbourne, Amy M; Elwy, A Rani; Sales, Anne E; Atkins, David

    2017-07-01

    Since 1998, the Veterans Health Administration (VHA) Quality Enhancement Research Initiative (QUERI) has supported more rapid implementation of research into clinical practice. With the passage of the Veterans Access, Choice and Accountability Act of 2014 (Choice Act), QUERI further evolved to support VHA's transformation into a Learning Health Care System by aligning science with clinical priority goals based on a strategic planning process and alignment of funding priorities with updated VHA priority goals in response to the Choice Act. QUERI updated its strategic goals in response to independent assessments mandated by the Choice Act that recommended VHA reduce variation in care by providing a clear path to implement best practices. Specifically, QUERI updated its application process to ensure its centers (Programs) focus on cross-cutting VHA priorities and specify roadmaps for implementation of research-informed practices across different settings. QUERI also increased funding for scientific evaluations of the Choice Act and other policies in response to Commission on Care recommendations. QUERI's national network of Programs deploys effective practices using implementation strategies across different settings. QUERI Choice Act evaluations informed the law's further implementation, setting the stage for additional rigorous national evaluations of other VHA programs and policies including community provider networks. Grounded in implementation science and evidence-based policy, QUERI serves as an example of how to operationalize core components of a Learning Health Care System, notably through rigorous evaluation and scientific testing of implementation strategies to ultimately reduce variation in quality and improve overall population health.

  4. Novel approaches in management of perioperative coagulopathy.

    Science.gov (United States)

    Tanaka, Kenichi A; Bader, Stephen O; Görlinger, Klaus

    2014-02-01

    The recent advances in hemostatic monitoring, and discussion of the clinical implications of hemostatic therapies based on different blood components and factor concentrates. Implementing suitable laboratory tests and transfusion protocols is highly recommended because the laboratory test guided, protocol-driven transfusion approach reduces blood component utilization, and possibly leads to improved outcomes. Timely assessment of coagulation has been difficult using conventional coagulation tests, but thrombocytopenia, fibrin polymerization defects, and fibrinolysis can be quickly assessed on thromboelastometry. The latter testing can be applied to guide the dosing of fibrinogen and prothrombin complex concentrate, which are selectively used to correct fibrinogen deficiency, and improve thrombin generation in acquired coagulopathy. These therapeutic approaches are novel, and potentially effective in reducing the exposure to allogeneic components (e.g., plasma and platelets) and side-effects of transfusion. Although the accessibility of different therapies among different countries, tranexamic acid is widely available, and is an effective blood conservation measure with a good safety profile in various surgical settings. Our understanding of perioperative coagulopathy, diagnostic tools, and therapeutic approaches has evolved in recent years. Additional multidisciplinary efforts are required to understand the optimal combinations, cost-effectiveness, and safety profiles of allogeneic components, and available factor concentrates.

  5. PERIOPERATIVE MANAGEMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    V. N. Amirdzhanova

    2014-01-01

    Full Text Available The paper considers the joint management of rheumatoid arthritis patients needing endoprosthetic replacement of the large joints of the lower extremities by rheumatologists and orthopedic traumatologists.Due to the fact that there are no conventional standards or guidelines for the perioperative management of patients with rheumatic diseases, adopted by international rheumatology associations, the authors generalize their experience in managing the patients in terms of international approaches and guidelines from different countries. The medical assessment and reduction of cardiovascular risks, the prevention of infectious complications, hemorrhages, and lower extremity deep vein thrombosis, and the specific features of management of patients with osteoporosis are under consideration. The authors' experience in managing the patients receiving antirheumatic therapy with nonsteroidal antiinflammatory and disease-modifying antirheumatic drugs, such as methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine, is detailed. Recommendations for managing patients taking glucocorticoids and biologic agents (tumor necrosis factor-α inhibitors, anti-B-cell therapy, and interleukin-6 receptor inhibitors in the preoperative andpostoperative periods are given.

  6. Perioperative nursing and education: what the IOM future of nursing report tells us.

    Science.gov (United States)

    Battié, Renae N

    2013-09-01

    Changes in the current health care system have rendered the system unprepared to support new demands. Similarly, nursing education both before and after licensure is no longer adequate. Four of the eight recommendations in the Institute of Medicine's Future of Nursing report involve changes to nursing education and pose significant goals to achieve. This makes creating innovative ways to meet the demand for educating RNs a necessity. This article discusses the Institute of Medicine's recommendations, how they relate to perioperative nursing, and ways in which nurses and educators can help promote expectations. Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  7. Proceedings of the 2013 CINP summit: innovative partnerships to accelerate CNS drug discovery for improved patient care.

    Science.gov (United States)

    Phillips, Anthony George; Hongaard-Andersen, Peter; Moscicki, Richard A; Sahakian, Barbara; Quirion, Rémi; Krishnan, K Ranga Rama; Race, Tim

    2014-12-25

    Central nervous system (CNS) diseases and, in particular, mental health disorders, are becoming recognized as the health challenge of the 21(st) century. Currently, at least 10% of the global population is affected by a mental health disorder, a figure that is set to increase year on year. Meanwhile, the rate of development of new CNS drugs has not increased for many years, despite unprecedented levels of investment. In response to this state of affairs, the Collegium Internationale Neuro-Psychopharmacologicum (CINP) convened a summit to discuss ways to reverse this disturbing trend through new partnerships to accelerate CNS drug discovery. The objectives of the Summit were to explore the issues affecting the value chain (i.e. the chain of activities or stakeholders that a company engages in/with to deliver a product to market) in brain research, thereby gaining insights from key stakeholders and developing actions to address unmet needs; to identify achievable objectives to address the issues; to develop action plans to bring about measurable improvements across the value chain and accelerate CNS drug discovery; and finally, to communicate recommendations to governments, the research and development community, and other relevant stakeholders. Summit outputs include the following action plans, aligned to the pressure points within the brain research-drug development value chain: Code of conduct dealing with conflict of interest issues, Prevention, early diagnosis, and treatment, Linking science and regulation, Patient involvement in trial design, definition of endpoints, etc., Novel trial design, Reproduction and confirmation of data, Update of intellectual property (IP) laws to facilitate repurposing and combination therapy (low priority), Large-scale, global patient registries, Editorials on nomenclature, biomarkers, and diagnostic tools, and Public awareness, with brain disease advocates to attend G8 meetings and World Economic Forum (WEF) Annual meetings in

  8. Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature.

    Science.gov (United States)

    Fouladpour, Nick; Jesudoss, Rajinish; Bolden, Norman; Shaman, Ziad; Auckley, Dennis

    2016-01-01

    Obstructive sleep apnea (OSA) is common in patients undergoing surgery. OSA, known or suspected, has been associated with significant perioperative adverse events, including severe neurologic injury and death. This study was undertaken to assess the legal consequences associated with poor outcomes related to OSA in the perioperative setting. A retrospective review of the legal literature was performed by searching 3 primary legal databases between the years 1991 and 2010 for cases involving adults with known or suspected OSA who underwent a surgical procedure associated with an adverse perioperative outcome. OSA had to be directly implicated in the outcome, and surgical mishaps (i.e., uncontrolled bleeding) were excluded. The adverse perioperative outcome had to result in a lawsuit that was then adjudicated in a court of law with a final decision rendered. Data were abstracted from each case regarding patient demographics, type of surgery, type and location of adverse event, associated anesthetic and opioid use, and legal outcome. Twenty-four cases met the inclusion criteria. The majority (83%) occurred in or after 2007. Patients were young (average age, 41.7 years), male (63%), and had a known diagnosis of OSA (96%). Ninety-two percent of cases were elective with 33.3% considered general procedures, 37.5% were ears, nose and throat procedures for the treatment of OSA, and 29.1% were considered miscellaneous interventions. Complications occurred intraoperatively (21%), in the postanesthesia care unit (33%), and on the surgical floors (46%). The most common complications were respiratory arrest in an unmonitored setting and difficulty in airway management. Immediate adverse outcomes included death (45.6%), anoxic brain injury (45.6%), and upper airway complications (8%). Overall, 71% of the patients died, with 6 of the 11 who suffered anoxic brain injury dying at an average of 113 days later. The use of opioids and general anesthetics was believed to play a role in

  9. Future accelerators (?)

    Energy Technology Data Exchange (ETDEWEB)

    John Womersley

    2003-08-21

    I describe the future accelerator facilities that are currently foreseen for electroweak scale physics, neutrino physics, and nuclear structure. I will explore the physics justification for these machines, and suggest how the case for future accelerators can be made.

  10. Perioperative Management of Children With Giant Encephalocele: A Clinical Report of 29 Cases.

    Science.gov (United States)

    Mahajan, Charu; Rath, Girija P; Bithal, Parmod K; Mahapatra, Ashok K

    2017-07-01

    Giant encephalocele, a rare entity, makes anesthesiologists wary of challenging anesthetic course. Apart from inherent challenges of pediatric anesthesia, the anesthesiologist has to deal with unusual positioning, difficult tracheal intubation, and associated anomalies during the perioperative course. Medical records of 29 children with giant encephalocele, who underwent excision and repair, during a period of 13 years, were retrospectively analyzed. Data pertaining to anesthetic management, perioperative complications, and outcome at discharge were reviewed. The average age at admission was 164 days. Hydrocephalus and delayed milestones were present in 19 (65.5%) and 7 (24.1%) children, respectively. Difficulty in tracheal intubation was encountered, in 15 (51.7%) children. Tracheal intubation was attempted with direct laryngoscopy, most often, in lateral position (24 [82.8%]). Intraoperative hemodynamic and respiratory complications were observed in 9 (31.0%) and 5 (17.2%) children, respectively. Intraoperative hypothermia was observed in 4 (13.8%) children. The average stay in the intensive care unit was 2.7 days and average hospital stay was 11.5 days. The condition at discharge remained same as the preoperative period in 24 children (82.7%), deteriorated in 2 (6.9%), and 3 children (10.3%) died. Management of children with giant encephalocele requires the updated knowledge on possible difficulties encountered during the perioperative period. They need specialized anesthetic care for dealing with difficult tracheal intubation, associated congenital anomalies, unusual positioning, electrolyte abnormalities, hypothermia, and cardiorespiratory disturbances. For securing the airway, we suggest the practice of direct laryngoscopy in lateral position after inhalational induction. Muscle relaxant should be administered only after visualization of the glottis.

  11. Clinical benefits after the implementation of a multimodal perioperative protocol in elderly patients.

    Science.gov (United States)

    Aguilar-Nascimento, José Eduardo de; Salomão, Alberto Bicudo; Caporossi, Cervantes; Diniz, Breno Nadaf

    2010-01-01

    Multimodal protocol of perioperative care may enhance recovery after surgery. Based on evidence these new routines of perioperative care changed conventional prescriptions in surgery. To evaluate the results of a multimodal protocol (ACERTO protocol) in elderly patients. Non-randomized historical cohort study was performed at the surgical ward of a tertiary university hospital. One hundred seventeen patients aged 60 and older were submitted to elective abdominal operations under either conventional (n = 42; conventional group, January 2004-June 2005) or a fast-track perioperative protocol named ACERTO (n = 75; ACERTO group, July 2005-December 2007). Main endpoints were preoperative fasting time, postoperative day of re-feeding, volume of intravenous fluids, length of hospital stay and morbidity. The implantation of the ACERTO protocol was followed by a decrease in both preoperative fasting (15 [8-20] vs 4 [2-20] hours, P<0.001) and postoperative day of refeeding (1st [1st-10th] vs 0 [0-5th] PO day; P<0.01), and intravenous fluids (10.7 [2.5-57.5] vs 2.5 [0.5-82] L, P<0.001). The changing of protocols reduced the mean length of hospital stay by 4 days (6[1-43] vs 2[1-97] days; P = 0.002) and surgical site infection rate by 85.7% (19%; 8/42 vs 2.7%; 2/75, P<0.001; relative risk = 1.20; 95% confidence interval = 1.03-1.39). Per-protocol analysis showed that hospital stay in major operations diminished only in patients who completed the protocol (P<0.01). The implementation of multidisciplinary routines of the ACERTO protocol diminished both hospitalization and surgical site infection in elderly patients submitted to abdominal operations.

  12. American Thyroid Association statement on the essential elements of interdisciplinary communication of perioperative information for patients undergoing thyroid cancer surgery.

    Science.gov (United States)

    Carty, Sally E; Doherty, Gerard M; Inabnet, William B; Pasieka, Janice L; Randolph, Gregory W; Shaha, Ashok R; Terris, David J; Tufano, Ralph P; Tuttle, R Michael

    2012-04-01

    Thyroid cancer specialists require specific perioperative information to develop a management plan for patients with thyroid cancer, but there is not yet a model for effective interdisciplinary data communication. The American Thyroid Association Surgical Affairs Committee was asked to define a suggested essential perioperative dataset representing the critical information that should be readily available to participating members of the treatment team. To identify and agree upon a multidisciplinary set of critical perioperative findings requiring communication, we examined diverse best-practice documents relating to thyroidectomy and extracted common features felt to enhance precise, direct communication with nonsurgical caregivers. Suggested essential datasets for the preoperative, intraoperative, and immediate postoperative findings and management of patients undergoing surgery for thyroid cancer were identified and are presented. For operative reporting, the essential features of both a dictated narrative format and a synoptic computer format are modeled in detail. The importance of interdisciplinary communication is discussed with regard to the extent of required resection, the final pathology findings, surgical complications, and other factors that may influence risk stratification, adjuvant treatment, and surveillance. Accurate communication of the important findings and sequelae of thyroidectomy for cancer is critical to individualized risk stratification as well as to the clinical issues of thyroid cancer care that are often jointly managed in the postoperative setting. True interdisciplinary care is essential to providing optimal care and surveillance.

  13. Perioperative antibiotics for surgical site infection in pancreaticoduodenectomy: does the SCIP-approved regimen provide adequate coverage?

    Science.gov (United States)

    Donald, Graham W; Sunjaya, Dharma; Lu, Xuyang; Chen, Formosa; Clerkin, Barbara; Eibl, Guido; Li, Gang; Tomlinson, James S; Donahue, Timothy R; Reber, Howard A; Hines, Oscar J

    2013-08-01

    The Joint Commission Surgical Care Improvement Project (SCIP) includes performance measures aimed at reducing surgical site infections (SSI). One measure defines approved perioperative antibiotics for general operative procedures. However, there may be a subset of procedures not adequately covered with the use of approved antibiotics. We hypothesized that piperacillin-tazobactam is a more appropriate perioperative antibiotic for pancreaticoduodenectomy (PD). In collaboration with hospital epidemiology and the Division of Infectious Diseases, we retrospectively reviewed records of 34 patients undergoing PD between March and May 2008 who received SCIP-approved perioperative antibiotics and calculated the SSI rate. After changing our perioperative antibiotic to piperacillin-tazobactam, we prospectively reviewed PDs performed between June 2008 and March 2009 and compared the SSI rates before and after the change. For 34 patients from March through May 2008, the SSI rate for PD was 32.4 per 100 cases. Common organisms from wound cultures were Enterobacter and Enterococcus (50.0% and 41.7%, respectively), and these were cefoxitin resistant. From June 2008 through March 2009, 106 PDs were performed. During this period, the SSI rate was 6.6 per 100 surgeries, 80% lower than during March through May 2008 (relative risk, 0.204; 95% confidence interval [CI], 0.086-0.485; P = .0004). Use of piperacillin-tazobactam as a perioperative antibiotic in PD may reduce SSI compared with the use of SCIP-approved antibiotics. Continued evaluation of SCIP performance measures in relationship to patient outcomes is integral to sustained quality improvement. Copyright © 2013 Mosby, Inc. All rights reserved.

  14. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  15. The role of perioperative warming in surgery: a systematic review

    Directory of Open Access Journals (Sweden)

    Muhammad Shafique Sajid

    Full Text Available OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD. RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

  16. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study.

    Science.gov (United States)

    Garg, Rakesh; Khanna, Puneet; Sinha, Renu

    2011-05-01

    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  17. Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures.

    Science.gov (United States)

    Kothari, Anai N; Zapf, Matthew A C; Blackwell, Robert H; Markossian, Talar; Chang, Victor; Mi, Zhiyong; Gupta, Gopal N; Kuo, Paul C

    2015-10-01

    We hypothesized that perioperative hospital resources could overcome the "weekend effect" (WE) in patients undergoing emergent/urgent surgeries. The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

  18. Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility

    Directory of Open Access Journals (Sweden)

    Rodrigo de Carvalho Santana

    2016-04-01

    Full Text Available Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260. From 2007-2013, this percentage was 18.1% (965/5331. Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

  19. Tranexamic Acid: From Trauma to Routine Perioperative Use

    Science.gov (United States)

    Simmons, Jeff; Sikorski, Robert A.; Pittet, Jean-Francois

    2015-01-01

    Purpose Of Review Optimizing hemostasis with antifibrinolytics is becoming a common surgical practice. Large clinical studies have demonstrated efficacy and safety of tranexamic acid (TXA) in the trauma population to reduce blood loss and transfusions. Its use in patients without preexisting coagulopathies is debated, as thromboembolic events are a concern. In this review, perioperative administration of TXA is examined in non-trauma surgical populations. Additionally, risk of thromboembolism, dosing regimens, and timing of dosing are assessed. Recent Findings Perioperative use of tranexamic acid is associated with reduced blood loss and transfusions. Thromboembolic effects do not appear to be increased. However, optimal dosing and timing of TXA administration is still under investigation for non-trauma surgical populations. Summary As part of a perioperative blood management program, tranexamic acid can be used to help reduce blood loss and mitigate exposure to blood transfusion. PMID:25635366

  20. Old, new and hidden causes of perioperative hypersensitivity

    DEFF Research Database (Denmark)

    Garvey, Lene Heise

    2016-01-01

    intravenously such as neuromuscular blocking agents (NMBA), induction agents and antibiotics have traditionally been reported to be implicated most commonly. It has recently become apparent that there are geographical differences in sensitization patterns related to variation in exposures, referral patterns...... and performance and interpretation of investigations. Differences in sensitization to NMBAs are partly explained by cross sensitization to pholcodine, an ingredient in cough-medicines available in some countries. While NMBAs are the most common causes of perioperative hypersensitivity in some countries, this may...... in causes of perioperative hypersensitivity emerging over time and to increase awareness about the “hidden allergens” in the perioperative setting. Some practical advice on how to approach the patient testing negative on all initial investigations is also included....

  1. Accelerating the rate of improvement in cystic fibrosis care: contributions and insights of the learning and leadership collaborative.

    Science.gov (United States)

    Godfrey, Marjorie M; Oliver, Brant J

    2014-04-01

    The Learning and Leadership Collaborative (LLC) supports cystic fibrosis (CF) centres' responses to the variation in CF outcomes in the USA. Between 2002 and 2013, the Cystic Fibrosis Foundation (CFF) designed, tested and modified the LLC to guide front line staff efforts in these efforts. This paper describes the CFF LLC evolution and essential elements that have facilitated increased improvement capability of CF centres and improved CF outcomes. CF centre improvement teams across the USA have participated in 11 LLCs of 12 months' duration since 2002. Based on the Dartmouth Microsystem Improvement Curriculum, the original LLC included face to face meetings, an email listserv, conference calls and completion of between learning session task books. The LLCs evolved over time to include internet based learning, an electronic repository of improvement resources and examples, change ideas driven by evidence based clinical practice guidelines, benchmarking site visits, an applied QI measurement curriculum and team coaching. Over 90% of the CF centres in the USA have participated in the LLCs and have increased their improvement capabilities. Ten essential elements were identified as contributors to the successful LLCs: LLC national leadership and coordination, local leadership, people with CF and families involvement, registry data transparency, standardised improvement curriculum with evidence based change ideas, internet resources with reminders, team coaching, regular progress reporting and tracking, benchmarking site visits and applied improvement measurement. The LLCs have contributed to improved medical and process outcomes over the past 10 years. Ten essential elements of the LLCs may benefit improvement efforts in other chronic care populations and health systems.

  2. Significant complications occurred in the perioperative period of peripheral vascular interventions:an analysis of 1620 consecutive procedures

    International Nuclear Information System (INIS)

    Yan Zicai; Liu Li; Zhang Haibo; Wang Ning; Li Yu; Yan Ying

    2010-01-01

    Objective: To categorize the significant complications occurred in the perioperative period of peripheral vascular interventions and to analyze their causes, outcomes and managements in order to make a further understanding of the cause of occurrence and to improve the handling ability. Methods: Over the past five years a total of 1620 consecutive peripheral vascular interventions were carried out in our institute. Significant complications, which occurred in the perioperative period, and the clinical data were carefully examined. The occurrence, treatment, consequence and final outcome of each complication were retrospectively analyzed. Results: Of 1620 consecutive peripheral interventional procedures, significant complication which developed during the operation or within one week after the treatment was seen in 76 (4.69%). The significant complications could be classified into twelve kinds. After proper management most complications were cured without leaving any sequelae. Nevertheless, in some patients permanent damages such as paraplegia, lower limb paralysis, necrosis of gluteus, etc. were left over. Death occurred in six patients. Of the six patients, four died of concomitant hepatic failure and agranulocytosis, one of retroperitoneal hematoma and hemoperitoneum, and another one of pulmonary embolism. Conclusion: (1) Significant complications may occur in most peripheral vascular interventional therapies, which, in most cases, are mainly related to the insufficient understanding of the disease and improper manipulation. (2) A comprehensive and solid fundamental knowledge of the disease, strictly following the indications and careful handling the operation are the key points to reduce the occurrence of severe complications in the perioperative period of peripheral vascular interventions. (authors)

  3. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ehab A. Wahby

    2016-08-01

    Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.

  4. Strategier til begraensning af det perioperative forbrug af allogent blod

    DEFF Research Database (Denmark)

    Jørgensen, B G; Qvist, N

    2001-01-01

    Allogenic blood transfusion carries the risk of immunological and non-immunological adverse effects. Consequently, blood transfusion should be limited to situations where alternatives are not available. This article reviews current by available alternative strategies that reduce the need...... for perioperative allogenic blood transfusion. The effectiveness of a number of these alternatives needs to be documented and potential adverse effects clarified. The acceptance of a lower haemoglobin level as the transfusion trigger value is perhaps the most important factor in reducing the need for peri......-operative allogenic blood transfusion...

  5. Electrostatic accelerators

    OpenAIRE

    Hinterberger, F

    2006-01-01

    The principle of electrostatic accelerators is presented. We consider Cockcroft– Walton, Van de Graaff and Tandem Van de Graaff accelerators. We resume high voltage generators such as cascade generators, Van de Graaff band generators, Pelletron generators, Laddertron generators and Dynamitron generators. The speci c features of accelerating tubes, ion optics and methods of voltage stabilization are described. We discuss the characteristic beam properties and the variety of possible beams. We ...

  6. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    , 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......BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE...... (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational...

  7. Successful implementation of a perioperative glycemic control protocol in cardiac surgery: barrier analysis and intervention using lean six sigma.

    Science.gov (United States)

    Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  8. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Science.gov (United States)

    Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

  9. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Martinez

    2011-01-01

    Full Text Available Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.

  10. Electrostatic accelerators

    CERN Document Server

    Hinterberger, F

    2006-01-01

    The principle of electrostatic accelerators is presented. We consider Cockcroft– Walton, Van de Graaff and Tandem Van de Graaff accelerators. We resume high voltage generators such as cascade generators, Van de Graaff band generators, Pelletron generators, Laddertron generators and Dynamitron generators. The speci c features of accelerating tubes, ion optics and methods of voltage stabilization are described. We discuss the characteristic beam properties and the variety of possible beams. We sketch possible applications and the progress in the development of electrostatic accelerators.

  11. Accelerator development

    International Nuclear Information System (INIS)

    Anon.

    1975-01-01

    Because the use of accelerated heavy ions would provide many opportunities for new and important studies in nuclear physics and nuclear chemistry, as well as other disciplines, both the Chemistry and Physics Divisions are supporting the development of a heavy-ion accelerator. The design of greatest current interest includes a tandem accelerator with a terminal voltage of approximately 25 MV injecting into a linear accelerator with rf superconducting resonators. This combined accelerator facility would be capable of accelerating ions of masses ranging over the entire periodic table to an energy corresponding to approximately 10 MeV/nucleon. This approach, as compared to other concepts, has the advantages of lower construction costs, lower operating power, 100 percent duty factor, and high beam quality (good energy resolution, good timing resolution, small beam size, and small beam divergence). The included sections describe the concept of the proposed heavy-ion accelerator, and the development program aiming at: (1) investigation of the individual questions concerning the superconducting accelerating resonators; (2) construction and testing of prototype accelerator systems; and (3) search for economical solutions to engineering problems. (U.S.)

  12. Association of perioperative blood pressure with long-term survival in rectal cancer patients.

    Science.gov (United States)

    Yu, Hui-Chuan; Luo, Yan-Xin; Peng, Hui; Wang, Xiao-Lin; Yang, Zi-Huan; Huang, Mei-Jin; Kang, Liang; Wang, Lei; Wang, Jian-Ping

    2016-04-11

    Several studies suggested that hypertension is positively related to cancer incidence and mortality. In this study, we investigated the association between perioperative blood pressure (BP) and long-term survival outcomes in patients with rectal cancer. This study included a cohort of 358 patients with stages I-III rectal cancer who underwent a curative resection between June 2007 and June 2011. Both pre- and postoperative BPs were measured, by which patients were grouped (low BP: cancer-specific survival (CSS). Univariate analysis showed that patients with high preoperative systolic BP had lower 3-year DFS (67.2% vs. 82.1%, P = 0.041) and CSS rates (81.9% vs. 94.8%, P = 0.003) than patients with low preoperative systolic BP, and the associations remained significant in the Cox multivariate analysis, with the adjusted hazard ratios equal to 1.97 [95% confidence interval (CI) = 1.08-3.60, P = 0.028] and 2.85 (95% CI = 1.00-8.25, P = 0.050), respectively. Similarly, in postoperative evaluation, patients with high systolic BP had significantly lower 3-year CSS rates than those with low systolic BP (78.3% vs. 88.9%, P = 0.032) in univariate analysis. Moreover, high pre- and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension, with and/or without perioperative administration of antihypertensive drugs. High preoperative systolic BP was an independent risk factor for both CSS and DFS rates, and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer patients. Additionally, our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative care. However, further studies should be conducted to determine the association between BP and CSS and targets of BP control.

