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Sample records for conventional postoperative care

  1. Pediatric cardiac postoperative care

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    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  2. Postoperative care in trichiasis surgery

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    Esmael Ali

    2016-10-01

    Full Text Available Postoperative care is an important aspect of trachomatous trichiasis (TT surgical services. Follow-up visits should ideally take place on the first postoperative day (to remove the eye patch, after 8–14 days (to remove sutures; optional if absorbable sutures are used, at 3 months (to re-examine the operated lid for intermediate surgical outcomes, and then at or after six months.

  3. Postoperative sensitivity associated with low shrinkage versus conventional composites

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    Ivanović Vladimir; Savić-Stanković Tatjana; Karadžić Branislav; Ilić Jugoslav; Santini Ario; Beljić-Ivanović Katarina

    2013-01-01

    Introduction. Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives’ ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage. Objective. The study assessed possible reduction in postoperative sensitivity with low shrinkage compared to conventional composites using different bonding agents and the influence of the operator skill on the incidence of postoperative sensitivity. Methods. N...

  4. Postoperative sensitivity associated with low shrinkage versus conventional composites

    Directory of Open Access Journals (Sweden)

    Ivanović Vladimir

    2013-01-01

    Full Text Available Introduction. Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives’ ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage. Objective. The study assessed possible reduction in postoperative sensitivity with low shrinkage compared to conventional composites using different bonding agents and the influence of the operator skill on the incidence of postoperative sensitivity. Methods. Nine hundred and sixty permanent premolars and molars with primary carious lesions from patients 21 to 40 years old were used. Cavities 2 to 3 mm deep and with margins in enamel were prepared by four operators. Two operators had five years (A and B and two had over 20 years (C and D of clinical experience. Teeth were divided into eight groups each contained 120 restorations: (1 Els®+James-2 (original formula, (2 Els®+James-2 (new formula, (3 Els®+Excite, (4 InTenSe®+James-2 (original formula, (5 InTenSe®+James-2 (new formula, (6 InTenSe®+Excite, (7 Tetric Ceram®+Excite, and (8 Point 4®+OptiBond Solo Plus. At 14 days postoperatively, two independent operators, who did not take part in the clinical procedure, assessed postoperative teeth sensitivity using special questionnaires. Data were analyzed using non-parametric chi-square, Mann-Whitney and ANOVA tests. Results. Group 8 showed significantly higher score than the other groups. Less postoperative sensitivity was reported with two low-shrinkage composites (groups 2, 3, and 5 but with no significant difference. There was no statistical difference between groups 1, 2, 3, 4, 5, 6 and 7. Operator A had the highest postoperative sensitivity score compared to the other three. Conclusion. Conventional composite material Point 4® with its bonding agent caused significantly more postoperative sensitivity than low shrinkage composites combined with different adhesives. Operator skill influenced the incidence of

  5. Postoperative sensitivity associated with low shrinkage versus conventional composites

    National Research Council Canada - National Science Library

    Ivanović, Vladimir; Savić-Stanković, Tatjana; Karadzić, Branislav; Ilić, Jugoslav; Santini, Ario; Beljić-lvanović, Katarina

    2013-01-01

    Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives' ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage...

  6. Comparative Evaluation of Pain, Stress, Neuropeptide Y, ACTH, and Cortisol Levels Between a Conventional Postoperative Care Protocol and a Fast-Track Recovery Program in Patients Undergoing Major Abdominal Surgery.

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    Kapritsou, Maria; Papathanassoglou, Elizabeth D; Bozas, Evangelos; Korkolis, Dimitrios P; Konstantinou, Evangelos A; Kaklamanos, Ioannis; Giannakopoulou, Margarita

    2017-03-01

    Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols. To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols. A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT ( n = 29) or CON ( n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge. ACTHT1 and ACTHT2 levels were positively correlated with self-reported stress levels (ρ = .43 and ρ = .45, respectively, p levels in the FT group were higher than those in the CON group at all time points ( p ≤ .004); this difference remained significant after adjusting for T1 levels through analysis of covariance for age, gender, and body mass index ( F = .003, F = .149, F = .015, respectively, p > .05). Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress.

  7. Convalescence after colonic resection with fast-track versus conventional care

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    Hjort Jakobsen, D; Sonne, E; Basse, L;

    2004-01-01

    BACKGROUND: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. AIM: The objectives were to compare convalescence data (fatigue, sleep...... results in earlier resumption of normal activities with reduced fatigue and need for sleep postoperatively compared to conventional care, and without increased need for nursing care or visits to general practitioners. However, readmissions may occur more frequently....... vs. 8 days in the fast-track vs. conventional care group, respectively (p sleep were increased in the conventional care group when compared with the fast-track group (p

  8. Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Gang Wang; Zhi-Wei Jiang; Jing Xu; Jian-Feng Gong; Yang Bao; Li-Fei Xie; Jie-Shou Li

    2011-01-01

    AIM: To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS: One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded.RESULTS: The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care (2.1 d vs 3.2 d, P < 0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P < 0.05). Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P < 0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P <0.01). No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%).CONCLUSION: The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

  9. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

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    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel

    2015-01-01

    AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how patie...

  10. Perioperative complications of cardiac surgery and postoperative care.

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    Nearman, Howard; Klick, John C; Eisenberg, Paul; Pesa, Nicholas

    2014-07-01

    The care of the cardiac surgical patient postoperatively is fraught with several complications because of the nature of the surgical procedure itself and the common comorbidities of this patient population. Most complications occurring in the immediate postoperative period are categorized by organ system, and their pathophysiology is presented. Current diagnostic approaches and treatment options are offered. Preventive measures, where appropriate, are also included in the discussion.