  13. Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia.

    Science.gov (United States)

    John, M; Crook, D; Dasari, K; Eljelani, F; El-Haboby, A; Harper, C M

    2016-02-01

    Forced-air warming is a commonly used warming modality, which has been shown to reduce the incidence of inadvertent perioperative hypothermia (heating mattresses offer a potentially cheaper alternative, however, and one of the research recommendations from the National Institute for Health and Care Excellence was to evaluate such devices formally. We conducted a randomized single-blinded study comparing perioperative hypothermia in patients receiving resistive heating or forced-air warming. A total of 160 patients undergoing non-emergency surgery were recruited and randomly allocated to receive either forced-air warming (n=78) or resistive heating (n=82) in the perioperative period. Patient core temperatures were monitored after induction of anaesthesia until the end of surgery and in the recovery room. Our primary outcome measures included the final intraoperative temperature and incidence of hypothermia at the end of surgery. There was a significantly higher rate of hypothermia at the end of surgery in the resistive heating group compared with the forced-air warming group (P=0.017). Final intraoperative temperatures were also significantly lower in the resistive heating group (35.9 compared with 36.1°C, P=0.029). Hypothermia at the end of surgery in both warming groups was common (36% forced air warming, 54% resistive heating). Our results suggest that forced-air warming is more effective than resistive heating in preventing postoperative hypothermia. NCT01056991. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Perioperative mortality in cats and dogs undergoing spay or castration at a high-volume clinic.

    Science.gov (United States)

    Levy, J K; Bard, K M; Tucker, S J; Diskant, P D; Dingman, P A

    2017-06-01

    High volume spay-neuter (spay-castration) clinics have been established to improve population control of cats and dogs to reduce the number of animals admitted to and euthanazed in animal shelters. The rise in the number of spay-neuter clinics in the USA has been accompanied by concern about the quality of animal care provided in high volume facilities, which focus on minimally invasive, time saving techniques, high throughput and simultaneous management of multiple animals under various stages of anesthesia. The aim of this study was to determine perioperative mortality for cats and dogs in a high volume spay-neuter clinic in the USA. Electronic medical records and a written mortality log were used to collect data for 71,557 cats and 42,349 dogs undergoing spay-neuter surgery from 2010 to 2016 at a single high volume clinic in Florida. Perioperative mortality was defined as deaths occurring in the 24h period starting with the administration of the first sedation or anesthetic drugs. Perioperative mortality was reported for 34 cats and four dogs for an overall mortality of 3.3 animals/10,000 surgeries (0.03%). The risk of mortality was more than twice as high for females (0.05%) as for males (0.02%) (P=0.008) and five times as high for cats (0.05%) as for dogs (0.009%) (P=0.0007). High volume spay-neuter surgery was associated with a lower mortality rate than that previously reported in low volume clinics, approaching that achieved in human surgery. This is likely to be due to the young, healthy population of dogs and cats, and the continuous refinement of techniques based on experience and the skills and proficiency of teams that specialize in a limited spectrum of procedures. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia.

    Science.gov (United States)

    Maker, Ajay V; Sheikh, Raashid; Bhagia, Vinita

    2017-09-01

    infusion, and glucagon rescue therapy has greatly improved management in the modern era and constitute the current standard of care. A simple immediate post-operative algorithm was constructed. Successful perioperative surgical management of total pancreatectomy and resulting pancreatogenic diabetes is critical to achieve acceptable post-operative outcomes, and we review the pertinent literature and provide a simple, evidence-based algorithm for immediate post-resection glycemic control.

  16. Developing and testing accelerated partner therapy for partner notification for people with genital Chlamydia trachomatis diagnosed in primary care: a pilot randomised controlled trial.

    Science.gov (United States)

    Estcourt, Claudia S; Sutcliffe, Lorna J; Copas, Andrew; Mercer, Catherine H; Roberts, Tracy E; Jackson, Louise J; Symonds, Merle; Tickle, Laura; Muniina, Pamela; Rait, Greta; Johnson, Anne M; Aderogba, Kazeem; Creighton, Sarah; Cassell, Jackie A

    2015-12-01

    Accelerated partner therapy (APT) is a promising partner notification (PN) intervention in specialist sexual health clinic attenders. To address its applicability in primary care, we undertook a pilot randomised controlled trial (RCT) of two APT models in community settings. Three-arm pilot RCT of two adjunct APT interventions: APTHotline (telephone assessment of partner(s) plus standard PN) and APTPharmacy (community pharmacist assessment of partner(s) plus routine PN), versus standard PN alone (patient referral). Index patients were women diagnosed with genital chlamydia in 12 general practices and three community contraception and sexual health (CASH) services in London and south coast of England, randomised between 1 September 2011 and 31 July 2013. 199 women described 339 male partners, of whom 313 were reported by the index as contactable. The proportions of contactable partners considered treated within 6 weeks of index diagnosis were APTHotline 39/111 (35%), APTPharmacy 46/100 (46%), standard patient referral 46/102 (45%). Among treated partners, 8/39 (21%) in APTHotline arm were treated via hotline and 14/46 (30%) in APTPharmacy arm were treated via pharmacy. The two novel primary care APT models were acceptable, feasible, compliant with regulations and capable of achieving acceptable outcomes within a pilot RCT but intervention uptake was low. Although addition of these interventions to standard PN did not result in a difference between arms, overall PN uptake was higher than previously reported in similar settings, probably as a result of introducing a formal evaluation. Recruitment to an individually randomised trial proved challenging and full evaluation will likely require service-level randomisation. Registered UK Clinical Research Network Study Portfolio id number 10123. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Perioperative nursing for patients receiving endovascular therapy for ruptured abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Dong Yanfen; Pan Wei; Zhang Hongpeng; Guo Wei; Liu Xiaoping; Wei Ren

    2010-01-01

    Objective: To discuss the nursing strategy and practical measures for patients with ruptured abdominal aortic aneurysm during the perioperative period of endovascular intervention. Methods: Endovascular therapy was carried out in 34 patients with ruptured abdominal aortic aneurysm,who were encountered in our department during the period of July 1997 to September 2008. The clinical data were retrospectively analyzed and the nursing points were summarized. Results: The average hospitalization days of the 34 patients were (14 ± 5) days, the mortality rate within 30 days was 23.5% (8/34). No nursing-related complications occurred. Conclusion: A comprehensive understanding of the mechanism, development and clinical evolution of ruptured abdominal aortic aneurysm is very important for nursing care. For nursing staff, well mastering the relevant nursing technique, carefully guarding against any nursing errors and lessening patient's suffering as far as possible, all these are the task of primary importance. (authors)

  18. Perioperative challenges in management of a deaf and dumb patient posted for high-risk cardiac surgery

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2016-01-01

    Full Text Available Perioperative management of deaf and dumb patients can be a challenging task. For smooth postoperative recovery, proper care should begin in the preoperative period. Understanding the patients′ needs and training him to follow the instructions requires to involve a communication specialist. Judicious use of sedatives and analgesics is essential to keep the patient pain-free and comfortable. Postoperatively, the patient should be kept awake, enough to understand the internal need of the body and to make a meaningful response to external stimuli. Adequate preoperative planning and coordinated team efforts with involvement of specialists can help in delivering better postoperative care.

  19. Perioperative challenges in management of a deaf and dumb patient posted for high-risk cardiac surgery.

    Science.gov (United States)

    Chowdhry, Vivek; Padhi, Manoranjan; Mohanty, B B; Biswal, Suvakanta

    2016-01-01

    Perioperative management of deaf and dumb patients can be a challenging task. For smooth postoperative recovery, proper care should begin in the preoperative period. Understanding the patients' needs and training him to follow the instructions requires to involve a communication specialist. Judicious use of sedatives and analgesics is essential to keep the patient pain-free and comfortable. Postoperatively, the patient should be kept awake, enough to understand the internal need of the body and to make a meaningful response to external stimuli. Adequate preoperative planning and coordinated team efforts with involvement of specialists can help in delivering better postoperative care.

  20. Desmopressin use for minimising perioperative blood transfusion

    Science.gov (United States)

    Desborough, Michael J; Oakland, Kathryn; Brierley, Charlotte; Bennett, Sean; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Stanworth, Simon J; Estcourt, Lise J

    2017-01-01

    Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low

  1. RECIRCULATING ACCELERATION

    International Nuclear Information System (INIS)

    BERG, J.S.; GARREN, A.A.; JOHNSTONE, C.

    2000-01-01

    This paper compares various types of recirculating accelerators, outlining the advantages and disadvantages of various approaches. The accelerators are characterized according to the types of arcs they use: whether there is a single arc for the entire recirculator or there are multiple arcs, and whether the arc(s) are isochronous or non-isochronous

  2. LIBO accelerates

    CERN Multimedia

    2002-01-01

    The prototype module of LIBO, a linear accelerator project designed for cancer therapy, has passed its first proton-beam acceleration test. In parallel a new version - LIBO-30 - is being developed, which promises to open up even more interesting avenues.

  3. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG)

    International Nuclear Information System (INIS)

    Leong, Trevor; Smithers, B Mark; Michael, Michael; Gebski, Val; Boussioutas, Alex; Miller, Danielle; Simes, John; Zalcberg, John; Haustermans, Karin; Lordick, Florian; Schuhmacher, Christoph; Swallow, Carol; Darling, Gail; Wong, Rebecca

    2015-01-01

    The optimal management of patients with resectable gastric cancer continues to evolve in Western countries. Following publication of the US Intergroup 0116 and UK Medical Research Council MAGIC trials, there are now two standards of care for adjuvant therapy in resectable gastric cancer, at least in the Western world: postoperative chemoradiotherapy and perioperative epirubicin/cisplatin/fluorouracil (ECF) chemotherapy. We hypothesize that adding chemoradiation to standard perioperative ECF chemotherapy will achieve further survival gains. We also believe there are advantages to administering chemoradiation in the preoperative rather than postoperative setting. In this article, we describe the TOPGEAR trial, which is a randomised phase III trial comparing control arm therapy of perioperative ECF chemotherapy with experimental arm therapy of preoperative chemoradiation plus perioperative ECF chemotherapy. Eligible patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either perioperative chemotherapy alone (3 preoperative and 3 postoperative cycles of ECF) or perioperative chemotherapy plus preoperative chemoradiation. In the chemoradiation arm, patients receive 2 cycles of ECF plus chemoradiation prior to surgery, and then following surgery 3 further cycles of ECF are given. The trial is being conducted in two Parts; Part 1 (phase II component) has recruited 120 patients with the aim of assessing feasibility, safety and preliminary efficacy of preoperative chemoradiation. Part 2 (phase III component) will recruit a further 632 patients to provide a total sample size of 752 patients. The primary endpoint of the phase III trial is overall survival. The trial includes quality of life and biological substudies, as well as a health economic evaluation. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of

  4. Accelerating Inspire

    CERN Document Server

    AUTHOR|(CDS)2266999

    2017-01-01

    CERN has been involved in the dissemination of scientific results since its early days and has continuously updated the distribution channels. Currently, Inspire hosts catalogues of articles, authors, institutions, conferences, jobs, experiments, journals and more. Successful orientation among this amount of data requires comprehensive linking between the content. Inspire has lacked a system for linking experiments and articles together based on which accelerator they were conducted at. The purpose of this project has been to create such a system. Records for 156 accelerators were created and all 2913 experiments on Inspire were given corresponding MARC tags. Records of 18404 accelerator physics related bibliographic entries were also tagged with corresponding accelerator tags. Finally, as a part of the endeavour to broaden CERN's presence on Wikipedia, existing Wikipedia articles of accelerators were updated with short descriptions and links to Inspire. In total, 86 Wikipedia articles were updated. This repo...

  5. Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany

    Directory of Open Access Journals (Sweden)

    Froessler B

    2018-04-01

    Full Text Available Bernd Froessler,1,2 Alexandra M Rueger,3,4 Mark P Connolly5,6 1Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia; 2Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia; 3Vifor Pharma, Munich, Germany; 4Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany; 5Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands; 6Global Market Access Solutions Sàrl, St-Prex, Switzerland Background: Perioperative administration of ferric carboxymaltose (FCM was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA. In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling.Materials and methods: The model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis.Results: The average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day.Conclusion: Perioperative administration

  6. Peri-operative Blood Transfusion in open Suprapubic Transvesical ...

    African Journals Online (AJOL)

    INTRODUCTION: Open simple prostatectomy is the most effective and the most durable method of controlling symptoms associated with benign prostatic hyperplasia, especially in sub- Saharan Africa, where TURP set and expertise are unavailable in most health institutions. The risk of perioperative heterologous blood ...

  7. Pediatric Perioperative Pulmonary Arterial Hypertension: A Case-Based Primer

    Directory of Open Access Journals (Sweden)

    Shilpa Shah

    2017-10-01

    Full Text Available The perioperative period is an extremely tenuous time for the pediatric patient with pulmonary arterial hypertension. This article will discuss a multidisciplinary approach to preoperative planning, the importance of early identification of pulmonary hypertensive crises, and practical strategies for postoperative management for this unique group of children.

  8. Important issues for perioperative systemic antimicrobial prophylaxis in surgery

    NARCIS (Netherlands)

    Sinha, Bhanu; van Assen, Sander; Friedrich, Alexander W.

    PURPOSE OF REVIEW: Prevention of surgical site infections is a key issue to patient safety and the success of surgical interventions. Systemic antimicrobial prophylaxis is one important component of a perioperative infection prevention bundle. This review focuses on selected recent developments and

  9. Perioperative adverse airway events in cleft lip and palate repair ...

    African Journals Online (AJOL)

    Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate ...

  10. The need for peri-operative supplemental oxygen | Chikungwa ...

    African Journals Online (AJOL)

    The need for peri-operative supplemental oxygen. M. T. Chikungwa, K. Jonsson. Abstract. (Central African Journal of Medicine: 2002 48 (5-6): 72-73). AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms and Conditions of Use ...

  11. Neuroanaesthetic and perioperative challenges in the management of giant encephaloceles

    Directory of Open Access Journals (Sweden)

    V Bhatnagar

    2013-01-01

    Full Text Available There are complex issues involved in the surgical management of giant occipital encephaloceles, especially in neonates and young infants. Airway management can cause technical difficulties due to location of lesion, associated abnormalities and the position to be maintained during surgery. We present perioperative challenges we faced in the management of one such case.

  12. Current attitudes regarding the use of perioperative analgesics and ...

    African Journals Online (AJOL)

    A survey was performed in 2017 to evaluate the use of perioperative analgesia and routine anaesthetic management in dogs and cats by Cameroon veterinarians in 19 veterinary clinics, including 7 and 12 in Douala and Yaounde, respectively. The questionnaire consisted of five sections recording demographic data, ...

  13. Current aspects of perioperative fluid handling in vascular surgery

    NARCIS (Netherlands)

    Jacob, Matthias; Chappell, Daniel; Hollmann, Markus W.

    2009-01-01

    Purpose of review Perioperative fluid management influences patient outcome. Vascular surgery unites various surgical procedures, mainly with a high impact on patients who often have relevant preexisting illnesses. There are only scarce data on this specialty, forcing the clinician to extrapolate

  14. An Audit Of Perioperative Cardiac Arrest At Lagos University ...

    African Journals Online (AJOL)

    Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests ...

  15. Benefits and harms of perioperative beta-blockade

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Juul, Anne Benedicte

    2006-01-01

    randomized trials. However, confidence intervals of the intervention effects in the meta-analyses are wide, leaving room for both benefits and harms. The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk...

  16. Nursing reflections from journaling during a perioperative internship.

    Science.gov (United States)

    Kuiper, Ruth Ann

    2004-01-01

    AN IMPORTANT CONCERN in nursing practice and education is the difficulties nurses experience as they transition into a new clinical area. THIS STUDY compared the reflective journals of 26 experienced and inexperienced nurses participating in a nine-week perioperative internship. THE STUDY examined self-regulated learning strategies used to enhance metacognitive critical thinking abilities.

  17. Clinical and diagnostic features of perioperative hypersensitivity to cefuroxime

    DEFF Research Database (Denmark)

    Christiansen, I S; Krøigaard, M; Mosbech, H

    2015-01-01

    of causation in the perioperative setting. Provocations were always positive when carried out in skin test positive patients; however 8 patients had positive provocations only, highlighting the need for provocation in skin test negative patients. This article is protected by copyright. All rights reserved....

  18. Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period

    Directory of Open Access Journals (Sweden)

    Masami Yoshioka

    2013-04-01

    Full Text Available Objective: During the perioperative period, oral ingestion is changed considerably in esophagectomy patients. The aim of this study was to investigate oral environment modifications in patients undergoing esophageal cancer treatments due to changes in dietary intake and swallowing functions. Material and Methods: Thirty patients who underwent operation for removal of esophageal cancer in Tokushima University Hospital were enrolled in this study. Results: It was found that 1 the flow rate of resting saliva decreased significantly at postoperative period by deprived feeding for one week, although it did not recover several days after oral ingestion began, 2 the accumulation of dental plaque and the number of mutans streptococci in saliva decreased significantly after operation, while both increased relatively quick when oral ingestion began, and 3 the swallowing function decreased significantly in the postoperative period. Conclusions: These results suggest that dental professionals should emphasize the importance of oral health care and provide instructions on plaque control to patients during the perioperative period of esophageal cancer treatment.

  19. Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic.

    Science.gov (United States)

    Hah, Jennifer M; Bateman, Brian T; Ratliff, John; Curtin, Catherine; Sun, Eric

    2017-11-01

    Physicians, policymakers, and researchers are increasingly focused on finding ways to decrease opioid use and overdose in the United States both of which have sharply increased over the past decade. While many efforts are focused on the management of chronic pain, the use of opioids in surgical patients presents a particularly challenging problem requiring clinicians to balance 2 competing interests: managing acute pain in the immediate postoperative period and minimizing the risks of persistent opioid use after the surgery. Finding ways to minimize this risk is particularly salient in light of a growing literature suggesting that postsurgical patients are at increased risk for chronic opioid use. The perioperative care team, including surgeons and anesthesiologists, is poised to develop clinical- and systems-based interventions aimed at providing pain relief in the immediate postoperative period while also reducing the risks of opioid use longer term. In this paper, we discuss the consequences of chronic opioid use after surgery and present an analysis of the extent to which surgery has been associated with chronic opioid use. We follow with a discussion of the risk factors that are associated with chronic opioid use after surgery and proceed with an analysis of the extent to which opioid-sparing perioperative interventions (eg, nerve blockade) have been shown to reduce the risk of chronic opioid use after surgery. We then conclude with a discussion of future research directions.

  20. Prognostic significance of perioperative nutritional parameters in patients with gastric cancer.

    Science.gov (United States)

    Oh, Sung Eun; Choi, Min-Gew; Seo, Jeong-Meen; An, Ji Yeong; Lee, Jun Ho; Sohn, Tae Sung; Bae, Jae Moon; Kim, Sung

    2018-02-20

    It has been suggested that nutritional status is related to the survival outcomes of cancer patients. The purpose of the current research is to evaluate the importance of the prognosis of various nutritional parameters during the perioperative period in patients with gastric cancer. This study enrolled patients with gastric cancer who underwent D2 gastrectomy at the Department of Surgery, Samsung Medical Center, in 2008. The prognostic significance of nutritional parameters was analyzed, along with other clinical and pathological variables, preoperatively and postoperatively at 3, 6, and 12 months. The total number of patients was 1415. The mean values of nutritional parameters, weight, body mass index (BMI), hemoglobin, total cholesterol, and total lymphocyte count (TLC) decreased significantly over time after surgery. On the contrary, albumin and prognostic nutritional index (PNI) score increased significantly during the postoperative follow-up period. Preoperatively, low BMI (nutritional prognostic indicators. Various perioperative nutritional parameters were confirmed as independent prognostic factors in patients with gastric cancer. Our results imply prognostic benefit from careful nutritional support for patients with poor nutritional parameters. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  1. Anaesthetic management and perioperative complications during deep brain stimulation surgery: Our institutional experience

    Directory of Open Access Journals (Sweden)

    Renu Bala

    2016-01-01

    Full Text Available Background: Deep brain stimulation (DBS surgery is an established therapeutic option for alleviating movement disorders. It represents unique challenges for anaesthesiologists. We retrospectively reviewed the patients, who underwent this surgery at our institution, to study anaesthetic management and perioperative complications. Materials and Methods: After taking approval from the Institutional Ethics Committee, medical, surgical and anaesthesia records of 67 patients who were admitted to undergo DBS surgery during 11 years period (January 2001 to December 2011 were retrieved and reviewed. Sixty-five patients underwent the procedure. Various anaesthetic events and perioperative complications were noted and appropriate statistical analysis was carried out to analyse the data. Results: Electrode placement under monitored anaesthesia care (MAC was the most commonly used technique (86% of patients. Intra-operative complications occurred in 16 patients (24% whereas post-operative complication occurred in 10 patients (15.4%. There was one mortality. Though age >60 years and American Society of Anesthesiologists status > II were found to be the risk factors for post-operative complications in the bivariate analysis; they were not significant in multivariate analysis. Conclusions: We report our experience of DBS surgery, which was performed using MAC in majority of patients, though general anaesthesia is also feasible. Further prospective randomised studies comprising large number of patients are warranted to corroborate our finding and to find out the most suitable sedative agent.

  2. Peri-operative communication patterns and media usage--implications for systems design.

    Science.gov (United States)

    Karlsen, Ero S; Toussaint, Pieter Jelle

    2010-01-01

    Inter-hospital communication amounts for a great deal of clinicians' work time. While communication is essential to coordinate care, it can also be time consuming and interruptive, and breakdown in communication is an important source of medical errors. One contributor to the interruptive nature of communication is the use of synchronous media, and there is clearly a potential for novel technologies. To assess communication patterns and media usage we performed an ethnographic field study in the peri-operative environment at a Norwegian hospital, as well as interviews with nurses. We analyze the results with regards to choice of media, characteristics of the conversations taking place and meta-messages, and account for addressing, obtrusiveness and information richness in the message exchanges. We find a relative high degree of interruptiveness in communication, and ascribe it to 1) a lack of situational awareness between locations in the peri-operative domain, as well as 2) use of synchronous media. This suggests that design of novel technology for intra-hospital communication should aim at supporting sender-receiver awareness and signaling of availability.

  3. Perioperative medicine. The surgeons point of view

    DEFF Research Database (Denmark)

    Kehlet, H

    2001-01-01

    A satisfactory postoperative outcome goes through the control of several factors, to ensure well-being and free-pain state. A multi-disciplinary effort is necessary to achieve this goal, and the adjustment of postoperative surgical care is as important as the supply of anesthesiological techniques....

  4. Perioperative blood loss and diclofenac in major arthroplastic surgery

    Directory of Open Access Journals (Sweden)

    Ljiljana Gvozdenović

    2011-04-01

    Full Text Available Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg and also as intramuscular injection (75 mg preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05 compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

  5. Interprofessional collaborative teamwork facilitates patient centred care: a student practitioner's perspective.

    Science.gov (United States)

    Osbiston, Mark

    2013-05-01

    Interprofessional teamwork and collaboration are essential for facilitating perioperative patient centred care. Operating department practitioners (ODPs) and nurses are registered professional 'practitioner' members of the perioperative team. Standards of conduct, communication skills, ethical principles and confidentiality legislation associated with documented patient information underpin and guide perioperative practitioner practice. This article will discuss, from a student's theoretical and practice experience perspective, the registered professional 'practitioner' role in the context of the interprofessional team.

  6. FMIT accelerator

    International Nuclear Information System (INIS)

    Armstrong, D.D.

    1983-01-01

    A 35-MeV 100-mA cw linear accelerator is being designed by Los Alamos for use in the Fusion Materials Irradiation Test (FMIT) Facility. Essential to this program is the design, construction, and evaluation of performance of the accelerator's injector, low-energy beam transport, and radio-frequency quadrupole sections before they are shipped to the facility site. The installation and testing of some of these sections have begun as well as the testing of the rf, noninterceptive beam diagnostics, computer control, dc power, and vacuum systems. An overview of the accelerator systems and the performance to date is given

  7. Electron accelerator

    International Nuclear Information System (INIS)

    Abramyan.

    1981-01-01

    The USSR produces an electron accelerator family of a simple design powered straight from the mains. The specifications are given of accelerators ELITA-400, ELITA-3, ELT-2, TEUS-3 and RIUS-5 with maximum electron energies of 0.3 to 5 MeV, a mean power of 10 to 70 kW operating in both the pulsed and the continuous (TEUS-3) modes. Pulsed accelerators ELITA-400 and ELITA-3 and RIUS-5 in which TESLA resonance transformers are used are characterized by their compact size. (Ha)

  8. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

    Science.gov (United States)

    Xu, Jieyun; Hu, Jing; Yu, Pei; Wang, Weiwang; Hu, Xingxue; Hou, Jinsong; Fang, Silian; Liu, Xiqiang

    2017-01-01

    Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

  9. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

    Directory of Open Access Journals (Sweden)

    Jieyun Xu

    Full Text Available Postoperative pneumonia (POP is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC surgery.Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later.The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP.Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

  10. Horizontal Accelerator

    Data.gov (United States)

    Federal Laboratory Consortium — The Horizontal Accelerator (HA) Facility is a versatile research tool available for use on projects requiring simulation of the crash environment. The HA Facility is...

  11. Acceleration theorems

    International Nuclear Information System (INIS)

    Palmer, R.

    1994-06-01

    Electromagnetic fields can be separated into near and far components. Near fields are extensions of static fields. They do not radiate, and they fall off more rapidly from a source than far fields. Near fields can accelerate particles, but the ratio of acceleration to source fields at a distance R, is always less than R/λ or 1, whichever is smaller. Far fields can be represented as sums of plane parallel, transversely polarized waves that travel at the velocity of light. A single such wave in a vacuum cannot give continuous acceleration, and it is shown that no sums of such waves can give net first order acceleration. This theorem is proven in three different ways; each method showing a different aspect of the situation

  12. LINEAR ACCELERATOR

    Science.gov (United States)

    Christofilos, N.C.; Polk, I.J.

    1959-02-17

    Improvements in linear particle accelerators are described. A drift tube system for a linear ion accelerator reduces gap capacity between adjacent drift tube ends. This is accomplished by reducing the ratio of the diameter of the drift tube to the diameter of the resonant cavity. Concentration of magnetic field intensity at the longitudinal midpoint of the external sunface of each drift tube is reduced by increasing the external drift tube diameter at the longitudinal center region.

  13. A protocol for a systematic review for perioperative pregabalin use

    Directory of Open Access Journals (Sweden)

    Eipe Naveen

    2012-09-01

    Full Text Available Abstract Background Perioperative pain management has recently been revolutionized with the recognition of novel mechanisms and introduction of newer drugs. Many randomized trials have studied the use of the gabapentinoid anti-epileptic, pregabalin, in acute pain. Published systematic reviews suggest that using pregabalin for perioperative pain management may decrease analgesic requirements and pain scores, at the expense of troublesome side effects. A major limitation of the extant reviews is the lack of rigorous investigation of clinical characteristics that would maximize the benefit harms ratio in favor of surgical patients. We posit that effects of pregabalin for perioperative pain management vary by the type of surgical pain model and propose this systematic review protocol to update previous systematic reviews and investigate the heterogeneity in findings across subgroups of surgical pain models. Methods/Design Using a peer-reviewed search strategy, we will search key databases for clinical trials on perioperative pregabalin use in adults. The electronic searches will be supplemented by scanning the reference lists of included studies. No limits of language, country or year will be imposed. Outcomes will include pain; use of co-analgesia, particularly opioids; enhanced recovery; and drug-related harms. We will focus on the identification of surgical models and patient characteristics that have shown benefit and adverse effects from pregabalin. Two clinical experts will independently screen the studies for inclusion using eligibility criteria established a priori. Data extracted by the reviewers will then be verified. Publication bias will be assessed, as will risk of bias using the Cochrane Risk of Bias tool. Meta-analysis and meta-regression are planned if the studies are deemed statistically, methodologically and clinically homogenous. Evidence will be graded for its strength for a select number of outcomes. Discussion We will explore

  14. The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes.

    Science.gov (United States)

    Kash, Bita A; Zhang, Yichen; Cline, Kayla M; Menser, Terri; Miller, Thomas R

    2014-12-01

    Policy Points: The perioperative surgical home (PSH) is complementary to the patient-centered medical home (PCMH) and defines methods for improving the patient experience and clinical outcomes, and controlling costs for the care of surgical patients. The PSH is a physician-led care delivery model that includes multi-specialty care teams and cost-efficient use of resources at all levels through a patient-centered, continuity of care delivery model with shared decision making. The PSH emphasizes "prehabilitation" of the patient before surgery, intraoperative optimization, improved return to function through follow-up, and effective transitions to home or post-acute care to reduce complications and readmissions. The evolving concept of more rigorously coordinated and integrated perioperative management, often referred to as the perioperative surgical home (PSH), parallels the well-known concept of a patient-centered medical home (PCMH), as they share a vision of improved clinical outcomes and reductions in cost of care through patient engagement and care coordination. Elements of the PSH and similar surgical care coordination models have been studied in the United States and other countries. This comprehensive review of peer-reviewed literature investigates the history and evolution of PSH and PSH-like models and summarizes the results of studies of PSH elements in the United States and in other countries. We reviewed more than 250 potentially relevant studies. At the conclusion of the selection process, our search had yielded a total of 152 peer-reviewed articles published between 1980 and 2013. The literature reports consistent and significant positive findings related to PSH initiatives. Both US and non-US studies stress the role of anesthesiologists in perioperative patient management. The PSH may have the greatest impact on preparing patients for surgery and ensuring their safe and effective transition to home or other postoperative rehabilitation. There appear

  15. Perioperative smoking cessation in vascular surgery

    DEFF Research Database (Denmark)

    Kehlet, M.; Heesemann, Sabine; Tonnesen, H.

    2015-01-01

    Background: The effect of intensive smoking cessation programs on postoperative complications has never before been assessed in soft tissue surgery when smoking cessation is initiated on the day of surgery. Methods: A single-blinded randomized clinical trial conducted at two vascular surgery...... departments in Denmark. The intervention group was offered the Gold Standard Program (GSP) for smoking cessation intervention. The control group was offered the departments' standard care. Inclusion criteria were patients with planned open peripheral vascular surgery and who were daily smokers. According...

  16. Perioperative use of cerebral and renal near-infrared spectroscopy in neonates

    DEFF Research Database (Denmark)

    Koch, Henrik W; Hansen, Tom G

    2016-01-01

    of NIRS in neonates and premature infants undergoing noncardiac surgeries. METHOD: Neonates were monitored with both cerebral and renal NIRS for 24 h after induction of anesthesia and compared with systemic blood pressure (BP), peripheral oxygen saturation (SpO2 ), and heart rate (HR). RESULTS: A total...... of 23 368 min of data were collected from 21 neonates. NIRS reported cerebral/renal hypoxia 2.8 (±8.3)%/19.3 (±25.4)% of the time intraoperatively and 9.6 (±17.0)%/9.9 (±18.9)% of the time postoperatively. A moderate positive correlation was found between SpO2 and NIRS (φcerebral = 0.371, φrenal = 0...... specific regional cerebral and renal monitoring. Despite some practical and economical limitations, NIRS may be considered a useful supplement to perinatal perioperative intensive care....

  17. Perioperative nurses' experiences of communication in a multicultural operating theatre: A qualitative study.

    Science.gov (United States)

    Clayton, Judy; Isaacs, Anton Neville; Ellender, Isabel

    2016-02-01

    To explore the lived experiences of perioperative nurses in a multicultural operating theatre in Melbourne, Australia. Multiculturalism has become the norm in the health workforce of several developed countries due mostly to immigration. Within an operating theatre setting where good communication is paramount, the presence of nurses and doctors from multiple cultures and different training backgrounds could pose a major challenge. Using a qualitative research methodology underpinned by phenomenology, we interviewed fourteen nurses from different sections of an operating theatre. From the lived experiences of the participants, difficulties in communication emerged as the major theme. Difficulties in communication affected patient care and the working atmosphere. In addition, social integration appeared to improve communication. Addressing the needs of patients from culturally and linguistically diverse backgrounds in the operating theatre continues to be challenging. However, developing a sense of camaraderie and fostering good relationships between staff through regular social gatherings can improve communication and the working atmosphere. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Intravenous sub-anesthetic ketamine for perioperative analgesia

    Directory of Open Access Journals (Sweden)

    Andrew W Gorlin

    2016-01-01

    Full Text Available Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine′s metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.

  19. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

    .9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...... (local infiltration analgesia), and a progressive mobilization and exercise program. The transsartorial approach coupled with a specific perioperative management program has proved successful for PAO surgery.......In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO...

  20. Inhaled therapy for the management of perioperative pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    C A Thunberg

    2015-01-01

    Full Text Available Patients with pulmonary hypertension (PH are at high risk for complications in the perioperative setting and often receive vasodilators to control elevated pulmonary artery pressure (PAP. Administration of vasodilators via inhalation is an effective strategy for reducing PAP while avoiding systemic side effects, chiefly hypotension. The prototypical inhaled pulmonary-specific vasodilator, nitric oxide (NO, has a proven track record but is expensive and cumbersome to implement. Alternatives to NO, including prostanoids (such as epoprostenol, iloprost, and treprostinil, NO-donating drugs (sodium nitroprusside, nitroglycerin, and nitrite, and phosphodiesterase inhibitors (milrinone, sildenafil may be given via inhalation for the purpose of treating elevated PAP. This review will focus on the perioperative therapy of PH using inhaled vasodilators.

  1. Using YouTube in perioperative nursing education.

    Science.gov (United States)

    Logan, Rebecca

    2012-04-01

    Educators today need innovative teaching strategies to meet the learning needs of the multigenerational population of perioperative nurses. Emerging technologies, such as YouTube, the world's largest video-sharing web site, can be used as a component of an active learning strategy that can appeal to a broad group of nurses along the novice-to-expert proficiency continuum. Using video clips can be a useful method to engage learners and promote critical thinking, decision making, and creativity. YouTube videos can be used to teach skills or as a platform for discussion. Learners also can create and upload their own videos to educate others. Increased engagement and active learning can lead the perioperative nurse to a deeper understanding of the educational material. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  2. Validation of computerized sniffer for monitoring perioperative normothermia.

    Science.gov (United States)

    Giri, Jyothsna; Li, Man; Pickering, Brian; Subramanian, Arun; Kor, Daryl J; Herasevich, Vitaly

    2013-01-01

    The World Health Organization sets a standard to maintain patient core temperature greater than 36°C throughout the perioperative period. Normothermia (defined as >36°C) in the Operating Room (OR) is an important factor to preventing complications in patients (MI, infection, coagulopathy). Randomized studies suggests that maintaining at higher temperatures may further reduce complications in surgery (less complications for group at 36.4°C than the control group at 36.0°C) [1,2]. Perioperative normothermia is an important but often unrecognized element during anesthesia. Early recognition of hypothermia would allow for appropriate interventions and prevent complications. Manual validation of the diagnostic performance a clinical tool (alert) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery. The clinical tool (alert) was found to be 97 % sensitive.

  3. Fluid therapy in the perioperative setting-a clinical review

    DEFF Research Database (Denmark)

    Voldby, Anders Winther; Brandstrup, Birgitte

    2016-01-01

    BACKGROUND: Perioperative hypovolemia and fluid overload have effects on both complications following surgery and on patient survival. Therefore, the administration of intravenous fluids before, during, and after surgery at the right time and in the right amounts is of great importance. This review...... aims to analyze the literature concerning perioperative fluid therapy in abdominal surgery and to provide evidence-based recommendations for clinical practice. RESULTS: Preoperative oral or intravenous administration of carbohydrate containing fluids has been shown to improve postoperative well...... for most patients. It is less expensive and simpler than the zero-balance GDT approach and therefore recommended in this review. In outpatient surgery, 1-2 L of balanced crystalloids reduces postoperative nausea and vomiting and improves well-being....

  4. Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

    Science.gov (United States)

    Chilkoti, Geetanjali; Wadhwa, Rachna; Saxena, Ashok Kumar

    2015-01-01

    Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

  5. Perioperative management of the diabetic patient.

    Science.gov (United States)

    Yoo, Hyon K; Serafin, Bethany L

    2006-05-01

    Diabetes is a chronic disease characterized by the body's inability to process blood glucose properly. It is generally classified as insulin-dependent diabetes mellitus (IDDM), or type 1, and non-insulin-dependent diabetes mellitus (NIDDM), or type 2. Type 1 is characterized by a defect in insulin secretion by the beta cells of the pancreas, usually secondary to autoimmune destruction of those cells. Type 2 is characterized by peripheral insulin resistance with an insulin-secretory defect that varies in severity. Diabetes is a common medical condition that affects 6% of Americans younger than 50 years and approximately 10% to 15% of those older than 50 years. Increasing numbers of patients who have diabetes are presenting to the oral surgeon's office for care. Patients who have diabetes have a 50% chance of undergoing a surgical procedure in their lifetime.

  6. Perioperative Outcome of Dyssomnia Patients on Chronic Methylphenidate Use

    Directory of Open Access Journals (Sweden)

    Nicoleta Stoicea MD, PhD

    2014-01-01

    Full Text Available Methylphenidate is frequently prescribed for attention deficit hyperactivity disorder, narcolepsy, and other sleep disorders requiring psychostimulants. Our report is based on 2 different clinical experiences of patients with chronic methylphenidate use, undergoing general anesthesia. These cases contrast different strategies of taking versus withholding the drug treatment on the day of surgery. From the standpoint of anesthetic management and patient safety, the concerns for perioperative methylphenidate use are mainly related to cardiovascular stability and possible counteraction of sedatives and anesthetics.

  7. Ontology-based specification, identification and analysis of perioperative risks.

    Science.gov (United States)

    Uciteli, Alexandr; Neumann, Juliane; Tahar, Kais; Saleh, Kutaiba; Stucke, Stephan; Faulbrück-Röhr, Sebastian; Kaeding, André; Specht, Martin; Schmidt, Tobias; Neumuth, Thomas; Besting, Andreas; Stegemann, Dominik; Portheine, Frank; Herre, Heinrich

    2017-09-06

    Medical personnel in hospitals often works under great physical and mental strain. In medical decision-making, errors can never be completely ruled out. Several studies have shown that between 50 and 60% of adverse events could have been avoided through better organization, more attention or more effective security procedures. Critical situations especially arise during interdisciplinary collaboration and the use of complex medical technology, for example during surgical interventions and in perioperative settings (the period of time before, during and after surgical intervention). In this paper, we present an ontology and an ontology-based software system, which can identify risks across medical processes and supports the avoidance of errors in particular in the perioperative setting. We developed a practicable definition of the risk notion, which is easily understandable by the medical staff and is usable for the software tools. Based on this definition, we developed a Risk Identification Ontology (RIO) and used it for the specification and the identification of perioperative risks. An agent system was developed, which gathers risk-relevant data during the whole perioperative treatment process from various sources and provides it for risk identification and analysis in a centralized fashion. The results of such an analysis are provided to the medical personnel in form of context-sensitive hints and alerts. For the identification of the ontologically specified risks, we developed an ontology-based software module, called Ontology-based Risk Detector (OntoRiDe). About 20 risks relating to cochlear implantation (CI) have already been implemented. Comprehensive testing has indicated the correctness of the data acquisition, risk identification and analysis components, as well as the web-based visualization of results.

  8. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2011-01-01

    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  9. Nutrition in peri-operative esophageal cancer management.

    Science.gov (United States)

    Steenhagen, Elles; van Vulpen, Jonna K; van Hillegersberg, Richard; May, Anne M; Siersema, Peter D

    2017-07-01

    Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.

  10. A Systematic Approach to Creation of a Perioperative Data Warehouse.

    Science.gov (United States)

    Hofer, Ira S; Gabel, Eilon; Pfeffer, Michael; Mahbouba, Mohammed; Mahajan, Aman

    2016-06-01

    Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. This structure allows centralized definitions with simplified reporting by a large number of individuals who access only the Reporting Schemas. In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.

  11. Risk Factors for Perioperative Complications in Endoscopic Surgery with Irrigation

    Directory of Open Access Journals (Sweden)

    João Manoel Silva, Jr.

    2013-07-01

    Full Text Available Background and objectives: Currently, endoscopic medicine is being increasingly used, albeit not without risks. Therefore, this study evaluated the factors associated with perioperative complications in endoscopic surgery with intraoperative irrigation. Method: A cohort study of six months duration. Patients aged ≥ 18 years undergoing endoscopic surgery with the use of irrigation fluids during the intraoperative period were included. Exclusion criteria were: use of diuretics, kidney failure, cognitive impairment, hyponatremia prior to surgery, pregnancy, and critically ill. The patients who presented with or without complications during the perioperative period were allocated into two groups. Complications evaluated were related to neurological, cardiovascular and renal changes, and perioperative bleeding. Results: In total, 181 patients were enrolled and 39 excluded; therefore, 142 patients met the study criteria. Patients with complications amounted to 21.8%, with higher prevalence in endoscopic prostate surgery, followed by hysteroscopy, bladder, knee, and shoulder arthroscopy (58.1%, 36.9%, 19.4%, 3.8%, 3.2% respectively. When comparing both groups, we found association with complications in univariate analysis: age, sex, smoking, heart disease, ASA, serum sodium at the end of surgery, total irrigation fluid administered, TURP, and hysteroscopy. However, in multiple regression analysis for complications, only age (OR = 1.048, serum sodium (OR = 0.962, and volume of irrigation fluid administered during surgery (OR = 1.001 were independent variables. Keywords: Anesthesia, Endoscopy, Hyponatremia, Postoperative Complications, Risk Assessment, Risk Factors.

  12. Perioperative feedback in surgical training: A systematic review.

    Science.gov (United States)

    McKendy, Katherine M; Watanabe, Yusuke; Lee, Lawrence; Bilgic, Elif; Enani, Ghada; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C

    2017-07-01

    Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Accelerator microanalysis

    International Nuclear Information System (INIS)

    Tuniz, C.

    1997-01-01

    Particle accelerators have been developed more than sixty years ago to investigate nuclear and atomic phenomena. A major shift toward applications of accelerators in the study of materials structure and composition in inter-disciplinary projects has been witnessed in the last two decades. The Australian Nuclear Science and Technology Organisation (ANSTO) has developed advanced research programs based on the use of particle and photon beams. Atmospheric pollution problems are investigated at the 3 MV Van de Graff accelerator using ion beam analysis techniques to detect toxic elements in aerosol particles. High temperature superconductor and semiconductor materials are characterised using the recoil of iodine and other heavy ions produced at ANTARES, the 10-MV Tandem accelerator. A heavy-ion microprobe is presently being developed at ANTARES to map elemental concentrations of specific elements with micro-size resolution. An Accelerator mass Spectrometry (AMS) system has been developed at ANSTO for the ultra-sensitive detection of Carbon-14, Iodine-129 and other long-lived radioisotopes. This AMS spectrometer is a key instrument for climate change studies and international safeguards. ANSTO is also managing the Australian Synchrotron Research program based on facilities developed at the Photon Factory (Japan) and at the Advanced Photon Source (USA). Advanced projects in biology, materials chemistry, structural condensed matter and other disciplines are being promoted by a consortium involving Australian universities and research institutions. This paper will review recent advances in the use of particle accelerators, with a particular emphasis on applications developed at ANSTO and related to problems of international concern, such as global environmental change, public health and nuclear proliferation

  14. Musculoskeletal Problems Among Greek Perioperative Nurses in Regional Hospitals in Southern Peloponnese : Musculoskeletal Problems in Perioperative Nurses.

    Science.gov (United States)

    Bakola, Helen; Zyga, Sofia; Stergioulas, Apostolos; Kipreos, George; Panoutsopoulos, George

    2017-01-01

    The surgery unit is a particularly labor-intensive environment in the hospital. Studies reflect the correlation of labor risk factors for musculoskeletal injuries among nurses but few have investigated the relationship to perioperative nurses. The purpose of this study is the identification and definition of ergonomic risk factors in the operating room and their connection with musculoskeletal disorders in perioperative nurses in regional hospitals in Greece. Forty four Greek perioperative nurses working in regional hospitals in southern Peloponnese participated. Anonymous self-administered questionnaire was used to collect the data, which consisted of three parts (investigating musculoskeletal symptoms, description of work, psychometric evaluation). The analysis was done with the statistical program SPSS.19. Symptoms of musculoskeletal problems emerged. Specifically, 54.4% in the lumbar, 47.7% in the neck, 45.5% in the shoulder, followed by smaller percentages of the hip, knee, elbow and ankle. 6.8% of participants indicated no musculoskeletal symptoms in the last year while 74.9% of those who had symptoms presented them in two or more areas. Activities rated as a major problem among others were the manual handling, tools with weight and vibration etc. 100% of respondents agreed that the work in the surgery unit is demanding and has anxiety. The lack of support from the government (81.8%), combined with the low perioperative nurses (6.8%) having the opportunity to participate in administrative decisions concerning them were related to problems in the organization and management of work. Apart from engineers target factors, a main aim should be the organization of work within the framework of a national policy based on European directives on the protection and promotion of the health and safety of workers.

  15. Accelerator operations

    International Nuclear Information System (INIS)

    Anon.

    1980-01-01

    This section is concerned with the operation of both the tandem-linac system and the Dynamitron, two accelerators that are used for entirely different research. Developmental activities associated with the tandem and the Dynamitron are also treated here, but developmental activities associated with the superconducting linac are covered separately because this work is a program of technology development in its own right

  16. CNSTN Accelerator

    International Nuclear Information System (INIS)

    Habbassi, Afifa; Trabelsi, Adel

    2010-01-01

    This project give a big idea about the measurement of the linear accelerator in the CNSTN. During this work we control dose distribution for different product. For this characterisation we have to make an installation qualification ,operational qualification,performance qualification and of course for every step we have to control temperature and the dose ,even the distribution of the last one.

  17. Accelerators course

    CERN Multimedia

    CERN. Geneva HR-RFA; Métral, E

    2006-01-01

    1a) Introduction and motivation 1b) History and accelerator types 2) Transverse beam dynamics 3a) Longitudinal beam dynamics 3b) Figure of merit of a synchrotron/collider 3c) Beam control 4) Main limiting factors 5) Technical challenges

  18. Accelerator operations

    International Nuclear Information System (INIS)

    Anon.

    1979-01-01

    Operations of the SuperHILAC, the Bevatron/Bevalac, and the 184-inch Synchrocyclotron during the period from October 1977 to September 1978 are discussed. These include ion source development, accelerator facilities, the Heavy Ion Spectrometer System, and Bevelac biomedical operations

  19. Accelerator update

    International Nuclear Information System (INIS)

    Anon.

    1995-01-01

    When the Accelerator Conference, combined International High Energy and US Particle versions, held in Dallas in May, was initially scheduled, progress nearby for the US Superconducting Supercollider was high on the preliminary agenda. With the SSC voted down by Congress in October 1993, this was no longer the case. However the content of the meeting, in terms of both its deep implications for ambitious new projects and the breadth of its scope, showed that the worldwide particle accelerator field is far from being moribund. A traditional feature of such accelerator conferences is the multiplicity of parallel sessions. No one person can attend all sessions, so that delegates can follow completely different paths and emerge with totally different impressions. Despite this overload, and despite the SSC cancellation, the general picture is one of encouraging progress over a wide range of major new projects throughout the world. At the same time, spinoff from, and applications of, accelerators and accelerator technology are becoming increasingly important. Centrestage is now CERN's LHC proton-proton collider, where a test string of superconducting magnets is operating over long periods at the nominal LHC field of 8.36 tesla or more. The assignment of the underground areas in the existing 27- kilometre LEP tunnel is now quasidefinitive (see page 3). For CERN's existing big machine, the LEP electron-positron collider, ongoing work concentrates on boosting performance using improved optics and bunch trains. But the main objective is the LEP2 scheme using superconducting accelerating cavities to boost the beam energy (see page 6). After some initial teething problems, production and operation of these cavities appears to have been mastered, at least under test conditions. A highlight at CERN last year was the first run with lead ions (December 1994, page 15). Handling these heavy particles with systems originally designed for protons calls for ingenuity. The SPS

  20. Accelerator update

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1995-09-15

    When the Accelerator Conference, combined International High Energy and US Particle versions, held in Dallas in May, was initially scheduled, progress nearby for the US Superconducting Supercollider was high on the preliminary agenda. With the SSC voted down by Congress in October 1993, this was no longer the case. However the content of the meeting, in terms of both its deep implications for ambitious new projects and the breadth of its scope, showed that the worldwide particle accelerator field is far from being moribund. A traditional feature of such accelerator conferences is the multiplicity of parallel sessions. No one person can attend all sessions, so that delegates can follow completely different paths and emerge with totally different impressions. Despite this overload, and despite the SSC cancellation, the general picture is one of encouraging progress over a wide range of major new projects throughout the world. At the same time, spinoff from, and applications of, accelerators and accelerator technology are becoming increasingly important. Centrestage is now CERN's LHC proton-proton collider, where a test string of superconducting magnets is operating over long periods at the nominal LHC field of 8.36 tesla or more. The assignment of the underground areas in the existing 27- kilometre LEP tunnel is now quasidefinitive (see page 3). For CERN's existing big machine, the LEP electron-positron collider, ongoing work concentrates on boosting performance using improved optics and bunch trains. But the main objective is the LEP2 scheme using superconducting accelerating cavities to boost the beam energy (see page 6). After some initial teething problems, production and operation of these cavities appears to have been mastered, at least under test conditions. A highlight at CERN last year was the first run with lead ions (December 1994, page 15). Handling these heavy particles with systems originally designed for protons calls for ingenuity. The SPS has managed

  1. Temperature Management After Cardiac Arrest: An Advisory Statement by the Advanced Life Support Task Force of the International Liaison Committee on Resuscitation and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation.

    Science.gov (United States)

    Donnino, Michael W; Andersen, Lars W; Berg, Katherine M; Reynolds, Joshua C; Nolan, Jerry P; Morley, Peter T; Lang, Eddy; Cocchi, Michael N; Xanthos, Theodoros; Callaway, Clifton W; Soar, Jasmeet

    2016-01-01

    For more than a decade, mild induced hypothermia (32 °C-34 °C) has been standard of care for patients remaining comatose after resuscitation from out-of-hospital cardiac arrest with an initial shockable rhythm, and this has been extrapolated to survivors of cardiac arrest with initially nonshockable rhythms and to patients with in-hospital cardiac arrest. Two randomized trials published in 2002 reported a survival and neurological benefit with mild induced hypothermia. One recent randomized trial reported similar outcomes in patients treated with targeted temperature management at either 33 °C or 36 °C. In response to these new data, the International Liaison Committee on Resuscitation Advanced Life Support Task Force performed a systematic review to evaluate 3 key questions: (1) Should mild induced hypothermia (or some form of targeted temperature management) be used in comatose post-cardiac arrest patients? (2) If used, what is the ideal timing of the intervention? (3) If used, what is the ideal duration of the intervention? The task force used Grading of Recommendations Assessment, Development and Evaluation methodology to assess and summarize the evidence and to provide a consensus on science statement and treatment recommendations. The task force recommends targeted temperature management for adults with out-of-hospital cardiac arrest with an initial shockable rhythm at a constant temperature between 32 °C and 36 °C for at least 24 hours. Similar suggestions are made for out-of-hospital cardiac arrest with a nonshockable rhythm and in-hospital cardiac arrest. The task force recommends against prehospital cooling with rapid infusion of large volumes of cold intravenous fluid. Additional and specific recommendations are provided in the document. Copyright © 2015. Published by Elsevier Ireland Ltd.

  2. Perioperative Management of a Child with Hypoplastic Left Heart Syndrome of the Jehovah's Witness Faith Presenting for Hybrid Comprehensive Stage II Procedure

    OpenAIRE

    Karuppiah, Sathappan; Mckee, Christopher; Hodge, Ashley; Galantowicz, Mark; Tobias, Joseph; Naguib, Aymen

    2016-01-01

    Over the years, there has been a growing recognition of the potential negative sequelae of allogeneic blood products on postoperative outcomes following cardiac surgery. In addition, followers of the Jehovah's Witness (JW) faith have a religious restriction against receiving blood or blood components. Advances in perioperative care, cardiopulmonary bypass (CPB), and surgical technique have minimized the need for allogeneic blood products. Specific blood conservation strategies include maximiz...