  11. Study of Problems Arising during Perioperative Care of Postoperative Endophthalmitis

    Institute of Scientific and Technical Information of China (English)

    Jingyi Lin; Yue Cai; Jiehui Huang; Ronghua Ye

    2014-01-01

    Purpose:.To discuss the problems in perioperative nursing care for patients with postoperative infectious endophthalmitis. Methods: The medical records of 34 patients (35 eyes) pre-senting with infectious endophthalmitis at Zhongshan Oph-thalmic Center,.Sun Yat-sen University between April 2002 and December 2013 were collected to analyze preoperative and postoperative nursing care for endophthalmitis after ocular surgery. Results:Thirty-four patients (35 eyes) developed complications of infectious endophthalmitis after surgery..Thirty-three cases were successfully cured and only one patient (1 eye) was un-treated due to Pseudomonas aeruginosa infection. Conclusion: Perioperative nursing care plays a pivotal role in preventing and controlling the incidence and development of postoperative infectious endophthalmitis.

  12. Postoperative care and complications after ventricular assist device implantation.

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    Allen, Sara Jane; Sidebotham, David

    2012-06-01

    In this article, the routine postoperative care and complications of patients with ventricular assist devices are reviewed. Routine postoperative care encompasses patients who have undergone emergency ventricular assist device (VAD) implantation for acute cardiogenic shock, as a bridge to decision making, and semi-elective patients who have undergone VAD implantation for end-stage heart failure, either as destination therapy or as a bridge to heart transplantation. Early postoperative management should focus on haemodynamic optimisation, including fluid and inotrope therapy, VAD settings and support of right ventricular function. Echocardiography is an essential tool in optimising haemodynamics and identifying complications. Early postoperative complications include bleeding, arrhythmias, right ventricular failure and infection. Late postoperative problems include bleeding, thrombosis and thrombo-embolism, device failure and psychological problems. In a small percentage of patients, weaning and explantation of the VAD are possible. For patients undergoing VAD implantation for destination therapy, end-of-life care planning should form part of the multidisciplinary care of the patient.

  13. [Valvular heart disease: preoperative assessment and postoperative care].

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    Nägele, Reto; Kaufmann, Beat A

    2013-10-30

    Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

  14. Three-year postoperative outcomes between MIS and conventional TLIF in1-segment lumbar disc herniation.

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    Lv, You; Chen, Jingyang; Chen, Jinchuan; Wu, Yuling; Chen, Xiangyang; Liu, Yi; Chu, Zhaoming; Sheng, Luxin; Qin, Rujie; Chen, Ming

    2017-06-01

    The aim of this study is to assess the long-term clinical and radiological outcomes between minimally invasive (MIS) and conventional transforaminal lumbar interbody fusion (TLIF) in treating one-segment lumbar disc herniation (LDH). One-hundred and six patients treated by MIS-TLIF (50 cases) or conventional TLIF (56 cases) were included. Perioperative results were evaluated. Clinical outcomes were compared preoperatively and postoperatively. Radiologic parameters were based on a comparison of preoperative and three-year postoperative lumbar lordosis, segmental lordosis, sacral slope, the cross-sectional area of the paraspinal muscle and fusion rates. MIS TILF had significantly less blood, shorter operation time, mean return to work time and lower intramuscular pressure compared with the conventional group during the operation. VAS scores for lower back pain and ODI in MIS-TLIF were significantly decreased. The mean cross-sectional area of the paraspinal muscle was significantly decreased after surgery in the conventional TLIF group and no significant intragroup differences were established in the MIS-TLIF group. No significant differences were found in fusion rate, lumbar lordosis, segmental lordosis and sacral slope. Both MIS and conventional TLIF were beneficial for patients with LDH. However, MIS-TLIF manifests a great improvement in perioperative outcomes, low back pain, disability and preventing paraspinal muscle atrophy during the follow-up period observation.

  15. Postoperative care for the robotic surgery bowel resection patient.

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    Brenner, Zara R; Salathiel, Mary; Macey, Barbara A; Krenzer, Maureen

    2011-01-01

    A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.

  16. Postoperative pain after cholecystectomy: Conventional laparoscopy versus single-incision laparoscopic surgery

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    Prasad A

    2011-01-01

    Full Text Available Background: This study was undertaken to compare the postoperative pain after cholecystectomy done by single-incision laparoscopic surgery (SILS versus conventional four-port laparoscopy [conventional laparoscopic surgery (CLS]. SILS is a feasible and a promising method for cholecystectomy. It is possible to do this procedure without the use of special equipments. While there are cosmetic advantages to SILS, it is not clear whether or not the pain is also reduced. Methods: Patients undergoing cholecystectomy for symptomatic gallstones were offered the choice of the two methods and the first 100 consecutive patients from each group were included in this observational study. Only conventional instruments were used to keep the cost of surgery comparable. Pain scores were checked 8 hours after the surgery using visual analogue score. Student′s t test was done to check the statistical significance. Results: We observed no significant difference in the pain score between the CLS and SILS (2.78 versus 2.62. The operative time (OT was significantly lower in the CLS group (28 versus 67 minutes. Comparing the OTs of the first 50 patients undergoing SILS with the second 50 patients showed a significantly lower OT (79 versus 54 minutes. We also compared the pain score between these three groups. The second half of SILS group had a significantly lower pain score compared to the first half (2.58 versus 2.84. This group also had a lower pain score compared to conventional laparoscopy group but the difference was not statistically significant (2.58 versus 2.78. Conclusion: Although there was no significant difference in the overall postoperative pain as OT decreases with surgeon′s experience in single-incision laparoscopic cholecystectomy, postoperative pain at 8 hours appears to favour this method over conventional laparoscopic cholecystectomy.