  3. The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery.

    Science.gov (United States)

    Simsek, Esen; Karaman, Yucel; Gonullu, Mustafa; Tekgul, Zeki; Cakmak, Meltem

    2016-01-01

    The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. [The effect of passive exposure to tobacco smoke on perioperative respiratory complications and the duration of recovery].

    Science.gov (United States)

    Simsek, Esen; Karaman, Yucel; Gonullu, Mustafa; Tekgul, Zeki; Cakmak, Meltem

    2016-01-01

    The incidence of perioperative respiratory complications and postoperative care unit recovery time investigated in patients with passive tobacco smoke exposure according to the degree of exposure. Total 270 patients ranging in age from 18 to 60 years with the ASA physical status I or II exposed and not exposed to passive tobacco smoke received general anesthesia for various elective surgical operations evaluated for the study. Patients divided into two groups as exposed and non-exposed to passive tobacco smoke, those exposed to passive smoke are also divided into two groups according to the degree of exposure. Patients taken to the postoperative care unit (PACU) at the end of the operation and monitorized until Modified Aldrete's Scores became 9 and more. Respiratory complications evaluated and recorded in intraoperative and postoperative period. A total of 251 patients were enrolled; 63 (25.1%) patients had airway complications, 11 (4.4%) had complications intraoperatively and 52 (20.7%) patients had complications postoperatively. There has been found significant relation with passive tobacco smoke exposure and high incidences of perioperative and postoperative respiratory complications. The risk of cough, desaturation and hypersecretion complications were found to be increased depending on the degree of exposure. There was significant relation between the degree of passive smoke exposure and the duration of PACU stay. Passive tobacco smoke exposed general anesthesia receiving patients also regarding to the degree of exposure having high rates of perioperative respiratory complications and prolongation of PACU stays when compared with unexposed patients. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  5. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bradley Yudelowitz

    2016-12-01

    Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

  6. Accelerating Value Creation with Accelerators

    DEFF Research Database (Denmark)

    Jonsson, Eythor Ivar

    2015-01-01

    and developing the best business ideas and support the due diligence process. Even universities are noticing that the learning experience of the action learning approach is an effective way to develop capabilities and change cultures. Accelerators related to what has historically been associated...

  7. Peri-operative glycaemic control regimens for preventing surgical site infections in adults.

    Science.gov (United States)

    Kao, Lillian S; Meeks, Derek; Moyer, Virginia A; Lally, Kevin P

    2009-07-08

    RCTs met the pre-specified inclusion criteria for this review. No trials evaluated strict glycaemic control in the immediate pre-operative period or outside the intensive care unit. Due to heterogeneity in patient populations, peri-operative period, glycaemic target, route of insulin administration, and definitions of outcome measures, combination of the results of the five included trials into a meta-analysis was not appropriate. The methodological quality of the trials was variable. In terms of outcomes, only one trial demonstrated a significant reduction in SSIs with strict glycaemic control, but the quality of this trial was difficult to assess as a result of poor reporting; furthermore the baseline rate of SSIs was high (30%). The other trials were either underpowered to detect a difference in SSIs, due to a low baseline rate (less than or equal to 5%), or did not report SSIs as a single outcome but as part of a composite. Of the three trials reporting hypoglycaemia (which was not consistently defined) all had a higher rate in the strict glycaemic control group but none attributed significant morbidity to the hypoglycaemia. Adequacy of glucose control between groups was measured differently among studies. Studies could not be compared due to differences in target ranges, and were susceptible to measurement bias due to differences in frequency of measurement and lack of blinding by the providers following the glycaemic protocols. Infection-related mortality was not reported in any of the trials, and no trials demonstrated a significant difference in all-cause mortality. Length of hospital stay was significantly reduced in the strict glycaemic control groups in only one trial. There is insufficient evidence to support strict glycaemic control versus conventional management (maintenance of glucose operative period or outside the setting of an intensive care unit. The trials were limited by small sample size, inconsistencies in the definitions of the outcome measures

  8. Safety and efficacy of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Hua P

    2018-02-01

    Full Text Available Ping Hua,1 Jianyang Liu,2 Jun Tao,1 Xifeng Lin,1 Rongjun Zou,1 Dingwen Zhang,1 Songran Yang3,4 1Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 2Department of Vascular Surgery, Henan Provincial People’s Hospital, Zhengzhou, 3The Biobank of Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 4Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China Objective: Retrospective studies and a meta-analysis were performed to evaluate the safety and effectiveness of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP during cardiac surgery under extracorporeal circulation. Methods: Computerized literature searches were performed in Medline, Embase, The Cochrane Library, CNKI, CBM, and WANFANG to find randomized controlled trials (RCTs related to the perioperative administration of rhBNP during cardiac surgery starting from the database inception until December 2016. Two researchers independently performed study screening, information extraction, and quality evaluation according to the inclusion/exclusion criteria, and a meta-analysis was performed using RevMan 5.2 software. Results: A total of 12 studies were analyzed, including 12 RCTs and 727 patients. The meta-analysis results indicated that the perioperative administration of rhBNP could reduce the occurrence rate of postoperative complications, length of intensive care unit (ICU stay, length of hospital stay, and serum creatinine (Scr levels, and increase the 24-hour urine volume; however, it did not affect the postoperative mortality rate. Conclusion: The perioperative administration of rhBNP during cardiac surgery was safe and effective, and could improve the prognosis of the patients. Keywords: recombinant human brain natriuretic peptide, perioperative administration, meta-analysis

  9. Laser acceleration

    Science.gov (United States)

    Tajima, T.; Nakajima, K.; Mourou, G.

    2017-02-01

    The fundamental idea of Laser Wakefield Acceleration (LWFA) is reviewed. An ultrafast intense laser pulse drives coherent wakefield with a relativistic amplitude robustly supported by the plasma. While the large amplitude of wakefields involves collective resonant oscillations of the eigenmode of the entire plasma electrons, the wake phase velocity ˜ c and ultrafastness of the laser pulse introduce the wake stability and rigidity. A large number of worldwide experiments show a rapid progress of this concept realization toward both the high-energy accelerator prospect and broad applications. The strong interest in this has been spurring and stimulating novel laser technologies, including the Chirped Pulse Amplification, the Thin Film Compression, the Coherent Amplification Network, and the Relativistic Mirror Compression. These in turn have created a conglomerate of novel science and technology with LWFA to form a new genre of high field science with many parameters of merit in this field increasing exponentially lately. This science has triggered a number of worldwide research centers and initiatives. Associated physics of ion acceleration, X-ray generation, and astrophysical processes of ultrahigh energy cosmic rays are reviewed. Applications such as X-ray free electron laser, cancer therapy, and radioisotope production etc. are considered. A new avenue of LWFA using nanomaterials is also emerging.

  10. Laser acceleration

    International Nuclear Information System (INIS)

    Tajima, T.; Nakajima, K.; Mourou, G.

    2017-01-01

    The fundamental idea of LaserWakefield Acceleration (LWFA) is reviewed. An ultrafast intense laser pulse drives coherent wakefield with a relativistic amplitude robustly supported by the plasma. While the large amplitude of wake fields involves collective resonant oscillations of the eigenmode of the entire plasma electrons, the wake phase velocity ∼ c and ultra fastness of the laser pulse introduce the wake stability and rigidity. A large number of worldwide experiments show a rapid progress of this concept realization toward both the high-energy accelerator prospect and broad applications. The strong interest in this has been spurring and stimulating novel laser technologies, including the Chirped Pulse Amplification, the Thin Film Compression, the Coherent Amplification Network, and the Relativistic Mirror Compression. These in turn have created a conglomerate of novel science and technology with LWFA to form a new genre of high field science with many parameters of merit in this field increasing exponentially lately. This science has triggered a number of worldwide research centers and initiatives. Associated physics of ion acceleration, X-ray generation, and astrophysical processes of ultrahigh energy cosmic rays are reviewed. Applications such as X-ray free electron laser, cancer therapy, and radioisotope production etc. are considered. A new avenue of LWFA using nano materials is also emerging.

  11. Accelerating networks

    International Nuclear Information System (INIS)

    Smith, David M D; Onnela, Jukka-Pekka; Johnson, Neil F

    2007-01-01

    Evolving out-of-equilibrium networks have been under intense scrutiny recently. In many real-world settings the number of links added per new node is not constant but depends on the time at which the node is introduced in the system. This simple idea gives rise to the concept of accelerating networks, for which we review an existing definition and-after finding it somewhat constrictive-offer a new definition. The new definition provided here views network acceleration as a time dependent property of a given system as opposed to being a property of the specific algorithm applied to grow the network. The definition also covers both unweighted and weighted networks. As time-stamped network data becomes increasingly available, the proposed measures may be easily applied to such empirical datasets. As a simple case study we apply the concepts to study the evolution of three different instances of Wikipedia, namely, those in English, German, and Japanese, and find that the networks undergo different acceleration regimes in their evolution

  12. Robot-assisted partial nephrectomy for hilar tumors: perioperative outcomes.

    Science.gov (United States)

    Eyraud, Rémi; Long, Jean-Alexandre; Snow-Lisy, Devon; Autorino, Riccardo; Hillyer, Shahab; Klink, Joseph; Rizkala, Emad; Stein, Robert J; Kaouk, Jihad H; Haber, Georges-Pascal

    2013-06-01

    To compare perioperative outcomes of robot-assisted partial nephrectomy (RAPN) for hilar vs nonhilar tumors. The study retrospectively reviewed 364 patients with available computed tomography scans undergoing RAPN. Demographic data and perioperative outcomes results were compared between the hilar (group 1, n = 70) and nonhilar tumors (group 2, n = 294). Multivariate analysis was used to identify predictors of warm ischemia time (WIT), estimated blood loss (EBL), major perioperative complications, and postoperative renal function. There were no differences with respect to demographic variables. Hilar tumors had higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor and the location relative to polar lines) scores (P hilar tumors were associated with greater operative time (210 vs 180 minutes, P hilar vs nonhilar patients on postoperative day 3 (70.12 vs 74.71 mL/min/1.73 m(2), P = .31) or at last follow-up (72.62 vs 75.78 mL/min/1.73 m(2), P = .40), respectively. Multivariate analysis found hilar location was independently associated with increased WIT without significant changes in EBL, major complications, or postoperative renal function. RAPN represents a safe and effective procedure for hilar tumors. Hilar location for patients undergoing RAPN in a high-volume institution seems not be associated with an increased risk of transfusions, major complications, or decline of early postoperative renal function. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. The Efficacy of Perioperative Antibiotic Therapy in Tonsillectomy Patients.

    Science.gov (United States)

    Orłowski, Krzysztof; Lisowska, Grażyna; Misiołek, Hanna; Paluch, Zbigniew; Misiołek, Maciej

    2016-01-01

    While the results of early research suggested that perioperative antibiotic prophylaxis in tonsillectomy patients is associated with many benefits, these data were not confirmed by further studies and meta-analyses. The aim of this study was to investigate the usefulness and efficacy of antibiotic monotherapy in the healing of surgical wounds of patients undergoing bilateral resection of the palatine tonsils, based on an analysis of selected objective and subjective characteristics of wound healing during the postoperative period. The study included 50 men and women who underwent routine resection of the palatine tonsils. The patients were randomized into two groups: Group I, undergoing tonsillectomy with cefuroxime prophylaxis (n = 25), and Group II, who were not given perioperative antibiotic therapy (n = 25). The severity of signs and complaints recorded on postoperative days 1-10 was scored on 3- and 10-item scales. The only significant intergroup differences pertained to problems with swallowing food and fluids on postoperative days 4-6, 8 and 9 (less prevalent in Group II), postoperative use of analgesics on postoperative day 9 (less frequent in Group II), the degree of mucosal swelling in the operated area on postoperative days 3 and 7 (less severe in Group II), and the amount of fibrin covering the tonsillar niches on the third postoperative day (significantly higher in Group I). The administration of antibiotics for prevention or control of infection should be preceded by a comprehensive analysis of the potential benefits and risks. Perioperative use of antibiotics is justified only in selected cases, i.e. in individuals with comorbidities.

  14. Patient satisfaction with the perioperative surgical services and associated factors at a University Referral and Teaching Hospital, 2014: a cross-sectional study.

    Science.gov (United States)

    Gebremedhn, Endale Gebreegziabher; Lemma, Girmay Fitiwi

    2017-01-01

    Globally, increasing consideration has been given to the assessment of patient satisfaction as a method of monitor of the quality of health care provision in the health institutions. Perioperative patient satisfaction has been contemplated to be related with the level of postoperative pain intensity, patients' expectation of the outcome, patient health provider relationship, inpatient services, hospital facilities, access to care, waiting time, cost and helpfulness of treatments received. The study aimed to assess the level of patient satisfaction with perioperative surgical services and associated factors. Hospital based quantitative cross-sectional study was conducted in University of Gondar teaching hospital from April1-30, 2014. Structured Amharic version questionnaire and checklist used for data collection. All patients who operated upon during the study period were included. Both bivariate and multivariate logistic regression model used to identify the variables which had association with the dependent variable. P-values patient satisfaction with perioperative surgical services was 98.1%. The variables that had association with the outcome variable from the multivariate analysis were patient admission status (AOR=0.073, CI=0.007-0.765, P=0.029), information about the disease and operation (AOR=0.010, CI=0.001-0.140, P=0.001) and operation theatre staff attention to the patients complains (AOR=0.028, CI=0.002-0.390, P=0.008) respectively. The level of patient satisfaction with perioperative surgical services was high compared with previous studies conducted in the country and other countries in the world. Health professionals need to give emphasis for information on care provision processes, patients' health progress and patients' complaints.

  15. Severe antiphospholipid syndrome and cardiac surgery: Perioperative management.

    Science.gov (United States)

    Mishra, Pankaj Kumar; Khazi, Fayaz Mohammed; Yiu, Patrick; Billing, John Stephen

    2016-06-01

    Antiphospholipid syndrome is an antiphospholipid antibody-mediated prothrombotic state leading to arterial and venous thrombosis. This condition alters routine in-vitro coagulation tests, making results unreliable. Antiphospholipid syndrome patients requiring cardiac surgery with cardiopulmonary bypass present a unique challenge in perioperative anticoagulation management. We describe 3 patients with antiphospholipid syndrome who had successful heart valve surgery at our institution. We have devised an institutional protocol for antiphospholipid syndrome patients, and all 3 patients were managed according to this protocol. An algorithm-based approach is recommended because it improves team work, optimizes treatment, and improves patient outcome. © The Author(s) 2015.

  16. Advanced concepts for acceleration

    International Nuclear Information System (INIS)

    Keefe, D.

    1986-07-01

    Selected examples of advanced accelerator concepts are reviewed. Such plasma accelerators as plasma beat wave accelerator, plasma wake field accelerator, and plasma grating accelerator are discussed particularly as examples of concepts for accelerating relativistic electrons or positrons. Also covered are the pulsed electron-beam, pulsed laser accelerator, inverse Cherenkov accelerator, inverse free-electron laser, switched radial-line accelerators, and two-beam accelerator. Advanced concepts for ion acceleration discussed include the electron ring accelerator, excitation of waves on intense electron beams, and two-wave combinations

  17. Accelerators and the Accelerator Community

    Energy Technology Data Exchange (ETDEWEB)

    Malamud, Ernest; Sessler, Andrew

    2008-06-01

    In this paper, standing back--looking from afar--and adopting a historical perspective, the field of accelerator science is examined. How it grew, what are the forces that made it what it is, where it is now, and what it is likely to be in the future are the subjects explored. Clearly, a great deal of personal opinion is invoked in this process.

  18. Accelerators and the Accelerator Community

    International Nuclear Information System (INIS)

    Malamud, Ernest; Sessler, Andrew

    2008-01-01

    In this paper, standing back--looking from afar--and adopting a historical perspective, the field of accelerator science is examined. How it grew, what are the forces that made it what it is, where it is now, and what it is likely to be in the future are the subjects explored. Clearly, a great deal of personal opinion is invoked in this process

  19. Application of fast track surgery in elderly patients during perioperative period of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    ZHANG Yong

    2014-12-01

    Full Text Available ObjectiveTo investigate the safety and superiority of fast track surgery (FTS in elderly patients during the perioperative period of laparoscopic cholecystectomy (LC. MethodsThe clinical data of 124 elderly patients who underwent LC at the Department of General Surgery in our institution between January 2010 and March 2014 were assessed, with 62 cases assigned to FTS group and 62 cases to conventional method group. Anal exhaust time, feeding time, off-bed activity time, and length of hospital stay were compared between the two groups, and postoperative results and adverse reactions were recorded. Continuous data were analyzed using the independent-samples t test, and categorical data were compared using the chi-square test. Results Compared with the control method group, patients in the FTS group showed earlier postoperative anal exhaust, feeding, and off-bed activity, a shorter length of hospital stay, and a lower incidence of postoperative cardiovascular and cerebrovascular complications (P<0.05. ConclusionFTS is an effective approach to accelerate rehabilitation in elderly patients after LC.

  20. Ring accelerators

    International Nuclear Information System (INIS)

    Gisler, G.; Faehl, R.

    1983-01-01

    We present two-dimensional simulations in (r-z) and r-theta) cylinderical geometries of imploding-liner-driven accelerators of rings of charged particles. We address issues of azimuthal and longitudinal stability of the rings. We discuss self-trapping designs in which beam injection and extraction is aided by means of external cusp fields. Our simulations are done with the 2-1/2-D particle-in-cell plasma simulation code CLINER, which combines collisionless, electromagnetic PIC capabilities with a quasi-MHD finite element package

  1. accelerating cavity

    CERN Multimedia

    On the inside of the cavity there is a layer of niobium. Operating at 4.2 degrees above absolute zero, the niobium is superconducting and carries an accelerating field of 6 million volts per metre with negligible losses. Each cavity has a surface of 6 m2. The niobium layer is only 1.2 microns thick, ten times thinner than a hair. Such a large area had never been coated to such a high accuracy. A speck of dust could ruin the performance of the whole cavity so the work had to be done in an extremely clean environment.

  2. Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial.

    Science.gov (United States)

    Emond, Yvette E J J M; Calsbeek, Hiske; Teerenstra, Steven; Bloo, Gerrit J A; Westert, Gert P; Damen, Johan; Wolff, André P; Wollersheim, Hub C

    2015-01-08

    This study is initiated to evaluate the effects, costs, and feasibility at the hospital and patient level of an evidence-based strategy to improve the use of Dutch perioperative safety guidelines. Based on current knowledge, expert opinions and expertise of the project team, a multifaceted implementation strategy has been developed. This is a stepped wedge cluster randomized trial including nine representative hospitals across The Netherlands. Hospitals are stratified into three groups according to hospital type and geographical location and randomized in terms of the period for receipt of the intervention. All adult surgical patients meeting the inclusion criteria are assessed for patient outcomes. The implementation strategy includes education, audit and feedback, organizational interventions (e.g., local embedding of the guidelines), team-directed interventions (e.g., multi-professional team training), reminders, as well as patient-mediated interventions (e.g., patient safety cards). To tailor the implementation activities, we developed a questionnaire to identify barriers for effective guideline adherence, based on (a) a theoretical framework for classifying barriers and facilitators, (b) an instrument for measuring determinants of innovations, and (c) 19 semi-structured interviews with perioperative key professionals. Primary outcome is guideline adherence measured at the hospital (i.e., cluster) and patient levels by a set of perioperative Patient Safety Indicators (PSIs), which was developed parallel to the perioperative guidelines. Secondary outcomes at the patient level are in-hospital complications, postoperative wound infections and mortality, length of hospital stay, and unscheduled transfer to the intensive care unit, non-elective readmission to the hospital and unplanned reoperation, all within 30 days after the initial surgery. Also, patient safety culture and team climate will be studied as potential determinants. Finally, a process evaluation is

  3. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  4. In-Hospital Haloperidol Use and Perioperative Changes in QTc-Duration

    NARCIS (Netherlands)

    Blom, M T; de Jonghe, A; van Munster, B C; de Rooij, S E; Tan, H L; van der Velde, Nathalie; Jansen, S.

    2015-01-01

    OBJECTIVES: Haloperidol may prolong ECG QTc-duration but is often prescribed perioperatively to hip-fracture patients. We aimed to determine (1) how QTc-duration changes perioperatively, (2) whether low-dose haloperidol-use influences these changes, and (3) which clinical variables are associated

  5. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative

    DEFF Research Database (Denmark)

    Myles, P S; Boney, O; Botti, M

    2018-01-01

    Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. METHODS: We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus...

  6. Perioperative versus postoperative measurement of Taylor Spatial Frame mounting parameters.

    Science.gov (United States)

    Sökücü, Sami; Demir, Bilal; Lapçin, Osman; Yavuz, Umut; Kabukçuoğlu, Yavuz S

    2014-01-01

    The aim of this study was to determine the differences, if any, between application parameters for the Taylor Spatial Frame (TSF) system obtained during surgery under fluoroscopy and after surgery from digital radiography. This retrospective study included 17 extremities of 15 patients (8 male, 7 female; mean age: 21.9 years, range: 10 to 55 years) who underwent TSF after deformity and fracture. Application parameters measured by fluoroscopy at the end of surgery after mounting the fixator were compared with parameters obtained from anteroposterior and lateral digital radiographs taken 1 day after surgery. Fixator was applied to the femur in 8 patients, tibia in 6 and radius in 3. Mean time to removal of the frame was 3.5 (range: 3 to 7) months. Mean perioperative anteroposterior, lateral and axial frame offsets of patients were 9.1 (range: 3 to 20) mm, 18.1 (range: 5 to 37) mm and 95.3 (range: 25 to 155) mm, respectively. Mean postoperative anteroposterior, lateral and axial frame offset radiographs were 11.8 (range: 2 to 30) mm, 18 (range: 6 to 47) mm and 109.5 (range: 28 to 195) mm, respectively. There was no statistically significant difference between the groups (p>0.05). While measurements taken during operation may lengthen the duration in the operation room, fluoroscopy may provide better images and is easier to perform than digital radiography. On the other hand, there is no difference between measurements taken during perioperative fluoroscopy and postoperative digital radiography.

  7. Perioperative nutritional status changes in gastrointestinal cancer patients.

    Science.gov (United States)

    Shim, Hongjin; Cheong, Jae Ho; Lee, Kang Young; Lee, Hosun; Lee, Jae Gil; Noh, Sung Hoon

    2013-11-01

    The presence of gastrointestinal (GI) cancer and its treatment might aggravate patient nutritional status. Malnutrition is one of the major factors affecting the postoperative course. We evaluated changes in perioperative nutritional status and risk factors of postoperative severe malnutrition in the GI cancer patients. Nutritional status was prospectively evaluated using patient-generated subjective global assessment (PG-SGA) perioperatively between May and September 2011. A total of 435 patients were enrolled. Among them, 279 patients had been diagnosed with gastric cancer and 156 with colorectal cancer. Minimal invasive surgery was performed in 225 patients. PG-SGA score increased from 4.5 preoperatively to 10.6 postoperatively (pgastric cancer patients, postoperative severe malnourishment increased significantly (p60, pgastric cancer (pgastric cancer, and open surgery remained significant as risk factors of severe malnutrition. The prevalence of severe malnutrition among GI cancer patients in this study increased from 2.3% preoperatively to 26.3% after an operation. Old age, preoperative weight loss, gastric cancer, and open surgery were shown to be risk factors of postoperative severe malnutrition. In patients at high risk of postoperative severe malnutrition, adequate nutritional support should be considered.

  8. Evaluation of the appropriate perioperative antibiotic prophylaxis in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available BACKGROUND: The appropriate use of antibiotics prophylaxis in the prevention and reduction in the incidence of surgical site infection is widespread. This study evaluates the appropriateness of the prescription of antibiotics prophylaxis prior to surgery amongst hospitalized patients in the geographic area of Avellino, Caserta, and Naples (Italy and the factors associated with a poor adherence. METHODS: A sample of 382 patients admitted to 23 surgical wards and undergoing surgery in five hospitals were randomly selected. RESULTS: Perioperative antibiotic prophylaxis was appropriate in 18.1% of cases. The multivariate logistic regression analysis showed that patients with hypoalbuminemia, with a clinical infection, with a wound clean were more likely to receive an appropriate antibiotic prophylaxis. Compared with patients with an American Society of Anesthesiologists (ASA score ≥4, those with a score of 2 were correlated with a 64% reduction in the odds of having an appropriate prophylaxis. The appropriateness of the timing of prophylactic antibiotic administration was observed in 53.4% of the procedures. Multivariate logistic regression model showed that such appropriateness was more frequent in older patients, in those admitted in general surgery wards, in those not having been underwent an endoscopic surgery, in those with a higher length of surgery, and in patients with ASA score 1 when a score ≥4 was chosen as the reference category. The most common antibiotics used inappropriately were ceftazidime, sultamicillin, levofloxacin, and teicoplanin. CONCLUSIONS: Educational interventions are needed to improve perioperative appropriate antibiotic prophylaxis.

  9. High-dose buprenorphine: perioperative precautions and management strategies.

    Science.gov (United States)

    Roberts, D M; Meyer-Witting, M

    2005-02-01

    Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.

  10. Neurologic Evaluation and Management of Perioperative Nerve Injury.

    Science.gov (United States)

    Watson, James C; Huntoon, Marc A

    2015-01-01

    Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia-related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management. Studies pertinent to the recognition, evaluation, and treatment of neurologic assessment of perioperative nerve injury and published since the last advisory on the topic are reviewed and a new structured algorithmic approach is proposed. The evolving literature on postoperative inflammatory neuropathies is reviewed to help define the clinical criteria and to identify patients who would benefit from early neurological evaluation. New sections review potential acute interventions to improve neurologic outcome and long-term management of neuropathic pain resulting from perioperative nerve injury.

  11. IFMIF accelerators design

    International Nuclear Information System (INIS)

    Mosnier, A.; Ratzinger, U.

    2008-01-01

    The IFMIF requirement for 250 mA current of deuteron beams at a nominal energy of 40 MeV is met by means of two identical continuous wave (CW) 175 MHz linear accelerators running in parallel, each delivering a 125 mA, 40 MeV deuteron beam to the common target. This approach allows to stay within the current capability of present RF linac technology while providing operational redundancy in case of failure of one of the linacs. Each linac comprises a sequence of acceleration and beam transport/matching stages. The ion source generates a 140 mA deuteron beam at 100 keV. A low energy beam transport (LEBT) transfers the deuteron beam from the source to a radio frequency quadrupole (RFQ) cavity. The RFQ bunches and accelerates the 125 mA beam to 5 MeV. The RFQ output beam is injected through a matching section into a drift-tube-linac (DTL) where it is accelerated to the final energy of 40 MeV. In the reference design, the final acceleration stage is a conventional Alvarez-type DTL with post-couplers operating at room temperature. Operation of both the RFQ and the DTL at the same relatively low frequency is essential for accelerating the high current deuteron beam with low beam loss. The primary concern of the IFMIF linacs is the minimization of beam losses, which could limit their availability and maintainability due to excessive activation of the linac and irradiation of the environment. A careful beam dynamics design is therefore needed from the source to the target to avoid the formation of particle halo that could finally be lost in the linac or transfer lines. A superconducting solution for the high energy portion of the linac using, for example, CH-structure or coaxial-type resonators, could offer some advantages, in particular the reduction of operational costs. Careful beam dynamics simulations and comparison tests with beam during the EVEDA phase are however necessary in order to fully assess the technical feasibility of such alternative solutions

  12. Cosmic ray acceleration mechanisms

    International Nuclear Information System (INIS)

    Cesarsky, C.J.

    1982-09-01

    We present a brief summary of some of the most popular theories of cosmic ray acceleration: Fermi acceleration, its application to acceleration by shocks in a scattering medium, and impulsive acceleration by relativistic shocks

  13. Perioperative Management of a Child with Hypoplastic Left Heart Syndrome of the Jehovah's Witness Faith Presenting for Hybrid Comprehensive Stage II Procedure.

    Science.gov (United States)

    Karuppiah, Sathappan; Mckee, Christopher; Hodge, Ashley; Galantowicz, Mark; Tobias, Joseph; Naguib, Aymen

    2016-09-01

    Over the years, there has been a growing recognition of the potential negative sequelae of allogeneic blood products on postoperative outcomes following cardiac surgery. In addition, followers of the Jehovah's Witness (JW) faith have a religious restriction against receiving blood or blood components. Advances in perioperative care, cardiopulmonary bypass (CPB), and surgical technique have minimized the need for allogeneic blood products. Specific blood conservation strategies include maximizing the preoperative hematocrit and coagulation function as well as intraoperative strategies, such as acute normovolemic hemodilution and adjustments of the technique of CPB. We report a 7-month-old patient whose parents were of the JW faith who underwent a comprehensive stage II procedure for hypoplastic left heart syndrome without exposure to blood or blood products during his hospital stay. Perioperative techniques for blood avoidance are discussed with emphasis on their application to infants undergoing surgery for congenital heart disease.

  14. Specialist perioperative allergy clinic services in the UK 2016: Results from the Royal College of Anaesthetists Sixth National Audit Project.

    Science.gov (United States)

    Egner, W; Cook, T; Harper, N; Garcez, T; Marinho, S; Kong, K L; Nasser, S; Thomas, M; Warner, A; Hitchman, J; Floss, K

    2017-10-01

    Guidelines for investigation of perioperative drug allergy exist, but the quality of services is unknown. Specialist perioperative anaphylaxis services were surveyed through the Royal College of Anaesthetists 6 th National Audit Project. We compare self-declared UK practice in specialist perioperative allergy services with national recommendations. A SurveyMonkey™ questionnaire was distributed to providers of allergy services in the UK. Responses were assessed for adherence to the best practice recommendations of the British Society for Allergy and Clinical Immunology (BSACI), the Association of Anaesthetists of Great Britain and Ireland and the National Institute for Health and Care Excellence (NICE) Guidance on Drug Allergy-CG183. Over 1200 patients were evaluated in 44 centres annually. Variation in workload, waiting times, access, staffing and diagnostic approach was noted. Paediatric centres had the longest routine waiting times (most wait >13 weeks) in contrast to adult centres (most wait specialist nurses and 18/44 (41%) an anaesthetist] and provision of information [18/44 (41%) gave immediate information in clinic and 5/44 (11%) sign-posted support groups]. Most centres were able to provide diagnostic challenges to antibiotics [40/44 (91%]) and local anaesthetics [41/44 (93%)]. Diagnostic testing is not harmonized, with marked variability in the NMBA panels used to identify safe alternatives. Chlorhexidine and latex are not part of routine testing in many centres. Poor access to services and patient information provision require attention. Harmonization of diagnostic approach is desirable, particularly with regard to a minimum NMBA panel for identification of safe alternatives. © 2017 John Wiley & Sons Ltd.

  15. A national survey into perioperative anesthetic management of patients with a fractured neck of femur

    Directory of Open Access Journals (Sweden)

    Soinikoski Mirka

    2012-07-01

    Full Text Available Abstract Background We made a survey among Finnish anesthesiologists concerning the current perioperative anesthetic practice of hip fracture patients for further development in patient care. Methods All members of the Finnish Society of Anesthesiologists with a known e-mail address (786 were invited to participate in an internet-based survey. Results The overall response rate was 55% (423 responses; 298 respondents participated in the care of hip fracture patients. Preoperative analgesia was mostly managed with oxycodone and paracetamol; every fifth respondent applied an epidural infusion. Most respondents (98% employed a spinal block with or without an epidural catheter for intraoperative anesthesia. Midazolam, propofol and/or fentanyl were used for additional sedation. General anesthesia was used rarely. Postoperatively, paracetamol and non-steroidal anti-inflammatory drugs and occasionally peroral oxycodone, were prescribed in addition to epidural analgesia. Conclusions The survey suggests that the impact of more individualised analgesia regimens, both preoperatively and postoperatively, should be investigated in further studies.

  16. Barriers to effective perioperative communication in indigenous Australians: an audit of progress since 1996.

    Science.gov (United States)

    Cheng, W Y C; Blum, P; Spain, B

    2004-08-01

    This prospective study was designed to elucidate barriers limiting effective perioperative communication between indigenous Australians and anaesthetists, and to identify strategies for improving communication. A questionnaire was used to collect data on 1040 consecutive patients undergoing anaesthesia at Royal Darwin Hospital between February and March 2003. 27.1% of these patients described themselves as Aboriginal. Aboriginal patients were more likely to undergo emergency surgery and were more likely to be classified as ASA 3, 4 or 5 than non-indigenous patients. Communication difficulties were identified in 28.7% of all Aboriginal patients, which was 31 times higher than those in non-Aboriginal patients. The most common reason identified for this was difficulty in speaking English. Only 17.7% of Aboriginal patients presenting to the operating theatre spoke English as their first language. Unfortunately, the anaesthetic team utilized the Aboriginal interpreter service in only a minority of cases. Communication difficulty in indigenous Australians is pervasive and often goes unrecognized. The results suggest that heath care providers may need staff training in cross-cultural communication and that protocols need to be developed within the health care system so that interpreters are called upon automatically early in the admission process.

  17. A Dog Is a Doctor’s Best Friend: The Use of a Service Dog as a Perioperative Assistant

    Directory of Open Access Journals (Sweden)

    Shannon Tew

    2016-01-01

    Full Text Available Service dogs are beneficial in providing assistance to people with multiple types of disabilities and medical disorders including visual impairment, physical disabilities, seizure disorders, diabetes, and mental illness. Some service animals have been trained as a screening tool for cancer. We review a case involving a 6-year-old female with a history of mast cell mediator release and immediate hypersensitivity due to the urticaria pigmentosa variant of cutaneous mastocytosis who underwent a cystourethroscopy. Her service dog, JJ, who would alert to mast cell mediator release, was used throughout the perioperative course as a means of anxiolysis and comfort and to monitor for mast cell mediator release. This case presents an example of a service dog used in a family-care model in the field of anesthesiology and provides a unique example of using a service dog as an additional monitor to alert the care team for impending mast cell mediator release.

  18. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

    2017-10-01

    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  19. Application of electron accelerator worldwide

    International Nuclear Information System (INIS)

    Machi, Sueo

    2003-01-01

    Electron accelerator is an important radiation source for radiation technology, which covers broad fields such as industry, health care, food and environmental protection. There are about 1,000 electron accelerators for radiation processing worldwide. Electron accelerator has advantage over Co-60 irradiator in term of high dose rate and power, assurance of safety, and higher economic performance at larger volume of irradiation. Accelerator generating higher energy in the range of 10 MeV and high power electron beam is now commercially available. There is a trend to use high-energy electron accelerator replacing Co-60 in case of large through-put of medical products. Irradiated foods, in particular species, are on the commercial market in 35 countries. Electron accelerator is used efficiently and economically for production of new or modified polymeric materials through radiation-induced cross-linking, grafting and polymerization reaction. Another important application of electron beam is the curing of surface coatings in the manufacture of products. Electron accelerators of large capacity are used for cleaning exhaust gases in industrial scale. Economic feasibility studies of this electron beam process have shown that this technology is more cost effective than the conventional process. It should be noted that the conventional limestone process produce gypsum as a by-product, which cannot be used in some countries. By contrast, the by-product of the electron beam process is a valuable fertilizer. (Y. Tanaka)

  20. Application of electron accelerator worldwide

    Energy Technology Data Exchange (ETDEWEB)

    Machi, Sueo [Japan Atomic Industrial Forum, Inc., Tokyo (Japan)

    2003-02-01

    Electron accelerator is an important radiation source for radiation technology, which covers broad fields such as industry, health care, food and environmental protection. There are about 1,000 electron accelerators for radiation processing worldwide. Electron accelerator has advantage over Co-60 irradiator in term of high dose rate and power, assurance of safety, and higher economic performance at larger volume of irradiation. Accelerator generating higher energy in the range of 10 MeV and high power electron beam is now commercially available. There is a trend to use high-energy electron accelerator replacing Co-60 in case of large through-put of medical products. Irradiated foods, in particular species, are on the commercial market in 35 countries. Electron accelerator is used efficiently and economically for production of new or modified polymeric materials through radiation-induced cross-linking, grafting and polymerization reaction. Another important application of electron beam is the curing of surface coatings in the manufacture of products. Electron accelerators of large capacity are used for cleaning exhaust gases in industrial scale. Economic feasibility studies of this electron beam process have shown that this technology is more cost effective than the conventional process. It should be noted that the conventional limestone process produce gypsum as a by-product, which cannot be used in some countries. By contrast, the by-product of the electron beam process is a valuable fertilizer. (Y. Tanaka)

  1. Real-time assessment of perioperative behaviors in children and parents: development and validation of the perioperative adult child behavioral interaction scale.

    Science.gov (United States)

    Sadhasivam, Senthilkumar; Cohen, Lindsey L; Hosu, Liana; Gorman, Kristin L; Wang, Yu; Nick, Todd G; Jou, Jing Fang; Samol, Nancy; Szabova, Alexandra; Hagerman, Nancy; Hein, Elizabeth; Boat, Anne; Varughese, Anna; Kurth, Charles Dean; Willging, J Paul; Gunter, Joel B

    2010-04-01

    Behavior in response to distressful events during outpatient pediatric surgery can contribute to postoperative maladaptive behaviors, such as temper tantrums, nightmares, bed-wetting, and attention seeking. Currently available perioperative behavioral assessment tools have limited utility in guiding interventions to ameliorate maladaptive behaviors because they cannot be used in real time, are only intended to be used during 1 phase of the experience (e.g., perioperative), or provide only a static assessment of the child (e.g., level of anxiety). A simple, reliable, real-time tool is needed to appropriately identify children and parents whose behaviors in response to distressful events at any point in the perioperative continuum could benefit from timely behavioral intervention. Our specific aims were to (1) refine the Perioperative Adult Child Behavioral Interaction Scale (PACBIS) to improve its reliability in identifying perioperative behaviors and (2) validate the refined PACBIS against several established instruments. The PACBIS was used to assess the perioperative behaviors of 89 children aged 3 to 12 years presenting for adenotonsillectomy and their parents. Assessments using the PACBIS were made during perioperative events likely to prove distressing to children and/or parents (perioperative measurement of blood pressure, induction of anesthesia, and removal of the IV catheter before discharge). Static measurements of perioperative anxiety and behavioral compliance during anesthetic induction were made using the modified Yale Preoperative Anxiety Scale and the Induction Compliance Checklist (ICC). Each event was videotaped for later scoring using the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) and Observational Scale of Behavioral Distress (OSBD). Interrater reliability using linear weighted kappa (kappa(w)) and multiple validations using Spearman correlation coefficients were analyzed. The PACBIS demonstrated good to excellent

  2. Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Krystyna Serkies

    2016-12-01

    Full Text Available Purpose : To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT. The BT dose of 15 Gy (1 Gy/pulse/h was given on the following day after surgery. Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%, subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years, among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96% and 87% (95% CI: 80-94%, respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97% and 89% (95% CI: 82-96%, respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91% evaluable patients. Conclusions : Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation

  3. Perioperative Temperature Measurement Considerations Relevant to Reporting Requirements for National Quality Programs Using Data From Anesthesia Information Management Systems.

    Science.gov (United States)

    Epstein, Richard H; Dexter, Franklin; Hofer, Ira S; Rodriguez, Luis I; Schwenk, Eric S; Maga, Joni M; Hindman, Bradley J

    2018-02-01

    Perioperative hypothermia may increase the incidences of wound infection, blood loss, transfusion, and cardiac morbidity. US national quality programs for perioperative normothermia specify the presence of at least 1 "body temperature" ≥35.5°C during the interval from 30 minutes before to 15 minutes after the anesthesia end time. Using data from 4 academic hospitals, we evaluated timing and measurement considerations relevant to the current requirements to guide hospitals wishing to report perioperative temperature measures using electronic data sources. Anesthesia information management system databases from 4 hospitals were queried to obtain intraoperative temperatures and intervals to the anesthesia end time from discontinuation of temperature monitoring, end of surgery, and extubation. Inclusion criteria included age >16 years, use of a tracheal tube or supraglottic airway, and case duration ≥60 minutes. The end-of-case temperature was determined as the maximum intraoperative temperature recorded within 30 minutes before the anesthesia end time (ie, the temperature that would be used for reporting purposes). The fractions of cases with intervals >30 minutes between the last intraoperative temperature and the anesthesia end time were determined. Among the hospitals, averages (binned by quarters) of 34.5% to 59.5% of cases had intraoperative temperature monitoring discontinued >30 minutes before the anesthesia end time. Even if temperature measurement had been continued until extubation, averages of 5.9% to 20.8% of cases would have exceeded the allowed 30-minute window. Averages of 8.9% to 21.3% of cases had end-of-case intraoperative temperatures <35.5°C (ie, a quality measure failure). Because of timing considerations, a substantial fraction of cases would have been ineligible to use the end-of-case intraoperative temperature for national quality program reporting. Thus, retrieval of postanesthesia care unit temperatures would have been necessary. A

  4. Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.

    Science.gov (United States)

    Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Lagoo, Sandhya; Shortell, Cynthia K; Mureebe, Leila

    2017-01-01

    The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB). The 2011-2013 LEB-targeted American College of Surgeons National Surgical Quality Improvement Program database was used for this analysis (n = 5316). Patients were stratified by age <65 (n = 2171), 65-74 (n = 1858), 75-84 (n = 1190), and ≥85 (n = 394) years. Comparisons of patient- and procedure-related characteristics and 30-day postoperative outcomes stratified by age groups were performed with Pearson χ 2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. During the study period, 5316 total patients were identified. There were 2171 patients aged <65 years, 1858 patients in the 65-74 years age group, 1190 patients in the 75-84 years age group, and 394 patients in the ≥85 years age group. Increasing age was associated with an increased frequency of cardiopulmonary disease (P < 0.001) and a decreased frequency of diabetes, tobacco use, and prior surgical intervention (P < 0.001). Only 79% and 68% of all patients were on antiplatelet and statin therapies, respectively. Critical limb ischemia occurred more frequently in older patients (P < 0.001). Length of hospital stay, transfusion requirements, and discharge to a skilled nursing facility increased with age (P < 0.001). Thirty-day amputation rates did not differ significantly with age (P = 0.12). Geriatric patients undergoing LEB have unique and potentially modifiable perioperative factors that may improve postoperative outcomes. These

  5. ACCELERATION PHYSICS CODE WEB REPOSITORY.

    Energy Technology Data Exchange (ETDEWEB)

    WEI, J.

    2006-06-26

    In the framework of the CARE HHH European Network, we have developed a web-based dynamic accelerator-physics code repository. We describe the design, structure and contents of this repository, illustrate its usage, and discuss our future plans, with emphasis on code benchmarking.

  6. Effects of restricting perioperative use of intravenous chloride on kidney injury in patients undergoing cardiac surgery: the LICRA pragmatic controlled clinical trial.

    Science.gov (United States)

    McIlroy, David; Murphy, Deirdre; Kasza, Jessica; Bhatia, Dhiraj; Wutzlhofer, Lisa; Marasco, Silvana

    2017-06-01

    The administration of chloride-rich intravenous (IV) fluid and hyperchloraemia have been associated with perioperative renal injury. The aim of this study was to determine whether a comprehensive perioperative protocol for the administration of chloride-limited IV fluid would reduce perioperative renal injury in adults undergoing cardiac surgery. From February 2014 through to December 2015, all adult patients undergoing cardiac surgery within a single academic medical center received IV fluid according to the study protocol. The perioperative protocol governed all fluid administration from commencement of anesthesia through to discharge from the intensive care unit and varied over four sequential periods, each lasting 5 months. In periods 1 and 4 a chloride-rich strategy, consisting of 0.9% saline and 4% albumin, was adopted; in periods 2 and 3, a chloride-limited strategy, consisting of a buffered salt solution and 20% albumin, was used. Co-primary outcomes were peak delta serum creatinine (∆S Cr ) within 5 days after the operation and KDIGO-defined stage 2 or stage 3 acute kidney injury (AKI) within 5 days after the operation. We enrolled and analysed data from 1136 patients, with 569 patients assigned to a chloride-rich fluid strategy and 567 to a chloride-limited one. Compared with a chloride-limited strategy and adjusted for prespecified covariates, there was no association between a chloride-rich perioperative fluid strategy and either peak ∆S Cr , transformed to satisfy the assumptions of multivariable linear regression [regression coefficient 0.03, 95% confidence interval (CI) -0.03 to 0.08); p = 0.39], or stage 2 or 3 AKI (adjusted odds ratio 0.97, 95% CI 0.65-1.47; p = 0.90]. A perioperative fluid strategy to restrict IV chloride administration was not associated with an altered incidence of AKI or other metrics of renal injury in adult patients undergoing cardiac surgery. Clinicaltrials.gov Identifier: NCT02020538.

  7. Nursing team stress in the perioperative period: an integrative review

    Directory of Open Access Journals (Sweden)

    Dafne Eva Corrêa Brandão

    2013-09-01

    Full Text Available This integrative review aimed at analyzing evidences available in literature regarding stress levels in nursing teams during the perioperative period. Primary studies were searched in the following databases: PubMed, CINAHL and LILACS. Included studies were grouped into the following thematic categories: stress level in the workplace and stress factors (n=8 and stress coping strategies used by the nursing staff (n=6. Evidence suggests that stress in the workplace worsens the health of the nursing team, provoking undesirable effects both in the professional and personal lives of these professionals. The assessment of working conditions to identify the main stressing factors and the implementation of individual and organizational measures to reduce nursing teams stress may increase productivity and workers’ satisfaction, improving the assistance quality offered to surgical patients.

  8. Total hip and knee joint replacement: perioperative clinical aspects

    Directory of Open Access Journals (Sweden)

    Luciana Pereira Almeida de Piano

    2010-09-01

    Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

  9. Migraine and risk of perioperative ischemic stroke and hospital readmission

    DEFF Research Database (Denmark)

    Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D

    2017-01-01

    OBJECTIVE: To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN: Prospective hospital registry study. SETTING: Massachusetts General Hospital and two satellite campuses between...... was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS: 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.......9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). CONCLUSIONS: Surgical patients with a history of migraine are at increased...

  10. Perioperative management of patient with alkaptonuria and associated multiple comorbidities

    Directory of Open Access Journals (Sweden)

    Ravindra Pandey

    2011-01-01

    Full Text Available Alkaptonuria is a rare inherited genetic disorder of tyrosine metabolism characterized by a triad of homogentisic aciduria, ochronosis, and arthritis. The most common clinical manifestations of ochronosis involve the musculoskeletal, respiratory, airway, cardiovascular, genitourinary, cutaneous, and ocular systems. We report the perioperative anesthetic management of a 56-year-old alkaptonuric patient, with multiple comorbidities scheduled, for revision total hip replacement. A review of her medical history revealed alkaptonuria, hypothyroidism, rheumatoid arthritis, hypertension, diabetes mellitus, and Pott′s spine with disc prolapse. We want to highlight the need of thorough preoperative evaluation in patients of alkaptonuria, as it is associated with multiple comorbidities. The systemic involvement should determine the anesthetic plan. Caution should be exercised during positioning to prevent injury to the joints and the spine.

  11. Choice of fluids in the perioperative period of kidney transplantation

    Directory of Open Access Journals (Sweden)

    Alejandro Gonzalez-Castro

    2017-11-01

    Full Text Available Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid–base balance in these patients. Resumen: El suero salino normal (SSN ha sido clásicamente el fluido de resucitación elegido en el periodo perioperatorio del trasplante renal frente a aquellas soluciones balanceadas con potasio. Sin embargo, los problemas derivados de la hipercloremia desencadenada por la infusión de SSN han llevado a la realización de estudios que comparaban esta solución con los fluidos equilibrados. Mediante la presente revisión narrativa se deduce que el uso de cristaloides balanceados con contenido de potasio en su formulación, en el perioperatorio de trasplante renal, puede considerarse seguro. Estas soluciones no provocan una alteración del potasio sérico mayor que la provocada por el SSN y mantienen mejor el equilibrio ácido-base en estos enfermos. Keywords: Kidney transplantation, Normal saline, Balanced solutions, Hyperchloraemia, Hyperkalaemia, Palabras clave: Trasplante renal, Suero salino normal, Soluciones balanceadas, Hipercloremia, Hiperpotasemia

  12. Attacking Postoperative Metastases using Perioperative Oncolytic Viruses and Viral Vaccines

    Science.gov (United States)

    Tai, Lee-Hwa; Auer, Rebecca

    2014-01-01

    Surgical resection of solid primary malignancies is a mainstay of therapy for cancer patients. Despite being the most effective treatment for these tumors, cancer surgery has been associated with impaired metastatic clearance due to immunosuppression. In preclinical surgery models and human cancer patients, we and others have demonstrated a profound suppression of both natural killer (NK) and T cell function in the postoperative period and this plays a major role in the enhanced development of metastases following surgery. Oncolytic viruses (OV) were originally designed to selectively infect and replicate in tumors, with the primary objective of directly lysing cancer cells. It is becoming increasingly clear, however, that OV infection results in a profound inflammatory reaction within the tumor, initiating innate and adaptive immune responses against it that is critical for its therapeutic benefit. This anti-tumor immunity appears to be mediated predominantly by NK and cytotoxic T cells. In preclinical models, we found that preoperative OV prevents postoperative NK cell dysfunction and attenuates tumor dissemination. Due to theoretical safety concerns of administering live virus prior to surgery in cancer patients, we characterized safe, attenuated versions of OV, and viral vaccines that could stimulate NK cells and reduce metastases when administered in the perioperative period. In cancer patients, we observed that in vivo infusion with oncolytic vaccinia virus and ex vivo stimulation with viral vaccines promote NK cell activation. These preclinical studies provide a novel and clinically relevant setting for OV therapy. Our challenge is to identify safe and promising OV therapies that will activate NK and T cells in the perioperative period preventing the establishment of micrometastatic disease in cancer patients. PMID:25161958

  13. Accelerating the development of an information ecosystem in health care, by stimulating the growth of safe intermediate processing of health information (IPHI

    Directory of Open Access Journals (Sweden)

    Harshana Liyanage

    2013-03-01

    Full Text Available Health care, in common with many other industries, is generating large amounts of routine data, data that are challenging to process, analyse or curate, so-called ‘big data’. A challenge for health informatics is to make sense of these data. Part of the answer will come from the development of ontologies that support the use of heterogeneous data sources and the development of intermediate processors of health information (IPHI. IPHI will sit between the generators of health data and information, often the providers of health care, and the managers, commissioners, policy makers, researchers, and the pharmaceutical and other healthcare industries. They will create a health ecosystem by processing data in a way that stimulates improved data quality and potentially health care delivery by providers of health care, and by providing greater insights to legitimate users of data. Exemplars are provided of how a health ecosystem might be encouraged and developed to promote patient safety and more efficient health care. These are in the areas of how to integrate data around the unsafe use of alcohol and to explore vaccine safety. A challenge for IPHI is how to ensure that their processing of data is valid, safe and maintains privacy. Development of the healthcare ecosystem and IPHI should be actively encouraged internationally. Governments, regulators and providers of health care should facilitate access to health data and the use of national and international comparisons to monitor standards. However, most importantly, they should pilot new methods of improving quality and safety through the intermediate processing of health data.

  14. The peri-operative management of anti-platelet therapy in elective, non-cardiac surgery.

    Science.gov (United States)

    Alcock, Richard F; Naoum, Chris; Aliprandi-Costa, Bernadette; Hillis, Graham S; Brieger, David B

    2013-07-31

    Cardiovascular complications are important causes of morbidity and mortality in patients undergoing elective non-cardiac surgery, with adverse cardiac outcomes estimated to occur in approximately 4% of all patients. Anti-platelet therapy withdrawal may precede up to 10% of acute cardiovascular syndromes, with withdrawal in the peri-operative setting incompletely appraised. The aims of our study were to determine the proportion of patients undergoing elective non-cardiac surgery currently prescribed anti-platelet therapy, and identify current practice in peri-operative management. In addition, the relationship between management of anti-platelet therapy and peri-operative cardiac risk was assessed. We evaluated consecutive patients attending elective non-cardiac surgery at a major tertiary referral centre. Clinical and biochemical data were collected and analysed on patients currently prescribed anti-platelet therapy. Peri-operative management of anti-platelet therapy was compared with estimated peri-operative cardiac risk. Included were 2950 consecutive patients, with 516 (17%) prescribed anti-platelet therapy, primarily for ischaemic heart disease. Two hundred and eighty nine (56%) patients had all anti-platelet therapy ceased in the peri-operative period, including 49% of patients with ischaemic heart disease and 46% of patients with previous coronary stenting. Peri-operative cardiac risk score did not influence anti-platelet therapy management. Approximately 17% of patients undergoing elective non-cardiac surgery are prescribed anti-platelet therapy, the predominant indication being for ischaemic heart disease. Almost half of all patients with previous coronary stenting had no anti-platelet therapy during the peri-operative period. The decision to cease anti-platelet therapy, which occurred commonly, did not appear to be guided by peri-operative cardiac risk stratification. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Sector ring accelerator ''RESATRON''

    International Nuclear Information System (INIS)

    Schwabe, E.