  17. Postoperative Intensive Care Treatment after Esophageal Resection

    Institute of Scientific and Technical Information of China (English)

    DirkL.Stippel; K.TobiasE.Beckurts

    2004-01-01

    The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers and amiodarone. Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly successful in the therapy of these leakages. Microbiological surveillance and specific antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.

  18. National survey on postoperative care and treatment circuits in neurosurgery.

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    Valero, R; Carrero, E; Fàbregas, N; Iturri, F; Saiz-Sapena, N; Valencia, L

    2017-10-01

    The analysis of surgical processes should be a standard of health systems. We describe the circuit of care and postoperative treatment for neurosurgical interventions in the centres of our country. From June to October 2014, a survey dealing with perioperative treatments and postoperative circuits after neurosurgical procedures was sent to the chiefs of Anaesthesiology of 73 Spanish hospitals with neurosurgery and members of the Neuroscience Section of SEDAR. We obtained 45 responses from 30 centres (41.09%). Sixty percent of anaesthesiologists perform preventive locoregional analgesic treatment. Pain intensity is systematically assessed by 78%. Paracetamol, non-steroidal anti-inflammatory and morphine combinations are the most commonly used. A percentage of 51.1 are aware of the incidence of postoperative nausea after craniotomy and 86.7% consider multimodal prophylaxis to be necessary. Dexamethasone is given as antiemetic (88.9%) and/or anti-oedema treatment (68.9%). A percentage of 44.4 of anaesthesiologists routinely administer anticonvulsive prophylaxis in patients with supratentorial tumours (levetiracetam, 88.9%), and 73.3% of anaesthesiologists have postoperative surveillance protocols. The anaesthesiologist (73.3%) decides the patient's destination, which is usually ICU (83.3%) or PACU (50%). Postoperative neurological monitoring varied according to the type of intervention, although strength and sensitivity were explored in between 70-80%. There is great variability in the responses, probably attributable to the absence of guidelines, different structures and hospital equipment, type of surgery and qualified personnel. We need consensual protocols to standardize the treatment and the degree of monitoring needed during the postoperative period. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial.

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    Lee, Jeonghun; Na, Kuk Young; Kim, Ra Mi; Oh, Yeonju; Lee, Ji Hyun; Lee, Jandee; Lee, Jin-Seok; Kim, Chul-Ho; Soh, Euy-Young; Chung, Woong Youn

    2012-09-01

    To use objective and subjective voice function analysis to compare outcomes in patients who had undergone conventional open thyroidectomy or robotic thyroidectomy. The study involved 88 consecutive patients who underwent thyroid surgery between May 2009 and December 2009; 46 patients underwent a conventional open thyroidectomy, and 42 underwent a robotic thyroidectomy. Auditory perceptual evaluation was used to make subjective assessments of voice function, and videolaryngostroboscopy, acoustic voice analysis with aerodynamic study, electroglottography, and voice range profile were used to make objective assessments. Each assessment was made before surgery, and at 1 week and 3 months after surgery. The conventional open and robotic thyroidectomy groups were similar in terms of age, gender ratio, and disease profile. We found that 18 (20.5%) of the 88 patients showed some level of voice dysfunction at 1 week after surgery; that the dysfunction resolved by 3 months after surgery in all cases; and that it was not permanent according to postoperative videolaryngostroboscopy. The conventional open and robotic thyroidectomy groups were found to have similar levels of dysfunction at 1 week after surgery, except for jitter, which was greater in the robotic group. For both groups, any such dysfunction spontaneously resolved by 3 months after surgery, and there were no significant differences between the groups in terms of any voice function parameter. Voice dysfunction was present after both open and robotic thyroidectomy (without any evident laryngeal nerve injury). However, function subsequently normalized to preoperative levels at 3 months after surgery in both groups. Voice function outcomes after robotic thyroidectomy are similar to those after conventional open thyroidectomy.

  20. Retracted: Postoperative pain after irrigation with Vibringe versus a conventional needle: a randomized controlled trial.

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    Bilgili, D; Yilmaz, S; Dumani, A; Yoldas, O

    2016-08-01

    The following article from International Endodontic Journal, 'Postoperative pain after irrigation with Vibringe versus a conventional needle: a randomized controlled trial' by D. Bilgili, S. Yilmaz, A. Dumani & O. Yoldas, published online on 29 February 2016 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the Journal Editor in Chief, Prof. Paul Dummer, and John Wiley & Sons Ltd. The retraction has been agreed because the corresponding author did not contact the first author who carried out the work before alterations to the article were made prior to submission. This damages the integrity of the work and there are additional concerns over the number of patients and the accuracy of the results and conclusions.

  1. Assessment of quality of care in acute postoperative pain management

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    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  2. Comparison of sugammadex and conventional reversal on postoperative nausea and vomiting: a randomized, blinded trial.

    Science.gov (United States)

    Koyuncu, Onur; Turhanoglu, Selim; Ozbakis Akkurt, Cagla; Karcıoglu, Murat; Ozkan, Mustafa; Ozer, Cahit; Sessler, Daniel I; Turan, Alparslan

    2015-02-01

    To determine whether the new selective binding agent sugammadex causes less postoperative nausea and vomiting (PONV) than the cholinesterase inhibitor neostigmine. Prospective, randomized, double-blinded study. University-affiliated hospital. One hundred American Society of Anesthesiologists physical status 1 and 2 patients scheduled for extremity surgery. Patients were randomly assigned to neostigmine (70 μg/kg) and atropine (0.4 mg per mg neostigmine) or sugammadex 2 mg/kg for neuromuscular antagonism at the end of anesthesia, when 4 twitches in response to train-of-four stimulation were visible with fade. We recorded PONV, recovery parameters, antiemetic consumption, and side effects. Nausea and vomiting scores were lower in the sugammadex patients upon arrival in the postanesthesia care unit (med: 0 [min-max, 0-3] vs med: 0 [min-max, 0-3]; P sugammadex. Postoperative heart rates were significantly lower in all measured times patients given neostigmine. Nondepolarizing neuromuscular blocking antagonism with sugammadex speeds recovery of neuromuscular strength but only slightly and transiently reduces PONV compared with neostigmine and atropine. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Colonic surgery with accelerated rehabilitation or conventional care

    DEFF Research Database (Denmark)

    Basse, Linda; Thorbøl, Jens Erik; Løssl, Kristine;

    2004-01-01

    after colonic resection with conventional care compared with fast-track multimodal rehabilitation. METHODS: One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2...... ( P complication rate (35 patients) was lower in group 2 ( P...... complications (5 patients; P 0.05). CONCLUSIONS: Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast...

  4. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial.

    Science.gov (United States)

    Wang, Q; Suo, J; Jiang, J; Wang, C; Zhao, Y-Q; Cao, X

    2012-08-01

    The aim of the study was to evaluate the efficacy and safety of fast-track rehabilitation in elderly patients over 65 years of age, following laparoscopic surgery to remove colorectal cancer. A total of 78 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care programme (n = 40) or the conventional perioperative care protocol (control group, n = 38). Medical personnel conducting the study were blinded to patients' clinical outcomes prior to statistical analysis. The fast-track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. The length of time to regain bowel function, including the passage of flatus[31 (26-40) h vs 38 (32-51) h, P = 0.001], to the first bowel movement [55 (48-63) h vs 64 (48-71) h, P = 0.009] and to start a liquid diet (12 [11-16] h vs 47 [35-50] h, P = 0.000) were significantly shorter in patients receiving the fast-track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care (P = 0.0001). A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0%vs 21.1%, P = 0.045). This randomized controlled trial has shown that in the elderly undergoing laparoscopic colorectal surgery, the fast-track recovery programme resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and

  5. Music Benefits on Postoperative Distress and Pain in Pediatric Day Care Surgery

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    Valeria Calcaterra; Selene Ostuni; Irene Bonomelli; Simonetta Mencherini; Marco Brunero; Elisa Zambaiti; Savina Mannarino; Daniela Larizza; Riccardo Albertini; Carmine Tinelli; Gloria Pelizzo

    2014-01-01

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, g...

  6. Typhoid perforation: Post-operative Intensive Care Unit care and outcome

    Directory of Open Access Journals (Sweden)

    Mukaila Oyegbade Akinwale

    2016-01-01

    Full Text Available Background: Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU on account of sepsis or septic shock and to improve survival. Patients and Methods: This is a prospective observational study in which 67 consecutive patients who had exploratory laparotomy for typhoid perforation between August 2009 and October 2012 in the main operating theatre of the University College Hospital, Ibadan, were studied. The attending anaesthetists had the freedom of choosing the appropriate anaesthetic drugs depending on the patients' clinical condition. The reason for admission into the ICU, the types of organ support required and outcomes were recorded. Results: Twenty-five patients (37.3% out of 67 required critical care. Reasons for admission among others included poor respiratory effort, hypotension, septic shock and delayed recovery from anaesthesia. Twenty-one patients (84% required mechanical ventilation with a mean duration of 2.14 days (range 1–5 days. Fourteen patients required ionotropic support and the length of ICU stay ranged from 1 to 15 days (mean 4.32 days. Nineteen patients (76% were successfully managed and discharged to the ward while 24% (6 patients mortality rate was recorded. Conclusion: This study showed high rate of post-operative ICU admission in patients with typhoid perforation with a high demand for critical care involving mechanical ventilation and ionotropic support. In centres that manage patients presenting with typhoid ileitis and perforation, post-operative critical care should be available.

  7. Typhoid perforation: Post-operative Intensive Care Unit care and outcome.

    Science.gov (United States)

    Akinwale, Mukaila Oyegbade; Sanusi, Arinola A; Adebayo, Oluwaseun K

    2016-01-01

    Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU) on account of sepsis or septic shock and to improve survival. This is a prospective observational study in which 67 consecutive patients who had exploratory laparotomy for typhoid perforation between August 2009 and October 2012 in the main operating theatre of the University College Hospital, Ibadan, were studied. The attending anaesthetists had the freedom of choosing the appropriate anaesthetic drugs depending on the patients' clinical condition. The reason for admission into the ICU, the types of organ support required and outcomes were recorded. Twenty-five patients (37.3%) out of 67 required critical care. Reasons for admission among others included poor respiratory effort, hypotension, septic shock and delayed recovery from anaesthesia. Twenty-one patients (84%) required mechanical ventilation with a mean duration of 2.14 days (range 1-5 days). Fourteen patients required ionotropic support and the length of ICU stay ranged from 1 to 15 days (mean 4.32 days). Nineteen patients (76%) were successfully managed and discharged to the ward while 24% (6 patients) mortality rate was recorded. This study showed high rate of post-operative ICU admission in patients with typhoid perforation with a high demand for critical care involving mechanical ventilation and ionotropic support. In centres that manage patients presenting with typhoid ileitis and perforation, post-operative critical care should be available.