    1980-01-01

    Project of sector ring accelerator RESATRON is described. The curiosity of this accelerator is the second cycle of acceleration of the beam after stripping it on the foil. In such an accelerator heavy ions with a different ratio Z to A can be accelerated. (S.B.)

  16. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

    Science.gov (United States)

    Lees, Mackenzie C.; Merani, Shaheed; Tauh, Keerit; Khadaroo, Rachel G.

    2015-01-01

    Background Older adults (≥ 65 yr) are the fastest growing population and are presenting in increasing numbers for acute surgical care. Emergency surgery is frequently life threatening for older patients. Our objective was to identify predictors of mortality and poor outcome among elderly patients undergoing emergency general surgery. Methods We conducted a retrospective cohort study of patients aged 65–80 years undergoing emergency general surgery between 2009 and 2010 at a tertiary care centre. Demographics, comorbidities, in-hospital complications, mortality and disposition characteristics of patients were collected. Logistic regression analysis was used to identify covariate-adjusted predictors of in-hospital mortality and discharge of patients home. Results Our analysis included 257 patients with a mean age of 72 years; 52% were men. In-hospital mortality was 12%. Mortality was associated with patients who had higher American Society of Anesthesiologists (ASA) class (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.43–10.33, p = 0.008) and in-hospital complications (OR 1.93, 95% CI 1.32–2.83, p = 0.001). Nearly two-thirds of patients discharged home were younger (OR 0.92, 95% CI 0.85–0.99, p = 0.036), had lower ASA class (OR 0.45, 95% CI 0.27–0.74, p = 0.002) and fewer in-hospital complications (OR 0.69, 95% CI 0.53–0.90, p = 0.007). Conclusion American Society of Anesthesiologists class and in-hospital complications are perioperative predictors of mortality and disposition in the older surgical population. Understanding the predictors of poor outcome and the importance of preventing in-hospital complications in older patients will have important clinical utility in terms of preoperative counselling, improving health care and discharging patients home. PMID:26204143

  17. Multiperiodic accelerator structures for linear particle accelerators

    International Nuclear Information System (INIS)

    Tran, D.T.

    1975-01-01

    High efficiency linear accelerator structures, comprised of a succession of cylindrical resonant cavities for acceleration, are described. Coupling annular cavities are located at the periphery, each being coupled to two adjacent cylindrical cavities. (auth)

  18. Accelerated recovery after cardiac operations.

    Science.gov (United States)

    Kaplan, Mehmet; Kut, Mustafa Sinan; Yurtseven, Nurgul; Cimen, Serdar; Demirtas, Mahmut Murat

    2002-01-01

    The accelerated-recovery approach, involving early extubation, early mobility, decreased duration of intensive care unit stay, and decreased duration of hospitalization has recently become a controversial issue in cardiac surgery. We investigated timing of extubation, length of intensive care unit stay, and duration of hospitalization in 225 consecutive cardiac surgery patients. Of the 225 patients, 139 were male and 86 were female; average age was 49.73 +/- 16.95 years. Coronary artery bypass grafting was performed in 127 patients; 65 patients underwent aortic and/or mitral or pulmonary valvular operations; 5 patients underwent valvular plus coronary artery operations; and in 28 patients surgical interventions for congenital anomalies were carried out. The accelerated-recovery approach could be applied in 169 of the 225 cases (75.11%). Accelerated-recovery patients were extubated after an average of 3.97 +/- 1.59 hours, and the average duration of stay in the intensive care unit was 20.93 +/- 2.44 hours for these patients. Patients were discharged if they met all of the following criteria: hemodynamic stability, cooperativeness, ability to initiate walking exercises within wards, lack of pathology in laboratory investigations, and psychological readiness for discharge. Mean duration of hospitalization for accelerated-recovery patients was 4.24 +/- 0.75 days. Two patients (1.18%) who were extubated within the first 6 hours required reintubation. Four patients (2.36%) who were sent to the wards returned to intensive care unit due to various reasons and 6 (3.55%) of the discharged patients were rehospitalized. Approaches for decreasing duration of intubation, intensive care unit stay and hospitalization may be applied in elective and uncomplicated cardiac surgical interventions with short duration of aortic cross-clamping and cardiopulmonary bypass, without risking patients. Frequencies of reintubation, return to intensive care unit, and rehospitalization are quite

  19. Physiological and bodily changes associated with endurance athletic activities and challenges during peri-operative period

    Directory of Open Access Journals (Sweden)

    Umesh K Dash

    2016-01-01

    Full Text Available Endurance athletic activities, which requires top level cardio respiratory system fitness are recently becoming popular in the various parts of the country. Armed Forces are forefront in participation of those sporting activities, like marathon running, prolonged swimming or cycling. It has been found to have various long term beneficial effect in body function as a result of prolonged endurance activities, but it has also found that there are various bodily changes which may affect in anaesthetising the individual during emergency and elective surgeries. Literature review of various journals related to endurance sporting activities has described those bodily changes and effects of anaesthesia and pain on those changes. Based upon the available literature a guideline has been formulated for perioperative management of those patients. Most of those available literatures are from countries other than our country. The time has come for venturing in for carrying out further studies in our scenario, especially in Armed Forces in this new horizon of anaesthesia and critical care

  20. Shaping the operating room and perioperative systems of the future: innovating for improved competitiveness.

    Science.gov (United States)

    Seim, Andreas R; Sandberg, Warren S

    2010-12-01

    To review the current state of anesthesiology for operative and invasive procedures, with an eye toward possible future states. Anesthesiology is at once a mature specialty and in a crisis--requiring breakthrough to move forward. The cost of care now approaches reimbursement, and outcomes as commonly measured approach perfection. Thus, the cost of further improvements seems ready to topple the field, just as the specialty is realizing that seemingly innocuous anesthetic choices have long-term consequences, and better practice is required. Anesthesiologists must create more headroom between costs and revenues in order to sustain the academic vigor and creativity required to create better clinical practice. We outline three areas in which technological and organizational innovation in anesthesiology can improve competitiveness and become a driving force in collaborative efforts to develop the operating rooms and perioperative systems of the future: increasing the profitability of operating rooms; increasing the efficiency of anesthesia; and technological and organizational innovation to foster improved patient flow, communication, coordination, and organizational learning.

  1. Intensification of anxiety and depression, and personal resources among women during the peri-operative period

    Directory of Open Access Journals (Sweden)

    Magdalena Lewicka

    2014-03-01

    Full Text Available Aim. Surgical treatment of women due to gynaecological disorders is the cause of stress and may lead to psychological changes. Studies concerning human response to stress emphasize the importance of the effect of the level of the sense of coherence, anxiety, depression, dispositional optimism and skills of expressing emotions on the quality of feelings and experiences in difficult situations. Materials and methods. The study covered 232 women who had undergone gynaecological surgery due to various causes. Permission to conduct the research was obtained from the Bioethical Commission at the Medical University in Lublin. The study was carried out with the use of the State-Trait Anxiety Inventory (STAI, the Beck Depression Inventory, Courtauld Emotional Control Scale (CECS, and Life Orientation Test – Revised (LOT-R. Results and conclusions. The study showed that investigations of the sense of coherence, level of anxiety and depression, and personal resources allow determination of the characteristics of patients who should be covered with special psychoprophylactic care during the peri-operative period. In addition, the results of own studies obtained may be used for the development of adequate principles of psycho-prophylactic management in the course of the diagnostic-treatment proces with respect to women who had undergone surgical treatment due to gynaecological disorders.

  2. Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint Arthroplasty.

    Science.gov (United States)

    Day, Molly A; Anthony, Christopher A; Bedard, Nicholas A; Glass, Natalie A; Clark, Charles R; Callaghan, John J; Noiseux, Nicolas O

    2018-01-01

    Automated mobile phone messaging has not been reported in total joint arthroplasty (TJA). Our purpose was to compare Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between TJA patients who did and did not receive perioperative automated mobile phone messages. Patients were prospectively enrolled and received messages for 1 week prior until 2 weeks after TJA. Message content included reminders, activity, and pain control. Patients answered select PG/HCAHPS and questions regarding their experience with the automated communication platform. Average PG/HCAHPS scores were compared to historical TJA patients in the 3-year window prior (control group) with significance P communication via automated mobile phone messaging had improved patient satisfaction scores postoperatively. Patients perceived this form of communication was useful and kept them better informed. Automated mobile phone messaging can be an easily integrated, helpful adjunct to surgeons, healthcare systems, and case managers to more effectively communicate with patients undergoing TJA in this era of value-based care. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Enhanced recovery pathways in thoracic surgery from Italian VATS Group: perioperative analgesia protocols.

    Science.gov (United States)

    Piccioni, Federico; Segat, Matteo; Falini, Stefano; Umari, Marzia; Putina, Olga; Cavaliere, Lucio; Ragazzi, Riccardo; Massullo, Domenico; Taurchini, Marco; Del Naja, Carlo; Droghetti, Andrea

    2018-03-01

    Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique that allows a faster recovery after thoracic surgery. Although enhanced recovery after surgery (ERAS) principles seem reasonably applicable to thoracic surgery, there is little literature on the application of such a strategy in this context. In regard to pain management, ERAS pathways promote the adoption of a multimodal strategy, tailored to the patients. This approach is based on combining systemic and loco-regional analgesia to favour opioid-sparing strategies. Thoracic paravertebral block is considered the first-line loco-regional technique for VATS. Other techniques include intercostal nerve block and serratus anterior plane block. Nonsteroidal anti-inflammatory drugs and paracetamol are essential part of the multimodal treatment of pain. Also, adjuvant drugs can be useful as opioid-sparing agents. Nevertheless, the treatment of postoperative pain must take into account opioid agents too, if necessary. All above is useful for careful planning and execution of a multimodal analgesic treatment to enhance the recovery of patients. This article summarizes the most recent evidences from literature and authors' experiences on perioperative multimodal analgesia principles for implementing an ERAS program after VATS lobectomy.

  4. Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction

    Science.gov (United States)

    Rozen, Warren Matthew; Marsh, Daniel; Chow, Whitney T.H.; Vickers, Tobias; Khan, Lubna; Miller, George S.; Hunter-Smith, David J.; Ramakrishnan, Venkat V.

    2016-01-01

    Background Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. Methods We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. Results The useful apps have been subdivided: (I) communication apps—multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps—Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps—FlapApp, Touch Surgery, PubMed on tap: step by step guides to surgical procedures to aid learning and medical journal database; (IV) flap monitoring app—SilpaRamanitor: free flap monitoring app based on photographic analysis for earlier detection of compromised flaps. Conclusions There has been remarkable growth in smartphones use among surgeons. Apps are being developed for every conceivable use. The future will be in wearable smart devices that allow continuous monitoring with the potential to instigate change should deviations from the norm occur. The smart watch is the start of this digital revolution. PMID:27047783

  5. Accelerators of atomic particles

    International Nuclear Information System (INIS)

    Sarancev, V.

    1975-01-01

    A brief survey is presented of accelerators and methods of accelerating elementary particles. The principle of collective accelerating of elementary particles is clarified and the problems are discussed of its realization. (B.S.)

  6. Cortisol treatment affects locomotor activity and swimming behaviour of male smallmouth bass engaged in paternal care: A field study using acceleration biologgers.

    Science.gov (United States)

    Algera, Dirk A; Brownscombe, Jacob W; Gilmour, Kathleen M; Lawrence, Michael J; Zolderdo, Aaron J; Cooke, Steven J

    2017-11-01

    Paternal care, where the male provides sole care for the developing brood, is a common form of reproductive investment among teleost fish and ubiquitous in the Centrarchidae family. Throughout the parental care period, nesting males expend energy in a variety of swimming behaviours, including routine and burst swimming, vigilantly monitoring the nest area and protecting the brood from predators. Parental care is an energetically demanding period, which is presumably made even more difficult if fish are exposed to additional challenges such as those arising from human disturbance, resulting in activation of the hypothalamic-pituitary-interrenal axis (i.e., elevation of cortisol). To study this situation, we examined the effects of experimental manipulation of the stress hormone cortisol on locomotor activity and behaviour of nest guarding male smallmouth bass (Micropterus dolomieu). We exogenously elevated circulating cortisol levels (via intracoelomic implants) and attached tri-axial accelerometers to wild smallmouth bass for three days. During the recovery period (i.e., ≤4h post-release), cortisol-treated fish exhibited significantly reduced locomotor activity and performed significantly less burst and routine swimming relative to control fish, indicating cortisol uptake was rapid, as were the associated behavioural responses. Post-recovery (i.e., >4h post-release), fish with high cortisol exhibited lower locomotor activity and reduced routine swimming relative to controls. Fish were less active and reduced routine and burst swimming at night compared to daylight hours, an effect independent of cortisol treatment. Collectively, our results suggest that cortisol treatment (as a proxy for anthropogenic disturbance and stress) contributed to altered behaviour, and consequently cortisol-treated males decreased parental investment in their brood, which could have potential fitness implications. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Guidelines of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists and Indian College of Cardiac Anaesthesia for perioperative transesophageal echocardiography fellowship examination

    Directory of Open Access Journals (Sweden)

    Kanchi Muralidhar

    2016-01-01

    Full Text Available During current medical care, perioperative transesophageal echocardiography (TEE has become a vital component of patient management, especially in cardiac operating rooms and in critical care medicine. Information derived from echocardiography has an important bearing on the patient′s outcome. The Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA has promoted the use of TEE during routine clinical care of patients undergoing cardiac surgery. An important mission of IACTA is to oversee training and certify anesthesiologists in the perioperative and intensive care use of TEE. The provision of "Fellowship" is by way of conducting IACTA - TEE fellowship (F-TEE examination. This has been done annually for the past 7 years using well-established curriculums by accredited national and international societies. Now, with the transformation and reconstitution of IACTA education and research cell into the newly formed Indian College of Cardiac Anaesthesia, F-TEE is bound to meet international standards. To ensure that the examinations are conducted in a transparent and foolproof manner, the guideline committee (formulated in 2010 of IACTA has taken the onus of formulating the guidelines for the same. These guidelines have been formally reviewed and updated since 2010 and are detailed here to serve as a guide to both the examinee and examiner ensuring standardization, efficiency, and competency of the IACTA F-TEE certification process.

  8. Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Yamakage, Michiaki; Iwasaki, Sohshi; Namiki, Akiyoshi

    2008-01-01

    Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

  9. Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

    LENUS (Irish Health Repository)

    Burke, Siun M

    2010-04-01

    Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.

  10. Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4

    NARCIS (Netherlands)

    Hanart, Christophe; Khalife, Maher; de Villé, Andrée; Otte, Florence; de Hert, Stefan; van der Linden, Philippe

    2009-01-01

    OBJECTIVE: To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery. DESIGN: Prospective randomized study. SETTING: Single University Hospital. PATIENTS: Pediatric patients

  11. Perioperative Statin Therapy Is Not Associated With Reduced Risk of Anastomotic Leakage After Colorectal Resection

    DEFF Research Database (Denmark)

    Bisgård, Anne Sofie; Noack, Morten Westergaard; Klein, Mads

    2013-01-01

    Anastomotic leakage is a serious complication of colorectal surgery. Several studies have demonstrated the beneficial pleiotropic effects of statins, and preliminary studies have suggested that perioperative statin treatment may be associated with reduced risk of anastomotic leakage....

  12. Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

    DEFF Research Database (Denmark)

    Tengberg, L. T.; Bay-Nielsen, M.; Bisgaard, T.

    2017-01-01

    Background: Acute high-risk abdominal (AHA) surgery carries a very high risk of morbidity and mortality and represents a massive healthcare burden. The aim of the present study was to evaluate the effect of a standardized multidisciplinary perioperative protocol in patients undergoing AHA surgery...... = 0·004). Conclusion: The introduction of a multidisciplinary perioperative protocol was associated with a significant reduction in postoperative mortality in patients undergoing AHA surgery. NCT01899885 (http://www.clinicaltrials.gov)....

  13. Impact of surgical case order on perioperative outcomes for robotic-assisted radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Anil A Thomas

    2014-01-01

    Conclusions: Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3 rd round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.

  14. Developing and validating the Perioperative Thirst Discomfort Scale.

    Science.gov (United States)

    Martins, Pamela Rafaela; Fonseca, Lígia Fahl; Rossetto, Edilaine Giovanini

    2017-07-20

    Developing and validating a scale to assess perioperative thirst discomfort. A methodological research conducted in 2014 and 2015 at the surgical center of a public hospital in the north of Paraná, Brazil. The scale was developed after literature review, followed by face and content validation, and reliability assessment through its internal consistency and inter-observer equivalence. Seven items make up the scale: dry mouth; dry lips; thick tongue; thick saliva; dry throat, bad taste and desire to drink water. The content validity index for attributes and items was 0.98, and the reliability index was 1 for the scale attributes and items. Internal consistency assessed by Cronbach's alpha was 0.91 and inter-rater equivalence was 1, as measured by weighted kappa coefficient. ThePerioperative Thirst Discomfort Scaleshowed high content and reliability indexes. Elaborar e validar uma escala para avaliação do desconforto da sede perioperatória. Pesquisa metodológica realizada em 2014 e 2015, no centro cirúrgico de um hospital público do norte do Paraná. A escala foi elaborada após revisão bibliográfica, seguida de validação aparente e de conteúdo e avaliação da fidedignidade através de sua consistência interna e da equivalência inter observadores. Sete itens compuseram a escala: boca seca; lábios ressecados; língua grossa; saliva grossa; garganta seca; gosto ruim e vontade de beber água. O índice de validade de conteúdo para atributos e itens foi de 0,98, e o índice de fidedignidade foi de 1 para os atributos e itens da escala. A consistência interna avaliada pelo alfa de Cronbach foi de 0,91, e a equivalência interobservadores foi de 1, medida pelo coeficiente de kappa ponderado. A escala de desconforto da sede perioperatóriademonstrou altos índices de validade de conteúdo e fidedignidade.

  15. Faster recovery of gastrointestinal transit after laparoscopy and fast-track care in patients undergoing colonic surgery

    NARCIS (Netherlands)

    van Bree, Sjoerd; Vlug, Malaika; Bemelman, Willem; Hollmann, Markus; Ubbink, Dirk; Zwinderman, Koos; de Jonge, Wouter; Snoek, Susanne; Bolhuis, Karen; van der Zanden, Esmerij; The, Frans; Bennink, Roel; Boeckxstaens, Guy

    2011-01-01

    Postoperative ileus is characterized by delayed gastrointestinal (GI) transit and is a major determinant of recovery after colorectal surgery. Both laparoscopic surgery and fast-track multimodal perioperative care have been reported to improve clinical recovery. However, objective measures

  16. Comparative study of perioperative complication rates of cervical laminoplasty performed by residents and teaching neurosurgeons.

    Science.gov (United States)

    Niimura, Manabu; Takai, Keisuke; Taniguchi, Makoto

    2017-11-01

    Early surgical education is required for neurosurgical residents to learn many surgical procedures. However, the participation of less experienced residents may increase perioperative complication rates. Perioperative complication studies in the field of neurosurgery are being increasingly published; however, studies have not yet focused on cervical laminoplasty. The study population included 193 consecutive patients who underwent cervical laminoplasty in Tokyo Metropolitan Neurological Hospital between 2008 and 2014. Patient and surgeon background factors, as well as perioperative complication rates were retrospectively compared between resident and board-certified spine neurosurgeon groups. Deteriorated or newly developed neurological deficits and surgical site complications within 30days of cervical laminoplasty were defined as perioperative complications. Out of 193 patients, 123 (64%) were operated on by residents as the first operator and 70 (36%) by board-certified spine neurosurgeons. No significant differences were observed in patient and surgeon factors between the two groups, except for hyperlipidemia (13 vs 17, p=0.02). Furthermore, no significant differences were noted in perioperative complication rates between the two groups (7 [5.7%] vs 4 [5.7%], p=1). Cervical laminoplasty performed in a standardized manner by residents who received their surgical training in our hospital did not increase perioperative complication rates, and ensured the safety of patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. [The standardized perioperative treatment of chronic rhinosinusitis with nasal polyps and asthma].

    Science.gov (United States)

    Li, Tingting; Ju, Jianbao; Yu, Hailing; Xie, Daoyu

    2015-04-01

    To discuss the perioperative treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma. Retrospective analysis of perioperative clinical data of 43 cases with CRSwNP and asthma. The admitted and under endoscopic surgery. Patients with preventing perioperative asthma attacks and corresponding standardized treatment were Observed. Thirty-five cases were stable during perioperative period and without asthma. Seven patients diagnosed as mild and moderate asthma attacks because of low pulse oximetry (SpO2 92%-95%) and scattered wheeze heard in the lungs. So these patients were sent to ICU for the treatment. They went back to ward after their conditions turned to stable and no asthma during perioperative. One patient diagnosed as severe asthma attack, because irritability and suffocation happened, SpO2 decreased from 99% to 84%-81%, diffuse wheeze could be heard in the whole lung . So we give him tracheal intubation and sent him to ICU for advanced treatment after breathing smooth. Five days later the patient retuned to the ward in stable condition and with no asthma attack again. Before operation the patients should be give some corresponding standardized comprehensive treatment according to the nasal symptoms and the degree of asthma attack, such as the application of topical steroid and antiallergic medicine. And some special treatment should be given to reduce airway hyperresponsiveness mucosa during anesthesia. These methods can reduce the risk of the asthma attacks and improve perioperative safety, prevent serious complications.

  18. Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care

    Directory of Open Access Journals (Sweden)

    Samia Laokri

    2017-08-01

    Full Text Available BackgroundThere is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking.MethodSecondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness.FindingsOriginal studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care.DiscussionBottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public–private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various

  19. Collaborative Approaches and Policy Opportunities for Accelerated Progress toward Effective Disease Prevention, Care, and Control: Using the Case of Poverty Diseases to Explore Universal Access to Affordable Health Care.

    Science.gov (United States)

    Laokri, Samia

    2017-01-01

    There is a massive global momentum to progress toward the sustainable development and universal health coverage goals. However, effective policies to health-care coverage can only emerge through high-quality services delivered to empowered care users by means of strong local health systems and a translational standpoint. Health policies aimed at removing user fees for a defined health-care package may fail at reaching desired results if not applied with system thinking. Secondary data analysis of two country-based cost-of-illness studies was performed to gain knowledge in informed decision-making toward enhanced access to care in the context of resource-constraint settings. A scoping review was performed to map relevant experiences and evidence underpinning the defined research area, the economic burden of illness. Original studies reflected on catastrophic costs to patients because of care services use and related policy gaps. Poverty diseases such as tuberculosis (TB) may constitute prime examples to assess the extent of effective high-priority health-care coverage. Our findings suggest that a share of the economic burden of illness can be attributed to implementation failures of health programs and supply-side features, which may highly impair attainment of the global stated goals. We attempted to define and discuss a knowledge development framework for effective policy-making and foster system levers for integrated care. Bottlenecks to effective policy persist and rely on interrelated patterns of health-care coverage. Health system performance and policy responsiveness have to do with collaborative work among all health stakeholders. Public-private mix strategies may play a role in lowering the economic burden of disease and solving some policy gaps. We reviewed possible added value and pitfalls of collaborative approaches to enhance dynamic local knowledge development and realize integration with the various health-care silos. Despite a large political

  20. 22q11.2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot.

    Science.gov (United States)

    Mercer-Rosa, Laura; Pinto, Nelangi; Yang, Wei; Tanel, Ronn; Goldmuntz, Elizabeth

    2013-10-01

    We sought to investigate the impact of 22q11.2 deletion on perioperative outcome in tetralogy of Fallot. We conducted a retrospective review of patients with tetralogy of Fallot who underwent complete surgical reconstruction at The Children's Hospital of Philadelphia between 1995 and 2006. Inclusion criteria included diagnosis of tetralogy of Fallot and known genotype. Fisher exact and Mann-Whitney tests were used for categoric and continuous variables, respectively. Regression analysis was used to determine whether deletion status predicts outcome. We studied 208 subjects with tetralogy of Fallot, 164 (79%) without and 44 (20%) with 22q11.2 deletion syndrome. There were no differences in sex, race, gestational age, age at diagnosis, admission weight, and duration of mechanical ventilation. Presenting anatomy, survival, complications and reoperations were also comparable between patients with and without 22q11.2 deletion syndrome. Those with 22q11.2 deletion syndrome had more aortopulmonary shunts preceding complete surgical repair (21% vs 7%, P = .02). This association was present after adjustment for presenting anatomy (stenosis, atresia, or absence of pulmonary valve and common atrioventricular canal) and surgical era. In addition, those with 22q11.2 deletion syndrome had longer cardiopulmonary bypass time (84 vs 72 minutes, P = .02) and duration of intensive care (6 vs 4 days, P = .007). Genotype affects early operative outcomes in tetralogy of Fallot resulting, in particular, in longer duration of intensive care. Future studies are required to determine factors contributing to such differences in this susceptible population. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. [Current concepts in perioperative management of children : preface and comments].

    Science.gov (United States)

    Kuratani, Norifumi; Kikuchi, Hirosato

    2007-05-01

    In the past few years, pediatric anesthesia management changed rapidly to more evidence-based and patient-oriented practice. It has been emphasized that "focused and individualized" pre-anesthesia evaluation is preferred to routine screening of laboratory tests and X-rays. Anesthesia induction should be less stressful for children through the use of various approaches, such as preoperative preparation, sedative premedication, and parent-present induction. Cuffed tracheal tube is becoming popular for small children, and its indication should be considered individually. Laryngeal mask airway is frequently used for simple short cases. Perioperative fluid infusion therapy has been a controversial issue. Traditional therapeutic regimen using hypotonic solution with glucose is criticized as a result of the growing evidence of hyponatremia and hyperglycemia. New ventilatory modes and sedative medications are now available for pediatric patients, and lung-protective ventilatory strategy should be considered to protect immature lung from ventilator-induced lung injury. Emergence agitation from general anesthesia is an evolving problem. Sevoflurane is known to be a major risk factor for stormy wake-up. Pediatric anesthesiologists should pursue high quality of anesthesia emergence. All anesthesia residency programs should include pediatric rotation; otherwise anesthesia residents will lose opportunities to learn basic concepts of pediatric anesthesia.

  2. Evaluation of the intensity and discomfort of perioperative thirst

    Directory of Open Access Journals (Sweden)

    Isadora Pierotti

    2018-05-01

    Full Text Available Abstract Objective: To evaluate the intensity and discomfort of perioperative thirst and related factors during anesthesia recovery. Method: This is a quantitative, cross-sectional, descriptive study. Results: Of the 203 participants, 182 (89.6% reported they were thirsty. The mean intensity of thirst was 6.9 measured using a verbal numerical scale of 0 to 10 and discomfort was 7.3 on a scale of 0 to 14. All attributes evaluated by the scale were cited including dry mouth and desire to drink water (87.3%, dry lips (79.1%, thick tongue feeling (43.4%, thick saliva (56.5%, dry throat (75.2% and bad taste in the mouth (63.1%. There was a positive correlation between the intensity of thirst and discomfort assessed by the scale (Spearman coefficient: 0.474; p-value: <0.05. No correlation was found between age, length of fasting and use of opioids with the intensity of thirst and discomfort. Conclusion and implication in the clinical practice: Discomfort arising from the attributes of thirst is evidenced as the intensity of thirst increases.

  3. Open radical prostatectomy after transurethral resection: perioperative, functional, oncologic outcomes.

    Science.gov (United States)

    Fragkoulis, Charalampos; Pappas, Athanasios; Theocharis, Georgios; Papadopoulos, Georgios; Stathouros, Georgios; Ntoumas, Konstantinos

    2018-04-01

    To demonstrate any differences in the perioperative, functional and oncologic outcomes after radical retropubic prostatectomy (RRP) among those patients having previously performed transurethral resection of prostate (TURP) and those not. A total of 35 patients were diagnosed with prostate cancer (T1a and T1b) after TURP, underwent RRP and completed a 1 year follow up (group A). They were matched with a cohort of another 35 men (group B) in terms of age, body mass index (BMI), prostatic specific antigen (PSA), Gleason score, prostate volume (before surgery), pathological stage and neurovascular bundle-sparing technique. That was a retrospective study completed between September 2011 and March 2014. Not a significant difference was demonstrated among the two groups of patients concerning the functional and oncologic results. On the other hand, previous prostate surgery made the operation procedure more demanding. Besides, operative time and blood loss (though not translated in transfusion rates) were higher among patients in group A. Besides, catheter removal in group A patients was performed later than their counterparts of group B. RRP after TURP is a relatively safe procedure and in the hands of experienced surgeons, a previously performed TURP, does not seem to compromise oncologic outcomes of the operation. Continence is preserved, though erectile function seems to be compromised compared with patients undergoing RRP without prior TURP. Moreover, defining the prostate and bladder neck margins can be challenging and the surgeon has to be aware of the difficulties that might confront.

  4. Teamwork in perioperative nursing. Understanding team development, effectiveness, evaluation.

    Science.gov (United States)

    Farley, M J

    1991-03-01

    Teams are an essential part of perioperative nursing practice. Nurses who have a knowledge of teamwork and experience in working on teams have a greater understanding of the processes and problems involved as teams develop from new, immature teams to those that are mature and effective. This understanding will assist nurses in helping their teams achieve a higher level of productivity, and members will be more satisfied with team efforts. Team development progresses through several stages. Each stage has certain characteristics and desired outcomes. At each stage, team members and leaders have certain responsibilities. Team growth does not take place automatically and inevitably, but as a consequence of conscious and unconscious efforts of its leader and members to solve problems and satisfy needs. Building and maintaining a team is certainly work, but work that brings a great deal of satisfaction and feelings of pride in accomplishment. According to I Tenzer, RN, MS, teamwork "is not a panacea; it is a viable approach to developing a hospital's most valuable resource--people."

  5. Accelerators of future generation

    International Nuclear Information System (INIS)

    Kolomenskij, A.A.

    1983-01-01

    A brief review of the prospects of development of various of types accelerator over next 10 to 15 years is given. The following directions are considered: superhign energy proton accelerators and storage rings, electron-positron colliding beams, heavy ion accelerators, medium energy, high-current proton accelerators superhigh power particle beams (electrons light- and heavy ions) for inertial fusion

  6. Future accelerator technology

    International Nuclear Information System (INIS)

    Sessler, A.M.

    1986-05-01

    A general discussion is presented of the acceleration of particles. Upon this foundation is built a categorization scheme into which all accelerators can be placed. Special attention is devoted to accelerators which employ a wake-field mechanism and a restricting theorem is examined. It is shown how the theorem may be circumvented. Comments are made on various acceleration schemes

  7. Comunicação terapêutica no cuidado pré-operatório de mastectomia Comunicación terapéutica en la atención pre-operatoria de mastectomía Therapeutic communication in perioperative care of mastectomy

    Directory of Open Access Journals (Sweden)

    Miria Conceição Lavinas Santos

    2010-08-01

    that the practice of therapeutic communication becomes a favorable practice, because establish the nurse-patient relationship, with patient producing his own care. Understanding the fragility of the patient at this stage, the nurse takes commitment to predefine the nursing care in partnership, in order to meet the patient needs, aiming to, mainly, the autonomy of care. In this way, the authors present a proposal for nursing managed care based on a mutal relationship, human and participatory care.

  8. ETA-II accelerator upgrades

    International Nuclear Information System (INIS)

    Nilson, D.G.; Deadrick, F.J.; Hibbs, S.M.; Sampayan, S.E.; Petersen, D.E.

    1991-09-01

    We discuss recent improvements to the ETA-II linear induction electron accelerator. The accelerator's cells have been carefully reconditioned to raise the maximum accelerating gap voltage from approximately 100 kV to 125 kV. Insulators of Rexolite plastic in a new ''zero-gap'' arrangement replaced the alumina originals after several alternative materials were investigated. A new multi-cable current feed system will be used to eliminate pulse reflection interactions encountered in earlier experiments. Improved alignment fixtures have been installed to help minimize beam perturbation due to poorly aligned intercell magnets between 10-cell groups. A stretched wire alignment technique (SWAT) has been utilized to enhance overall magnetic alignment, and to characterize irreducible alignment errors. These changes are in conjunction with an expansion of the accelerator from a 20-cell to a 60-cell configuration. When completed, the upgraded accelerator is expected to deliver 2.5 kA of electron beam current at 7.5 MeV in bursts of up to fifty 70-ns pulses at a 5-kHz repetition rate. A 5.5-meter-long wiggler will convert the energy into 3-GW microwave pulses at 140 GHz for plasma heating experiments in the Microwave Tokamak Experiment (MTX)

  9. Implications of Perioperative Team Setups for Operating Room Management Decisions.

    Science.gov (United States)

    Doll, Dietrich; Kauf, Peter; Wieferich, Katharina; Schiffer, Ralf; Luedi, Markus M

    2017-01-01

    Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient. We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. We detrended and adjusted the data for potential confounders including age, American Society of Anesthesiologists physical status, and surgical list (scheduled cases of specific surgical specialties). The surgical lists were categorized as ear, nose, and throat surgery; trauma surgery; general surgery; and gynecology. We assessed the relationship between turnaround times and assignment of different anesthesiologists to specific surgeons using a Monte Carlo simulation. We found significant differences in team performances among the different surgical lists but no team learning. We constructed managerial decision tables for the assignment of anesthesiologists to specific surgeons at our hospital. We defined a decision algorithm based on these tables. Our analysis indicated that had this algorithm been used in staffing the operating room for the surgical cases represented in our data, median turnaround times would have a reduction potential of 6.8% (95% confidence interval 6.3% to 7.1%). A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital.

  10. Enhancing engraftment of islets using perioperative sodium 4-phenylbutyrate.

    Science.gov (United States)

    Hsu, Brend Ray-Sea; Chen, Szu-Tah; Fu, Shin-Huei

    2006-12-20

    Primary nonfunction (PNF) adversely impacts islet transplantation. In addition to determining whether sodium 4-phenylbutyrate (4-SPB), an anti-inflammatory agent, reduces PNF, this study investigates how 4-SPB affects PNF. Streptozotocin-induced diabetic C57BL/6 mice, that received 75 syngeneic islets underneath left subrenal space, were fed twice daily of either 4-SPB at 500 mg/kg body weight or isotonic saline (NaCl) from 2 days before through 7 days after transplantation. The graft was removed at days 3, 10 and 84 following transplantation. At 68 h following transplantation, serum levels of interleukin-1beta (IL-1beta) were 2.2+/-0.4 and 0.4+/-0.2 pmol/L (n=6, p<0.005) for NaCl and 4-SPB groups, respectively. Graft genetic expression of IL-1beta was significantly suppressed in 4-SPB group (p<0.01). At day 10, the blood glucose levels were 22.7+/-1.0 and 17.1+/-1.7 mmol/L (n=12, p<0.05) and graft insulin contents (IC) were 35.0+/-8.3 and 107.6+/-29.7 pmol (n=12, p<0.05) for NaCl and 4-SPB groups, respectively. Moreover, the 4-SPB group had a shorter temporary hyperglycemia (15+/-2, n=21 vs. 25+/-2 days, n=19, p=0.001) and a higher cumulative cure rate of diabetes (p<0.001) than the NaCl group. In-vitro studies indicated that 4-SPB did not impact the islets function. These experimental results demonstrated that perioperative administration of 4-SPB decreased serum level and graft genetic expression of IL-1beta and attenuated PNF, which enhanced islet engraftment in a syngeneic transplantation mouse model.

  11. Perioperative outcomes of video- and robot-assisted segmentectomies.

    Science.gov (United States)

    Rinieri, Philippe; Peillon, Christophe; Salaün, Mathieu; Mahieu, Julien; Bubenheim, Michael; Baste, Jean-Marc

    2016-02-01

    Video-assisted thoracic surgery appears to be technically difficult for segmentectomy. Conversely, robotic surgery could facilitate the performance of segmentectomy. The aim of this study was to compare the early results of video- and robot-assisted segmentectomies. Data were collected prospectively on videothoracoscopy from 2010 and on robotic procedures from 2013. Fifty-one patients who were candidates for minimally invasive segmentectomy were included in the study. Perioperative outcomes of video-assisted and robotic segmentectomies were compared. The minimally invasive segmentectomies included 32 video- and 16 robot-assisted procedures; 3 segmentectomies (2 video-assisted and 1 robot-assisted) were converted to lobectomies. Four conversions to thoracotomy were necessary for anatomical reason or arterial injury, with no uncontrolled bleeding in the robotic arm. There were 7 benign or infectious lesions, 9 pre-invasive lesions, 25 lung cancers, and 10 metastatic diseases. Patient characteristics, type of segment, conversion to thoracotomy, conversion to lobectomy, operative time, postoperative complications, chest tube duration, postoperative stay, and histology were similar in the video and robot groups. Estimated blood loss was significantly higher in the video group (100 vs. 50 mL, p = 0.028). The morbidity rate of minimally invasive segmentectomy was low. The short-term results of video-assisted and robot-assisted segmentectomies were similar, and more data are required to show any advantages between the two techniques. Long-term oncologic outcomes are necessary to evaluate these new surgical practices. © The Author(s) 2016.

  12. Predictive factors for perioperative blood transfusion in neck dissection.

    Science.gov (United States)

    Abu-Ghanem, Sara; Warshavsky, Anton; Carmel, Narin-Nard; Abu-Ghanem, Yasmin; Abergel, Avraham; Fliss, Dan M; Yehuda, Moshe

    2016-04-01

    There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND). Retrospective cohort study. Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction. Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery. Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia.

    Science.gov (United States)

    Campbell, Gillian; Alderson, Phil; Smith, Andrew F; Warttig, Sheryl

    2015-04-13

    Inadvertent perioperative hypothermia (a drop in core temperature to below 36°C) occurs because of interference with normal temperature regulation by anaesthetic drugs, exposure of skin for prolonged periods and receipt of large volumes of intravenous and irrigation fluids. If the temperature of these fluids is below core body temperature, they can cause significant heat loss. Warming intravenous and irrigation fluids to core body temperature or above might prevent some of this heat loss and subsequent hypothermia. To estimate the effectiveness of preoperative or intraoperative warming, or both, of intravenous and irrigation fluids in preventing perioperative hypothermia and its complications during surgery in adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE Ovid SP (1956 to 4 February 2014), EMBASE Ovid SP (1982 to 4 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 4 February 2014), Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCOhost (1980 to 4 February 2014) and reference lists of identified articles. We also searched the Current Controlled Trials website and ClinicalTrials.gov. We included randomized controlled trials or quasi-randomized controlled trials comparing fluid warming methods versus standard care or versus other warming methods used to maintain normothermia. Two review authors independently extracted data from eligible trials and settled disputes with a third review author. We contacted study authors to ask for additional details when needed. We collected data on adverse events only if they were reported in the trials. We included in this review 24 studies with a total of 1250 participants. The trials included various numbers and types of participants. Investigators used a range of methods to warm fluids to temperatures between 37°C and 41°C. We found that evidence was of moderate quality because descriptions of trial design were

  14. An analysis of acute complications and perioperative morbidity from high dose rate brachytherapy in the treatment of gynecological malignancies

    International Nuclear Information System (INIS)

    Sarkaria, Jann N.; Petereit, Daniel G.; Kinsella, Timothy J.; Buchler, Dolores A.

    1995-01-01

    Purpose: To evaluate the acute morbidity and mortality for high dose-rate (HDR) brachytherapy performed in an outpatient setting in the treatment of gynecological malignancies, and to identify possible risk factors for adverse outcomes. Materials and Methods: One hundred seventy-one patients with cervical (n=129) or uterine (n=42) carcinoma with an intact uterus were evaluated and treated from August 1989 through December 1994, with at least part of their therapy delivered with intracavitary HDR 192 Ir radiation. A total of 830 ICR insertions were performed with greater than 95% done on an outpatient basis under heavy intravenous sedation using fentanyl and midazolam. Perioperative morbidity and mortality were recorded for any event occurring within 30 days of the completion of therapy. Anesthesia risk was evaluated retrospectively in all patients based on the American Society of Anesthesiologists' (ASA) Physical Class System. Results: The uterine patients, many treated with radiation alone because of morbid obesity or medical inoperability, had a significantly higher perioperative morbidity and mortality rate as compared to the cervix patient cohort. Thirteen of the 42 (31%) uterine patients and 8 of the 129 (6%) cervix patients required hospitalization within 30 days of treatment completion (p 2) experienced greater morbidity and mortality, while the best predictor of complications in the cervix patients was age greater than 70 years. For the entire cohort of patients, no correlation was found between the 30 day morbidity and mortality and the doses of fentanyl and midazolam used or the length of the procedure. Conclusions: The acute complication rate from HDR brachytherapy performed on an outpatient basis with heavy intravenous sedation is acceptable for the great majority of patients who present for treatment. However, the high morbidity and mortality experienced by certain patient cohorts suggests that careful assessment of the risk/benefit ratio for treatment

  15. Is perioperative administration of 5% dextrose effective in reducing the incidence of PONV in laparoscopic cholecystectomy?: A randomized control trial.

    Science.gov (United States)

    Mishra, Ankita; Pandey, Ravinder Kumar; Sharma, Ankur; Darlong, Vanlalnghaka; Punj, Jyotsna; Goswami, Devalina; Sinha, Renu; Rewari, Vimi; Chandralekha, Chandralekha; Bansal, Virinder Kumar

    2017-08-01

    To compare the incidence of postoperative nausea and vomiting (PONV) during perioperative administration of 5% dextrose and normal saline in laparoscopic cholecystectomy. Prospective, randomized, double-blind trial. Operating rooms in a tertiary care hospital of Northern India. One hundred patients with American Society of Anesthesiologists status I to II undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomized into two groups [normal saline (NS) group and 5% dextrose (D) group]. Both the groups received Ringer acetate (Sterofundin ISO) intravenously as a maintenance fluid during intraoperative period. Besides this, patients of group NS received 250ml of 0.9% normal saline and patients of group D received 5% dextrose @ 100ml/h started at the time when gall bladder was taken out. It was continued in the postoperative period with the same rate till it gets finished. Incidence of PONV, Apfel score, intraoperative opioids used and consumption of rescue antiemetics. Demographic data was statistically similar. Out of total 100 patients, 47 patients (47%) had PONV. In group D, 14 patients (28%) had PONV while in group NS, 33 patients (66%) had PONV within 24h of surgery (p value 0.001). The incidence of PONV was reduced by 38% in group D which is significantly lower when compared with that of group NS (p value 0.001). The consumption of single dose of rescue antiemetics in group D was also reduced by 26% when compared to that of group NS (p value 0.002). Perioperative administration of 5% dextrose in patients undergoing laparoscopic surgery can reduce PONV significantly and even if PONV occurs, the quantity of rescue antiemetics to combat PONV is also reduced significantly. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Analysis of Perioperative Chemotherapy in Resected Pancreatic Cancer: Identifying the Number and Sequence of Chemotherapy Cycles Needed to Optimize Survival.

    Science.gov (United States)

    Epelboym, Irene; Zenati, Mazen S; Hamad, Ahmad; Steve, Jennifer; Lee, Kenneth K; Bahary, Nathan; Hogg, Melissa E; Zeh, Herbert J; Zureikat, Amer H

    2017-09-01

    Receipt of 6 cycles of adjuvant chemotherapy (AC) is standard of care in pancreatic cancer (PC). Neoadjuvant chemotherapy (NAC) is increasingly utilized; however, optimal number of cycles needed alone or in combination with AC remains unknown. We sought to determine the optimal number and sequence of perioperative chemotherapy cycles in PC. Single institutional review of all resected PCs from 2008 to 2015. The impact of cumulative number of chemotherapy cycles received (0, 1-5, and ≥6 cycles) and their sequence (NAC, AC, or NAC + AC) on overall survival was evaluated Cox-proportional hazard modeling, using 6 cycles of AC as reference. A total of 522 patients were analyzed. Based on sample size distribution, four combinations were evaluated: 0 cycles = 12.1%, 1-5 cycles of combined NAC + AC = 29%, 6 cycles of AC = 25%, and ≥6 cycles of combined NAC + AC = 34%, with corresponding survival. 13.1, 18.5, 37, and 36.8 months. On MVA (P cycles AC, receipt of 0 cycles [HR 3.57, confidence interval (CI) 2.47-5.18] or 1-5 cycles in any combination (HR 2.37, CI 1.73-3.23) was associated with increased hazard of death, whereas receipt of ≥6 cycles in any sequence was associated with optimal and comparable survival (HR 1.07, CI 0.78-1.47). Receipt of 6 or more perioperative cycles of chemotherapy either as combined neoadjuvant and adjuvant or adjuvant alone may be associated with optimal and comparable survival in resected PC.

  17. Caring for the Jehovah's Witness Parturient.

    Science.gov (United States)

    Mason, C LaToya; Tran, Connie K

    2015-12-01

    Caring for the Jehovah's Witness parturient is a complex task that presents a number of ethical, medical, and legal concerns because many Jehovah's Witnesses refuse allogeneic blood transfusion. Childbirth and its surrounding events may be associated with significant blood loss. Given their significant role in the intraoperative administration of blood products, anesthesia providers should be familiar with factors that must be considered in the perioperative care of Jehovah's Witness parturients. Several pharmacologic therapies, anesthetic techniques, and operative interventions aimed at blood conservation may be useful in the care of such patients. Aside from their refusal of transfusion, each Witness makes a personal decision on the acceptability of derivatives of plasma or cellular blood components and autologous blood management. Therefore, the patient-physician relationship must ensure that the individual patient's desires are accurately communicated, respected, and documented in the patient's medical record. The Perioperative Surgical Home model is appropriate for use in caring for Jehovah's Witness patients because it allows for the early and continuing coordination of care and communication between the patient and a multidisciplinary team. In this article, we present a focused review of concepts important to the provision of anesthetic care of parturients who are Jehovah's Witnesses and introduce an algorithmic perioperative approach that may be applied to the care of the Jehovah's Witness parturient undergoing an operative procedure.

  18. 2014 CERN Accelerator Schools: Plasma Wake Acceleration

    CERN Multimedia

    2014-01-01

    A specialised school on Plasma Wake Acceleration will be held at CERN, Switzerland from 23-29 November, 2014.   This course will be of interest to staff and students in accelerator laboratories, university departments and companies working in or having an interest in the field of new acceleration techniques. Following introductory lectures on plasma and laser physics, the course will cover the different components of a plasma wake accelerator and plasma beam systems. An overview of the experimental studies, diagnostic tools and state of the art wake acceleration facilities, both present and planned, will complement the theoretical part. Topical seminars and a visit of CERN will complete the programme. Further information can be found at: http://cas.web.cern.ch/cas/PlasmaWake2014/CERN-advert.html http://indico.cern.ch/event/285444/

  19. Neoadjuvant Treatment Does Not Influence Perioperative Outcome in Rectal Cancer Surgery

    International Nuclear Information System (INIS)

    Ulrich, Alexis; Weitz, Juergen; Slodczyk, Matthias; Koch, Moritz; Jaeger, Dirk; Muenter, Marc; Buechler, Markus W.

    2009-01-01

    Purpose: To identify the risk factors for perioperative morbidity in patients undergoing resection of primary rectal cancer, with a specific focus on the effect of neoadjuvant therapy. Methods and Materials: This exploratory analysis of prospectively collected data included all patients who underwent anterior resection/low anterior resection or abdominoperineal resection for primary rectal cancer between October 2001 and October 2006. The study endpoints were perioperative surgical and medical morbidity. Univariate and multivariate analyses of potential risk factors were performed. Results: A total of 485 patients were included in this study; 425 patients (88%) underwent a sphincter-saving anterior resection/low anterior resection, 47 (10%) abdominoperineal resection, and 13 (2%) multivisceral resection. Neoadjuvant chemoradiotherapy was performed in 100 patients (21%), and 168 (35%) underwent neoadjuvant short-term radiotherapy (5 x 5 Gy). Patient age and operative time were independently associated with perioperative morbidity, and operative time, body mass index >27 kg/m 2 (overweight), and resection type were associated with surgical morbidity. Age and a history of smoking were confirmed as independent prognostic risk factors for medical complications. Neoadjuvant therapy was not associated with a worse outcome. Conclusion: The results of this prospective study have identified several risk factors associated with an adverse perioperative outcome after rectal cancer surgery. In addition, neoadjuvant therapy was not associated with increased perioperative complications.

  20. Peri-operative chemotherapy in the management of resectable colorectal cancer pulmonary metastases

    Directory of Open Access Journals (Sweden)

    Hawkes Eliza A

    2012-08-01

    Full Text Available Abstract Background Surgery is often advocated in patients with resectable pulmonary metastases from colorectal cancer (CRC. Our study aims to evaluate peri-operative chemotherapy in patients with metastastic CRC undergoing pulmonary metastasectomy. Methods Patients treated for CRC who underwent pulmonary metastasectomy by a single surgeon were identified. Outcome measures included survival, peri-operative complications, radiological and histological evidence of chemotherapy-induced lung toxicities. Results Between 1997 and 2009, 51 eligible patients were identified undergoing a total of 72 pulmonary resections. Thirty-eight patients received peri-operative chemotherapy, of whom 9 received an additional biological agent. Five-year overall survival rate was 72% in the whole cohort - 74% and 68% in those who received peri-operative chemotherapy (CS and those who underwent surgery alone (S respectively. Five-year relapse free survival rate was 31% in the whole cohort - 38% and ≤18% in CS and S groups respectively. Only 8% had disease progression during neoadjuvant chemotherapy. There were no post-operative deaths. Surgical complications occurred in only 4% of patients who received pre-operative chemotherapy. There was neither radiological nor histological evidence of lung toxicity in resected surgical specimens. Conclusions Peri-operative chemotherapy can be safely delivered to CRC patients undergoing pulmonary metastasectomy. Survival in this selected group of patients was favourable.

  1. Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma.

    Science.gov (United States)

    Kimura, Norihisa; Toyoki, Yoshikazu; Ishido, Keinosuke; Kudo, Daisuke; Yakoshi, Yuta; Tsutsumi, Shinji; Miura, Takuya; Wakiya, Taiichi; Hakamada, Kenichi

    2015-05-01

    Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival. Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed. Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (Pblood transfusion was independently associated with recurrence (hazard ratio (HR)=2.839 (95 % confidence interval (CI), 1.370-5.884), P=0.005), while perioperative blood transfusion (HR=3.383 (95 % CI, 1.499-7.637), P=0.003) and R1 resection (HR=3.125 (95 % CI, 1.025-9.530), P=0.045) were independent risk factors for poor survival. Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.