  8. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz

    2011-01-01

    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  9. Postoperative hypoxia and length of intensive care unit stay after cardiac surgery: the underweight paradox?

    Directory of Open Access Journals (Sweden)

    Marco Ranucci

    Full Text Available OBJECTIVE: Cardiac operations with cardiopulmonary bypass can be associated with postoperative lung dysfunction. The present study investigates the incidence of postoperative hypoxia after cardiac surgery, its relationship with the length of intensive care unit stay, and the role of body mass index in determining postoperative hypoxia and intensive care unit length of stay. DESIGN: Single-center, retrospective study. SETTING: University Hospital. Patients. Adult patients (N = 5,023 who underwent cardiac surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: According to the body mass index, patients were attributed to six classes, and obesity was defined as a body mass index >30. POH was defined as a PaO2/FiO2 ratio <200 at the arrival in the intensive care unit. Postoperative hypoxia was detected in 1,536 patients (30.6%. Obesity was an independent risk factor for postoperative hypoxia (odds ratio 2.4, 95% confidence interval 2.05-2.78, P = 0.001 and postoperative hypoxia was a determinant of intensive care unit length of stay. There is a significant inverse correlation between body mass index and PaO2/FiO2 ratio, with the risk of postoperative hypoxia increasing by 1.7 folds per each incremental body mass index class. The relationship between body mass index and intensive care unit length of stay is U-shaped, with longer intensive care unit stay in underweight patients and moderate-morbid obese patients. CONCLUSIONS: Obese patients are at higher risk for postoperative hypoxia, but this leads to a prolonged intensive care unit stay only for moderate-morbid obese patients. Obese patients are partially protected against the deleterious effects of hemodilution and transfusions. Underweight patients present the "paradox" of a better lung gas exchange but a longer intensive care unit stay. This is probably due to a higher severity of their cardiac disease.

  10. A study of the impact of long-term tobacco smoking on postoperative intensive care admission

    DEFF Research Database (Denmark)

    Møller, A M; Pedersen, T; Villebro, N

    2003-01-01

    .01). The mortality rate was 37% in smokers with > 50 pack-years history and 24% in nonsmokers (odds ratio = 2.02, p = 0.08). We conclude long-term tobacco smoking (> 50 pack-years) carries a higher risk of postoperative admission to intensive care, and there seems to be a dose relationship between the amount...... of tobacco consumed and the risk of postoperative intensive care admission....

  11. [The Development of a Care Protocol for Postoperative Pressure Sore Prevention].

    Science.gov (United States)

    Huang, Yu-Ling; Lin, Hui-Ling; Wang, Fang; Wu, Shu-Fang Vivienne

    2015-12-01

    Pressure sores are a common complication caused by long periods of bed rest following major surgery. These sores may increase patient postoperative pain, increase the risk of infections, lengthen the pe-riod of hospitalization, and increase the duration and costs of nursing care. Therefore, maintaining the skin integrity of surgical patients is an important responsibility for operating room nurses and an indicator of nursing care quality. While pressure-sore risk assessment tools and interoperative strategies are available and used in foreign countries, there has been little related research conducted in Taiwan. After examining the relevant literature and considering the current postoperative pressure sore situation in Taiwan, the author developed a postoperative pressure sore care protocol as a reference for clinical staff. Protocol procedures include major breakthrough developments in areas such as post-survey risk assessment for pressure ulcers, pressure ulcer prevention strategies that take surgery-related risk factors into consideration, extra care and protection measures for surgical supine patients, and post-pressure sores. The developed postoperative pressure sore protocol may be incorporated into surgical care procedures during the post-surgical care period in order to effectively prevent the occurrence of post-surgery pressure ulcers. Furthermore, the developed protocol offers the potential to improve and strengthen the quality of surgical care in terms of both healthcare and post-surgical care.

  12. Postoperative radiation therapy for malignant glioma. Results of conventional radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Teshima, T.; Inoue, T.; Chatani, M.; Hata, K.; Taki, T.; Nii, Y.; Nakagawa, H.

    1987-02-01

    From December 1977 through September 1984, a total of 39 cases of malignant glioma were treated with radiation therapy (RT) postoperatively. Twenty-nine cases were classified into glioblastoma (GM) and 10 astrocytoma (AS) (low grade : 6 and anaplastic : 4) histologically. One third of cases received 50 Gy/25 FRX/5 WKS of whole brain RT. Another two thirds of cases underwent 60 Gy/30 FRX/6 WKS of whole brain or 50 Gy/25 FRX/5 WKS of whole brain + additional 20 Gy/10 FRX/2 WKS of localized field RT. Chemotherapy (BLM, MeCCNU and ACNU) was given for 34 cases. Survivals at 3 years for GM and AS were 12 % and 68 %, respectively. Prognostic factors for GM were age, neurologic function (RTOG), AJC-staging T-factor, pre-RT LDH level and volume of residual tumor. Corresponding factors for AS were histological subclassification and neurologic function (RTOG). However, RT dose and field did not impact on survival significantly. Acute adverse effects of RT were otitis media or externa (70 %) and conjunctivitis (8 %). Retinal bleeding was noted in three long-term survivors at 2 years after RT.

  13. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    OpenAIRE

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be appl...

  14. An audit of unplanned postoperative intensive care unit admissions ...

    African Journals Online (AJOL)

    2009-07-23

    Jul 23, 2009 ... operating theatres and ICU resource management,1 including quality ... Department of Anaesthesia, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu,. Nigeria .... more a global indicator of the safety of surgical care.

  15. Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients

    DEFF Research Database (Denmark)

    Vester-Andersen, M; Lundstrøm, Lars Hyldborg; Møller, M H

    2014-01-01

    operation in the standard ward, with a 30 day mortality of 14.3%, and 4.8% were admitted to the intensive care unit (ICU) after a median stay of 2 days (inter-quartile range: 1-6). When compared with 'admission to standard ward', 'admission to standard ward before ICU admission' and 'ICU admission after......BACKGROUND: Emergency major gastrointestinal (GI) surgery carries a considerable risk of mortality and postoperative complications. Effective management of complications and appropriate organization of postoperative care may improve outcome. The importance of the latter is poorly described...... in emergency GI surgical patients. We aimed to present mortality data and evaluate the postoperative care pathways used after emergency GI surgery. METHODS: A population-based cohort study with prospectively collected data from six Capital Region hospitals in Denmark. We included 2904 patients undergoing major...

  16. Postoperative pain after conventional laparoscopic versus single-port sleeve gastrectomy: a prospective, randomized, controlled pilot study.

    Science.gov (United States)

    Morales-Conde, Salvador; Del Agua, Isaías Alarcón; Moreno, Antonio Barranco; Macías, María Socas

    2017-04-01

    Laparoscopic approach is the gold standard for surgical treatment of morbid obesity. The single-port (SP) approach has been demonstrated to be a safe and effective technique for the treatment of morbid obesity in several case control studies. Compare conventional multiport laparoscopy (LAP) with an SP approach for the treatment of morbid obesity using sleeve gastrectomy in terms of postoperative pain using a visual analog scale (VAS) 0-100, surgical outcome, weight loss, and aesthetical satisfaction at 6 months after surgery. University Hospital, Spain. Randomized, controlled pilot study. The trial enrolled patients suitable for bariatric surgery, with a body mass index lower than 50 kg/m(2) and xiphoumbilical distance lower than 25 cm. Patients were randomly assigned to receive LAP or SP sleeve gastrectomy. A total of 30 patients were enrolled; 15 were assigned to LAP group and 15 to SP group. No patients were lost during follow-up. Baseline characteristics were similar in both groups. A significantly higher level of pain during movement was noted for the patients in the LAP group on the first (mean VAS 49.3±12.2 versus 34.1±8.9, P = .046) and second days (mean VAS 35.9±10.2 versus 22.1±7.9, P = .044) but not the third day (mean VAS 20.1±5.2 versus 34.12.9 ±4.3, P = .620). No differences regarding pain at rest, operative time, complications, or weight loss at 6 months were observed. Higher aesthetical satisfaction was noticed in SP group. In selected patients, SP surgery presented less postoperative pain in sleeve gastrectomy compared with the conventional laparoscopic approach with similar surgical results. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Experience with "Fast track" postoperative care after deep brain stimulation surgery.

    Science.gov (United States)

    Martín, Nuria; Valero, Ricard; Hurtado, Paola; Gracia, Isabel; Fernández, Carla; Rumià, Jordi; Valldeoriola, Francesc; Carrero, Enrique J; Tercero, Francisco Javier; de Riva, Nicolás; Fàbregas, Neus

    A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). We evaluated the impact of a fast-track (FT) postoperative care protocol. An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6h. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...... with a stronger SOC experienced significantly less pain (P nurse anesthetists...

  19. Influence of Patients' "Sense of Coherence" on Main Postoperative Variables in the Postanesthesia Care Unit

    DEFF Research Database (Denmark)

    Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle;

    2015-01-01

    The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients...

  20. Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Rajeshwari Neela

    2016-04-01

    Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society. [Int J Basic Clin Pharmacol 2016; 5(2.000: 329-334

  1. Predictors of postoperative pulmonary complications after liver resection: Results from a tertiary care intensive care unit

    Directory of Open Access Journals (Sweden)

    Anirban Hom Choudhuri

    2014-01-01

    Full Text Available Background: Postoperative pulmonary complication (PPC is a serious complication after liver surgery and is a major cause of mortality and morbidity in the intensive care unit (ICU. Therefore, the early identification of risk factors of PPCs may help to reduce the adverse outcomes. Objective: The aim of this retrospective study was to determine the predictors of PPCs in patients undergoing hepatic resection. Design: Retrospective, observational. Methods: The patients admitted after hepatic resection in the gastrosurgical ICU of our institute between October 2009 and June 2013 was identified. The ICU charts were retrieved from the database to identify patients who developed PPCs. A comparison of risk factors was made between the patients who developed PPC (PPC group against the patients who did not (no-PPC group. Results: Of 117 patients with hepatic resection, 28 patients developed PPCs. Among these, pneumonia accounted for 12 (42.8% followed by atelectasis in 8 (28.5% and pleural effusion in 3 (10.7%. Among the patients developing PPCs, 16 patients were over a 70-year-old (57.1%, 21 patients were smokers (75% and 8 patients (28.5% had chronic obstructive pulmonary disease (COPD. The requirement for blood transfusion and duration of mechanical ventilation were greater in the patients developing PPC (2000 ± 340 vs. 1000 ± 210 ml; 10 ± 4.5 vs. 3 ± 1.3 days. Conclusion: Old age, chronic smoking, COPD, increased blood product transfusion, increased duration of mechanical ventilation and increased length of ICU stay increased the relative risk of PPC, presence of diabetes and occurrence of surgical complications (leak, dehiscence, etc. were independent predictive variables for the development of PPC.