  2. Does training of fellows affect peri-operative outcomes of robot-assisted partial nephrectomy?

    Science.gov (United States)

    Khene, Zine-Eddine; Peyronnet, Benoit; Bosquet, Elise; Pradère, Benjamin; Robert, Corentin; Fardoun, Tarek; Kammerer-Jacquet, Solène-Florence; Verhoest, Grégory; Rioux-Leclercq, Nathalie; Mathieu, Romain; Bensalah, Karim

    2017-10-01

    To evaluate the impact of fellows' involvement on the peri-operative outcomes of robot-assisted partial nephrectomy (RAPN). We analysed 216 patients who underwent RAPN for a small renal tumour. We stratified our cohort into two groups according to the involvement of a fellow surgeon during the procedure: expert surgeon operating alone (expert group) and fellow operating under the supervision of the expert surgeon (fellow group). Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows' involvement on peri-operative and postoperative outcomes. Trifecta and margins ischaemia complications (MIC) score achievement rates were used to assess the quality of surgery in both the expert and fellow groups. Trifecta was defined as a combination of warm ischaemia time negative surgical margins and no peri-operative complications. MIC score was defined as negative surgical margins, ischaemia time Training fellows to perform RAPN is associated with longer operating time and WIT but does not appear to compromise other peri-operative outcomes. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  3. Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

    Science.gov (United States)

    Zaw, Aye Sandar; Kantharajanna, Shashidhar B; Maharajan, Karthikeyan; Tan, Barry; Saparamadu, Amarasinghe A; Kumar, Naresh

    2017-11-01

    The question of independent association between allogeneic blood transfusion (ABT) and postoperative complications in cancer surgeries has been controversial and remains so. In metastatic spine tumor surgery (MSTS), previous studies investigated the influence of ABT on survival, but not on postoperative complications. We aimed to evaluate the influence of perioperative ABT on postoperative complications and infections in patients undergoing MSTS. This retrospective study included 247 patients who underwent MSTS at a single tertiary institution between 2005 and 2014. The outcome measures were postoperative complications and infections within 30 days after MSTS. Multivariate logistic regression analyses were performed to assess influence of blood transfusion on the outcomes after adjusting for potential confounders. Of 247 patients, 133 (54%) received ABT with overall median (range) of 2 (0-10) units. The adjusted odds of developing any postoperative complication was 2.27 times higher in patients with transfusion (95% confidence interval [CI], 1.17-4.38; p = 0.01) and 1.24 times higher odds per every unit increase in blood transfusion (95% CI, 1.05-1.46; p blood transfusion also increased the odds of having overall postoperative infections (odds ratio, 3.58; 95% CI, 1.15-11.11; p = 0.02) and there were 1.24 times higher odds per every unit increase in transfusion (95% CI, 1.01-1.54; p = 0.04). This study adds evidence to the literature implicating ABT to be influential on postoperative complications and infections in patients undergoing MSTS. Appropriate blood management measures should, therefore, be given a crucial place in the care of these patients so as to reduce any putative effect of blood transfusion. © 2017 AABB.

  4. Technician-Supported Remote Interrogation of CIEDs: Initial Use in US Emergency Departments and Perioperative Areas.

    Science.gov (United States)

    Ahmed, Imdad; Patel, Amisha S; Balgaard, Timothy J; Rosenfeld, Lynda E

    2016-03-01

    Interrogation/interpretation of cardiac implantable electronic devices (CIEDs) is frequently required in the emergency department (ED) or perioperative areas (OR) where resources to do this are often not available. CareLink Express (CLE; Medtronic, plc, Mounds View, MN, USA) is a technician-supported real-time remote interrogation system for Medtronic CIEDs. Using data from 136 US locations, this retrospective study was designed to assess CLE efficiency compared to traditional device management, and examine its findings. All 7,044 US CLE transmissions from the ED and OR (January 2012-October 2014) were compared to 217 traditional requests where CIED interrogations/interpretations were performed by calling industry representatives to these sites. CLE reduced the time to device interrogation/interpretation by 78%: 100 ± 140-22 ± 14 minutes, P < 0.0001, improving response time and consistency; ED: 82 ± 103-23 ± 18 minutes, P, ≤ 0.01; OR: 127 ± 181-17 ± 10 minutes, P < 0.0001. Actionable events (AE) (arrhythmia, device/lead abnormalities) were infrequent: 9.1% overall (ED: 9.9%; OR: 4.1%). Only 6.5% of patients with syncope/presyncope and 13.6% with a perceived shock had AE. AEs were more common in those with suspected device problems (30.4%) or audible alerts (52.6%). They were more likely in patients not enrolled in long-term remote monitoring (23.9% vs 8.2%, P < 0.0001) and in those with older CIED systems (7.4% in year 1 vs 31.0% after 10 years). The many patients with CIEDs, and the ability to quickly identify the minority with high-risk AE from the no/low-risk majority, strongly support CLE use in the ED and OR, sites which are expensive and prioritize efficiency. © 2015 Wiley Periodicals, Inc.

  5. More stapler firings increase the risk of perioperative morbidity after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Major, Piotr; Wysocki, Michał; Pędziwiatr, Michał; Pisarska, Magdalena; Małczak, Piotr; Wierdak, Mateusz; Dembiński, Marcin; Migaczewski, Marcin; Rubinkiewicz, Mateusz; Budzyński, Andrzej

    2018-03-01

    Staple-line bleeding and leakage are the most common serious complications of laparoscopic sleeve gastrectomy. The relationship between multiple stapler firings and higher risk of postoperative complications is well defined in colorectal surgery but has not been addressed in bariatric procedures so far. Identification of new factors such as "the numbers of stapler firings used during laparoscopic sleeve gastrectomy (LSG)" as a predictor for complications can lead to optimization of the patient care at bariatric centers. To determine the association between perioperative morbidity and the number of stapler firings during laparoscopic sleeve gastrectomy. This observational study was based on retrospective analysis of prospectively collected data in patients operated on for morbid obesity in a teaching hospital/tertiary referral center for general surgery. The patients who underwent LSG were analyzed in terms of the number of stapler firings used as a new potential risk predictor for postoperative complications after surgery, adjusting for other patient- and treatment-related factors. The study included 333 patients (209 women, 124 men, mean age: 40 ±11). During the first 30 days after surgery, complications were observed in 18 (5.41%) patients. Multivariate analysis showed that prolonging operative time increased morbidity (every minute, OR = 1.01; 95% CI: 1.00-1.02) and the complication rate increased with the number of stapler firings (every firing, OR = 1.91; 95% CI: 1.09-3.33; p = 0.023). Additional stapler firings above the usual number and a prolonged operation should alert a surgeon and the whole team about increased risk of postoperative complications.

  6. Other people's accelerators

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1987-06-15

    The first report from the Washington Accelerator Conference concentrated on news from the particle physics centres. But the bulk of the Conference covered the use of accelerators in other fields, underlining this valuable spinoff from particle physics.

  7. Improved plasma accelerator

    Science.gov (United States)

    Cheng, D. Y.

    1971-01-01

    Converging, coaxial accelerator electrode configuration operates in vacuum as plasma gun. Plasma forms by periodic injections of high pressure gas that is ionized by electrical discharges. Deflagration mode of discharge provides acceleration, and converging contours of plasma gun provide focusing.

  8. The electron accelerator Ridgetron

    International Nuclear Information System (INIS)

    Hayashizaki, N.; Hattori, T.; Odera, M.; Fujisawa, T.

    1999-01-01

    Many electron accelerators of DC or RF type have been widely used for electron beam irradiation (curing, crosslinking of polymers, sterilization of medical disposables, preservation of food, etc.). Regardless of the acceleration energy, the accelerators to be installed in industrial facilities, have to satisfy the requires of compact size, low power consumption and stable operation. The DC accelerator is realized very compact in the energy under 300 keV, however, it is large to prevent the discharge of an acceleration column in the energy over 300 keV. The RF electron accelerator Ridgetron has been developed to accelerate the continuous beam of the 0.5-10 MeV range in compact space. It is the first example as an electron accelerator incorporated a ridged RF cavity. A prototype system of final energy of 2.5 MeV has been studied to confirm the feasibility at present

  9. High brightness electron accelerator

    International Nuclear Information System (INIS)

    Sheffield, R.L.; Carlsten, B.E.; Young, L.M.

    1994-01-01

    A compact high brightness linear accelerator is provided for use, e.g., in a free electron laser. The accelerator has a first plurality of accelerating cavities having end walls with four coupling slots for accelerating electrons to high velocities in the absence of quadrupole fields. A second plurality of cavities receives the high velocity electrons for further acceleration, where each of the second cavities has end walls with two coupling slots for acceleration in the absence of dipole fields. The accelerator also includes a first cavity with an extended length to provide for phase matching the electron beam along the accelerating cavities. A solenoid is provided about the photocathode that emits the electrons, where the solenoid is configured to provide a substantially uniform magnetic field over the photocathode surface to minimize emittance of the electrons as the electrons enter the first cavity. 5 figs

  10. Unified accelerator libraries

    International Nuclear Information System (INIS)

    Malitsky, Nikolay; Talman, Richard

    1997-01-01

    A 'Universal Accelerator Libraries' (UAL) environment is described. Its purpose is to facilitate program modularity and inter-program and inter-process communication among heterogeneous programs. The goal ultimately is to facilitate model-based control of accelerators

  11. YEREVAN: Acceleration workshop

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    Sponsored by the Yerevan Physics Institute in Armenia, a Workshop on New Methods of Charged Particle Acceleration in October near the Nor Amberd Cosmic Ray Station attracted participants from most major accelerator centres in the USSR and further afield

  12. San Francisco Accelerator Conference

    International Nuclear Information System (INIS)

    Southworth, Brian

    1991-01-01

    'Where are today's challenges in accelerator physics?' was the theme of the open session at the San Francisco meeting, the largest ever gathering of accelerator physicists and engineers

  13. Large tandem accelerators

    International Nuclear Information System (INIS)

    Jones, C.M.

    1976-01-01

    The increasing importance of energetic heavy ion beams in the study of atomic physics, nuclear physics, and materials science has partially or wholly motivated the construction of a new generation of tandem accelerators designed to operate at maximum terminal potentials in the range 14 to 30 MV. In addition, a number of older tandem accelerators are now being significantly upgraded to improve their heavy ion performance. Both of these developments have reemphasized the importance of negative heavy ion sources. The new large tandem accelerators are described, and the requirements placed on negative heavy ion source technology by these and other tandem accelerators used for the acceleration of heavy ions are discussed. First, a brief description is given of the large tandem accelerators which have been completed recently, are under construction, or are funded for construction, second, the motivation for construction of these accelerators is discussed, and last, criteria for negative ion sources for use with these accelerators are presented

  14. Vp x B acceleration

    International Nuclear Information System (INIS)

    Sugihara, Ryo.

    1987-05-01

    A unique particle acceleration by an electrostatic (ES) wave, a magnetosonic shock wave as well as an electromagnetic (EM) wave is reviewed. The principle of the acceleration is that when a charged particle is carried across an external magnetic field the charge feels a DC field (the Lorentz force) and is accelerated. The theory for the ES wave acceleration is experimentally verified thought it is semi-quantitative. The shock acceleration is extensively studied theoretically and in a particle simulation method and the application is extended to phenomena in interplanetary space. The EM wave acceleration is based on a trapping in a moving neutral sheet created by the wave magnetic field and the external magnetic field, and the particle can be accelerated indefinitely. A brief sketch on a slow-wave-structure for this acceleration will be given. (author)

  15. Accelerator-timing system

    International Nuclear Information System (INIS)

    Timmer, E.; Heine, E.

    1985-01-01

    Along the NIKHEF accelerator in Amsterdam (Netherlands), at several places a signal is needed for the sychronisation of all devices with the acceleration process. In this report, basic principles and arrangements of this timing system are described

  16. Linear accelerator: A concept

    Science.gov (United States)

    Mutzberg, J.

    1972-01-01

    Design is proposed for inexpensive accelerometer which would work by applying pressure to fluid during acceleration. Pressure is used to move shuttle, and shuttle movement is sensed and calibrated to give acceleration readings.

  17. Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

    Science.gov (United States)

    Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

    2017-06-30

    'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

  18. 'Fast-track' colonic surgery in Austria and Germany--results from the survey on patterns in current perioperative practice.

    Science.gov (United States)

    Hasenberg, T; Keese, M; Längle, F; Reibenwein, B; Schindler, K; Herold, A; Beck, G; Post, S; Jauch, K W; Spies, C; Schwenk, W; Shang, E

    2009-02-01

    'Fast-track' rehabilitation has been shown to accelerate recovery, reduce general morbidity and decrease hospital stay after elective colonic surgery. Despite this evidence, there is no information on the acceptance and utilization of these concepts among the entirety of Austrian and German surgeons. In 2006, a questionnaire concerning perioperative routines in elective, open colonic resection was sent to the chief surgeons of 1270 German and 120 Austrian surgical centres. The response rate was 63% in Austria (76 centres) and 30% in Germany (385 centres). Mechanical bowel preparation is used by the majority (Austria, 91%; Germany, 94%); the vertical incision is the standard method of approach to the abdomen in Austria (79%) and Germany (83%), nasogastric decompression tubes are rarely used, one-third of the questioned surgeons in both countries use intra-abdominal drains. Half of the surgical centres allow the intake of clear fluids on the day of surgery and one-fifth offer solid food on that day. Epidural analgesia is used in three-fourths of the institutions. Although there is an evident benefit of fast-track management, the survey shows that they are not yet widely used as a routine in Austria and Germany.

  19. Polarized proton acceleration program at the AGS

    International Nuclear Information System (INIS)

    Lee, Y.Y.

    1981-01-01

    The unexpected importance of high energy spin effects and the success of the ZGS in correcting many intrinsic and imperfection depolarizing resonances led us to attempt to accelerate polarized protons in the AGS. A multi-university/laboratory collaborative effort involving Argonne, Brookhaven, Michigan, Rice and Yale is underway to improve and modify to accelerate polarized protons. From the experience at the ZGS and careful studies made us confident of the feasibility of achieving a polarization of over 60 percent up to 26 GeV/c with an intensity of 10 11 approx. 10 12 per pulse. The first polarized proton acceleration at the AGS is expected in 1983

  20. Heavy ion accelerators

    International Nuclear Information System (INIS)

    Schmelzer, C.

    1974-01-01

    This review of the present state of work on heavy-ion accelerators pays particular attention to the requirements for nuclear research. It is divided into the following sections: single-particle versus collective acceleration, heavy-ion accelerators, beam quality, and a status report on the UNILAC facility. Among the topics considered are the recycling cyclotron, linacs with superconducting resonators, and acceleration to the GeV/nucleon range. (8 figures, 2 tables) (U.S.)

  1. Accelerators at school

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    Latest subject covered by the CERN Accelerator School was 'Applied Geodesy of Particle Accelerators', which attracted an impressive number of outside participants to CERN for a week in April. Since the forerunners of today's particle accelerators were demonstrated over 50 years ago, the positioning of accelerator components has progressed from the laboratory bench-top to tunnels tens of kilometres long. Despite this phenomenal growth in size, sub-millimetre accuracy is still required

  2. Accelerators at school

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    1986-06-15

    Latest subject covered by the CERN Accelerator School was 'Applied Geodesy of Particle Accelerators', which attracted an impressive number of outside participants to CERN for a week in April. Since the forerunners of today's particle accelerators were demonstrated over 50 years ago, the positioning of accelerator components has progressed from the laboratory bench-top to tunnels tens of kilometres long. Despite this phenomenal growth in size, sub-millimetre accuracy is still required.

  3. Accelerators for Medicine

    CERN Multimedia

    CERN. Geneva

    2018-01-01

    This lecture will review the different applications of particle accelerators to the medical field, from cancer treatment with beams of accelerator-produced particles (photons, electrons, protons, ions and neutrons) to the generation of radioactive isotopes used in medical diagnostics, in cancer therapy and in the new domain of theragnostics. For each application will be outlined the state of the art, the potential, and the accelerator challenges to be faced to meet the increasing demand for therapeutic procedures based on accelerators.

  4. Large electrostatic accelerators

    International Nuclear Information System (INIS)

    Jones, C.M.

    1984-01-01

    The paper is divided into four parts: a discussion of the motivation for the construction of large electrostatic accelerators, a description and discussion of several large electrostatic accelerators which have been recently completed or are under construction, a description of several recent innovations which may be expected to improve the performance of large electrostatic accelerators in the future, and a description of an innovative new large electrostatic accelerator whose construction is scheduled to begin next year

  5. Particle beam accelerator

    International Nuclear Information System (INIS)

    Turner, N.L.

    1982-01-01

    A particle beam accelerator is described which has several electrodes that are selectively short circuited together synchronously with changes in the magnitude of a DC voltage applied to the accelerator. By this method a substantially constant voltage gradient is maintained along the length of the unshortened electrodes despite variations in the energy applied to the beam by the accelerator. The invention has particular application to accelerating ion beams that are implanted into semiconductor wafers. (U.K.)

  6. Superconducting accelerator technology

    International Nuclear Information System (INIS)

    Grunder, H.A.; Hartline, B.K.

    1986-01-01

    Modern and future accelerators for high energy and nuclear physics rely increasingly on superconducting components to achieve the required magnetic fields and accelerating fields. This paper presents a practical overview of the phenomenon of superconductivity, and describes the design issues and solutions associated with superconducting magnets and superconducting rf acceleration structures. Further development and application of superconducting components promises increased accelerator performance at reduced electric power cost

  7. Applications of particle accelerators

    International Nuclear Information System (INIS)

    Barbalat, O.

    1994-01-01

    Particle accelerators are now widely used in a variety of applications for scientific research, applied physics, medicine, industrial processing, while possible utilisation in power engineering is envisaged. Earlier presentations of this subject, given at previous CERN Accelerator School sessions have been updated with papers contributed to the first European Conference on Accelerators in Applied Research and Technology (ECAART) held in September 1989 in Frankfurt and to the Second European Particle Accelerator Conference in Nice in June 1990. (orig.)

  8. Perioperative incidents associated with internal maxillary distraction osteogenesis: a retrospective study of 20 patients.

    Science.gov (United States)

    Kristian, Andersen; Erik, Nørholt Sven; Annelise, Küseler; John, Jensen; Klit, Pedersen Thomas

    2012-12-01

    This retrospective study aimed to assess the frequency and distribution of incidents encountered during the perioperative period of maxillary distraction with internal devices. The perioperative period was defined as the period between device placement and removal. Records of 20 patients treated during 2004-2011 with internal maxillary distraction osteogenesis were examined. Incidents were registered in terms of severity and need of intervention. Eighty percent of the patients experienced minor incidents, of which the most frequent were pain during activation and infections; 80% of these experienced ≥1 hard and soft tissue-related incidents, and 20% ≥1 device-related incidents. All incidents were solved with minimal or no intervention. Maxillary distraction using internal devices is a safe treatment with only minor incidents in the perioperative period. Preoperative planning and good cooperation are essential for preventing postoperative incidents. Prophylactic antibiotic treatment during the distraction period may be indicated. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Perioperative pharmacological management of pulmonary hypertensive crisis during congenital heart surgery.

    Science.gov (United States)

    Brunner, Nathan; de Jesus Perez, Vinicio A; Richter, Alice; Haddad, François; Denault, André; Rojas, Vanessa; Yuan, Ke; Orcholski, Mark; Liao, Xiaobo

    2014-03-01

    Pulmonary hypertensive crisis is an important cause of morbidity and mortality in patients with pulmonary arterial hypertension secondary to congenital heart disease (PAH-CHD) who require cardiac surgery. At present, prevention and management of perioperative pulmonary hypertensive crisis is aimed at optimizing cardiopulmonary interactions by targeting prostacyclin, endothelin, and nitric oxide signaling pathways within the pulmonary circulation with various pharmacological agents. This review is aimed at familiarizing the practitioner with the current pharmacological treatment for dealing with perioperative pulmonary hypertensive crisis in PAH-CHD patients. Given the life-threatening complications associated with pulmonary hypertensive crisis, proper perioperative planning can help anticipate cardiopulmonary complications and optimize surgical outcomes in this patient population.

  10. [Perioperative management of Jehovah's Witness patients. Special consideration of religiously motivated refusal of allogeneic blood transfusion].

    Science.gov (United States)

    Habler, O; Voss, B

    2010-04-01

    The religious organization of Jehovah's Witnesses numbers more than 7 million members worldwide, including 165,000 members in Germany. Although Jehovah's Witnesses strictly refuse the transfusion of allogeneic red blood cells, platelets and plasma, Jehovah's Witness patients may nevertheless benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The present review describes the perioperative management of surgical Jehovah's Witness patients aiming to prevent fatal anemia and coagulopathy. The cornerstones of this concept are 1) education of the patient about blood conservation techniques generally accepted by Jehovah's Witnesses, 2) preoperative optimization of the cardiopulmonary status and correction of preoperative anemia and coagulopathy, 3) perioperative collection of autologous blood, 4) minimization of perioperative blood loss and 5) utilization of the organism's natural anemia tolerance and its acute accentuation in the case of life-threatening anemia.

  11. The clinical nurse leader in the perioperative setting: a preceptor experience.

    Science.gov (United States)

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

  12. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  13. Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

    Directory of Open Access Journals (Sweden)

    Marilia Ferrari Conchon

    2015-02-01

    Full Text Available A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

  14. Perioperative Myocardial Injury After Noncardiac Surgery: Incidence, Mortality, and Characterization.

    Science.gov (United States)

    Puelacher, Christian; Lurati Buse, Giovanna; Seeberger, Daniela; Sazgary, Lorraine; Marbot, Stella; Lampart, Andreas; Espinola, Jaqueline; Kindler, Christoph; Hammerer, Angelika; Seeberger, Esther; Strebel, Ivo; Wildi, Karin; Twerenbold, Raphael; du Fay de Lavallaz, Jeanne; Steiner, Luzius; Gurke, Lorenz; Breidthardt, Tobias; Rentsch, Katharina; Buser, Andreas; Gualandro, Danielle M; Osswald, Stefan; Mueller, Christian

    2018-03-20

    Perioperative myocardial injury (PMI) seems to be a contributor to mortality after noncardiac surgery. Because the vast majority of PMIs are asymptomatic, PMI usually is missed in the absence of systematic screening. We performed a prospective diagnostic study enrolling consecutive patients undergoing noncardiac surgery who had a planned postoperative stay of ≥24 hours and were considered at increased cardiovascular risk. All patients received a systematic screening using serial measurements of high-sensitivity cardiac troponin T in clinical routine. PMI was defined as an absolute high-sensitivity cardiac troponin T increase of ≥14 ng/L from preoperative to postoperative measurements. Furthermore, mortality was compared among patients with PMI not fulfilling additional criteria (ischemic symptoms, new ECG changes, or imaging evidence of loss of viable myocardium) required for the diagnosis of spontaneous acute myocardial infarction versus those that did. From 2014 to 2015 we included 2018 consecutive patients undergoing 2546 surgeries. Patients had a median age of 74 years and 42% were women. PMI occurred after 397 of 2546 surgeries (16%; 95% confidence interval, 14%-17%) and was accompanied by typical chest pain in 24 of 397 patients (6%) and any ischemic symptoms in 72 of 397 (18%). Crude 30-day mortality was 8.9% (95% confidence interval [CI], 5.7-12.0) in patients with PMI versus 1.5% (95% CI, 0.9-2.0) in patients without PMI ( P PMI not fulfilling any other of the additional criteria required for spontaneous acute myocardial infarction (280/397, 71%) versus those with at least 1 additional criterion (10.4%; 95% CI, 6.7-15.7, versus 8.7%; 95% CI, 4.2-16.7; P =0.684). PMI is a common complication after noncardiac surgery and, despite early detection during routine clinical screening, is associated with substantial short- and long-term mortality. Mortality seems comparable in patients with PMI not fulfilling any other of the additional criteria required for

  15. Disruptive behaviour in the perioperative setting: a contemporary review.

    Science.gov (United States)

    Villafranca, Alexander; Hamlin, Colin; Enns, Stephanie; Jacobsohn, Eric

    2017-02-01

    Disruptive behaviour, which we define as behaviour that does not show others an adequate level of respect and causes victims or witnesses to feel threatened, is a concern in the operating room. This review summarizes the current literature on disruptive behaviour as it applies to the perioperative domain. Searches of MEDLINE ® , Scopus™, and Google books identified articles and monographs of interest, with backreferencing used as a supplemental strategy. Much of the data comes from studies outside the operating room and has significant methodological limitations. Disruptive behaviour has intrapersonal, interpersonal, and organizational causes. While fewer than 10% of clinicians display disruptive behaviour, up to 98% of clinicians report witnessing disruptive behaviour in the last year, 70% report being treated with incivility, and 36% report being bullied. This type of conduct can have many negative ramifications for clinicians, students, and institutions. Although the evidence regarding patient outcomes is primarily based on clinician perceptions, anecdotes, and expert opinion, this evidence supports the contention of an increase in morbidity and mortality. The plausible mechanism for this increase is social undermining of teamwork, communication, clinical decision-making, and technical performance. The behavioural responses of those who are exposed to such conduct can positively or adversely moderate the consequences of disruptive behaviour. All operating room professions are involved, with the rank order (from high to low) being surgeons, nurses, anesthesiologists, and "others". The optimal approaches to the prevention and management of disruptive behaviour are uncertain, but they include preventative and professional development courses, training in soft skills and teamwork, institutional efforts to optimize the workplace, clinician contracts outlining the clinician's (and institution's) responsibilities, institutional policies that are monitored and

  16. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries.

    Science.gov (United States)

    Pereira, Nayara de Castro; Turrini, Ruth Natalia Teresa; Poveda, Vanessa de Brito

    2017-05-25

    To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no

  17. The CERN Accelerator School

    CERN Multimedia

    2016-01-01

    Introduction to accelerator physics The CERN Accelerator School: Introduction to Accelerator Physics, which should have taken place in Istanbul, Turkey, later this year has now been relocated to Budapest, Hungary.  Further details regarding the new hotel and dates will be made available as soon as possible on a new Indico site at the end of May.

  18. Angular Acceleration without Torque?

    Science.gov (United States)

    Kaufman, Richard D.

    2012-01-01

    Hardly. Just as Robert Johns qualitatively describes angular acceleration by an internal force in his article "Acceleration Without Force?" here we will extend the discussion to consider angular acceleration by an internal torque. As we will see, this internal torque is due to an internal force acting at a distance from an instantaneous center.

  19. Accelerators and Dinosaurs

    CERN Multimedia

    Turner, Michael Stanley

    2003-01-01

    Using naturally occuring particles on which to research might have made accelerators become extinct. But in fact, results from astrophysics have made accelerator physics even more important. Not only are accelerators used in hospitals but they are also being used to understand nature's inner workings by searching for Higgs bosons, CP violation, neutrino mass and dark matter (2 pages)

  20. Far field acceleration

    International Nuclear Information System (INIS)

    Fernow, R.C.

    1995-07-01

    Far fields are propagating electromagnetic waves far from their source, boundary surfaces, and free charges. The general principles governing the acceleration of charged particles by far fields are reviewed. A survey of proposed field configurations is given. The two most important schemes, Inverse Cerenkov acceleration and Inverse free electron laser acceleration, are discussed in detail