  2. Morbidity and mortality predictivity of nutritional assessment tools in the postoperative care unit.

    Science.gov (United States)

    Özbilgin, Şule; Hanc, Volkan; Ömür, Dilek; Özbilgin, Mücahit; Tosun, Mine; Yurtlu, Serhan; Küçükgüçlü, Semih; Arkan, Atalay

    2016-10-01

    The aim was to evaluate the nutritional situation of patients admitted to the Postoperative Acute Care Unit using classic methods of objective anthropometry, systemic evaluation methods, and Nutrition Risk in Critically Ill (NUTRIC) score, and to compare them as a predictor of morbidity and mortality.At admission to the postoperative care unit, patients undergoing various surgeries were assessed for the following items: Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Nutritional Risk Screening (NRS)-2002, Mini Nutritional Assessment (MNA), Charlson comorbidity index (CCI), and NUTRIC score, anthropometric measurements, serum total protein, serum albumin, and lymphocyte count. Patients were monitored for postoperative complications until death or discharge. Correlation of complications with these parameters was also analyzed.A total of 152 patients were included in the study. In this study a positive correlation was determined between mortality and NRS-2002, SGA, CCI, Acute Physiology and Chronic Health Evaluation , Sepsis-related Organ Failure Assessment, and NUTRIC score, whereas a negative correlation was determined between mortality and NRI. There was a correlation between NUTRIC score and pneumonia, development of atrial fibrillation, delirium, renal failure, inotrope use, and duration of mechanical ventilation. In our study group of postoperative patients, MNA had no predictive properties for any complication, whereas SGA had no predictive properties for any complications other than duration of hospital stay and mortality.The NUTRIC score is an important indicator of mortality and morbidity in postoperative surgical patients. NRI correlated with many postoperative complications, and though SGA and NRS were correlated with mortality, they were not correlated with the majority of complications. MNA was determined not to have any correlation with any complication, mortality, and duration of hospital stay in our patient group.

  3. Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns.

    Science.gov (United States)

    Shew, Matthew; Carlisle, Michael P; Lu, Guanning Nina; Humphrey, Clinton; Kriet, J David

    2016-11-01

    Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on

  4. Postoperative delirium and factors related in a cardiac surgery unit care

    Directory of Open Access Journals (Sweden)

    Julia de las Pozas Abril

    2011-07-01

    Full Text Available Objective: Describe the incidence of postoperative delirium and related risk factors associated with this complication in patients undergoing cardiac surgery. Method: Cohort study conducted for 3 months in a sample of 105 patients undergoing cardiac surgery in a hospital in Madrid. The emergence of delirium with scale ICDSC (Intensive Care Delirium Screening Checklist was measured during the first five days of postoperative and collected data on preoperative, intra-operative and post-operative factors to relate to the emergence of delirium. Results: 95 Patients studied, 15 of them developed delirium, which means an incidence of 15.7%. We found that there was a significant relationship between delirium appearance and age of the patients, the presence of atrial fibrillation, intubation orotraqueal time and the administration of adrenaline during the immediate post-operative management. The multivariable model showed the duration of orotraqueal intubation to be independently associated with delirium. Conclusions: The incidence of delirium found in this study as well as the identification of the time of orotraqueal intubation as independent risk factor supposes a new contribution to the knowledge of this postoperative complication and allow us to begin to evaluate its importance in the unit of cardiac surgery.

  5. Comparison of postoperative changes in the distal and proximal segments between conventional and sliding mini-plate fixation following mandibular setback

    Science.gov (United States)

    Kim, Seong-Sik; Kwak, Kyoung-Ho; Ko, Ching-Chang; Park, Soo-Byung; Son, Woo-Sung

    2016-01-01

    Objective The purpose of the present study was to evaluate the postoperative three-dimensional (3D) changes in the proximal segments after mandibular setback sagittal split ramus osteotomy and to compare the changes between the conventional mini-plate fixation and semi-rigid sliding plate fixation. Methods Cone-beam computed tomography (CBCT) images were used to evaluate the postoperative 3D changes in the proximal segments during the healing process. CBCT images were superimposed using the symphysis and the lower anterior mandible as references. Results There were no statistically significant differences between the conventional mini-plate and semi-rigid sliding plate groups (p > 0.05). With respect to the distribution of changes greater than 2 mm in the landmarks, the right condylion, right coronoid process, and left condylion showed ratios of 55.6%, 50.0%, and 44.4%, respectively, in the semi-rigid sliding plate group; however, none of the landmarks showed ratios greater than 30% in the conventional mini-plate group. Conclusions There were no statistically significant differences in postoperative changes in the segments between the conventional mini-plate and semi-rigid sliding plate groups. Nevertheless, while selecting the type of fixation technique, clinicians should consider that landmarks with greater than 2 mm changes were higher in the semi-rigid sliding plate group than in the conventional mini-plate group. PMID:27896211

  6. Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments? A systematic review and meta analysis.

    Science.gov (United States)

    Al-Moraissi, E A; Elmansi, Y A; Al-Sharaee, Y A; Alrmali, A E; Alkhutari, A S

    2016-03-01

    A systematic review and meta-analysis was conducted to answer the clinical question "Does the piezoelectric surgical technique produce fewer postoperative sequelae after lower third molar surgery than conventional rotary instruments?" A systematic and electronic search of several databases with specific key words, a reference search, and a manual search were performed from respective dates of inception through November 2014. The inclusion criteria were clinical human studies, including randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies, with the aim of comparing the piezoelectric surgical osteotomy technique to the standard rotary instrument technique in lower third molar surgery. Postoperative sequelae (oedema, trismus, and pain), the total number of analgesics taken, and the duration of surgery were analyzed. A total of nine articles were included, six RCTs, two CCTs, and one retrospective study. Six studies had a low risk of bias and three had a moderate risk of bias. A statistically significant difference was found between piezoelectric surgery and conventional rotary instrument surgery for lower third molar extraction with regard to postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken (P=0.0001, P=0.0001, Ppiezoelectric osteotomy group (Ppiezoelectric surgery significantly reduced the occurrence of postoperative sequelae (oedema, trismus, and pain) and the total number of analgesics taken compared to the conventional rotary instrument technique in lower third molar surgery, but required a longer surgery time.

  7. Vulvar postoperative care, gestalt or evidence based medicine? A comprehensive systematic review.

    Science.gov (United States)

    Altman, Alon D; Robinson, Christine

    2017-05-01

    This paper reviews all current literature for vulvar postoperative care, and forms a summary of evidence based practice. Scopus, Cochrane Library, CINHAL, Web of Science Core Collection, PubMed, Embase, Google Scholar, clinicaltrials.gov and Medline databases were searched. Various combinations of key-terms were used to identify relevant articles. All identified primary research articles and review articles were then examined with their references in order to identify further relevant studies. The literature was examined within gynecology, gynecologic oncology, surgical oncology, urology, plastic surgery and dermatology. A total of 199 studies were reviewed and 80 were included in this paper. All relevant studies pertaining to the subject were included. Studies were excluded if there was no relevance to the review as deemed by both authors. There remains much room for improvement to minimize postoperative stay, decrease the chances of morbidity and improve patient outcome and satisfaction, while establishing standardized care pathways. Further research and clinical trials are needed in this area to help us to provide evidence-based care to our postoperative vulvar patient population. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Consumer behaviour towards organic, natural and conventional skin care products: a pilot study

    OpenAIRE

    Alina-Aida Drăgan; Dacinia-Crina Petrescu

    2013-01-01

    The aim of this pilot study is to outline consumers’ profile in terms of their interest in organic, natural and conventional skin care, their knowledge about these products and the differences between them, their opinion regarding the performance and price of organic skin care in relation to conventional skin care. The survey used a self-administered questionnaire and was conducted on a sample of 86 customers from Cluj-Napoca, Romania. The results indicate that consumers who pu...

  9. Music benefits on postoperative distress and pain in pediatric day care surgery

    Directory of Open Access Journals (Sweden)

    Valeria Calcaterra

    2014-09-01

    Full Text Available Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period or the non-music group (standard postoperative care. Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (P<0.001. Positive impact on reactions to pain was noted using the FLACC scale. Music improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

  10. Music benefits on postoperative distress and pain in pediatric day care surgery.

    Science.gov (United States)

    Calcaterra, Valeria; Ostuni, Selene; Bonomelli, Irene; Mencherini, Simonetta; Brunero, Marco; Zambaiti, Elisa; Mannarino, Savina; Larizza, Daniela; Albertini, Riccardo; Tinelli, Carmine; Pelizzo, Gloria

    2014-08-12

    Postoperative effect of music listening has not been established in pediatric age. Response on postoperative distress and pain in pediatric day care surgery has been evaluated. Forty-two children were enrolled. Patients were randomly assigned to the music-group (music intervention during awakening period) or the non-music group (standard postoperative care). Slow and fast classical music and pauses were recorded and played via ambient speakers. Heart rate, blood pressure, oxygen saturation, glucose and cortisol levels, faces pain scale and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were considered as indicators of response to stress and pain experience. Music during awakening induced lower increase of systolic and diastolic blood pressure levels. The non-music group showed progressive increasing values of glycemia; in music-group the curve of glycemia presented a plateau pattern (PMusic improves cardiovascular parameters, stress-induced hyperglycemia. Amelioration on pain perception is more evident in older children. Positive effects seems to be achieved by the alternation of fast, slow rhythms and pauses even in pediatric age.

  11. Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients.

    Science.gov (United States)

    Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima

    2016-03-01

    Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

  12. Telemedicine with mobile devices and augmented reality for early postoperative care.

    Science.gov (United States)

    Ponce, Brent A; Brabston, Eugene W; Shin Zu; Watson, Shawna L; Baker, Dustin; Winn, Dennis; Guthrie, Barton L; Shenai, Mahesh B

    2016-08-01

    Advanced features are being added to telemedicine paradigms to enhance usability and usefulness. Virtual Interactive Presence (VIP) is a technology that allows a surgeon and patient to interact in a "merged reality" space, to facilitate both verbal, visual, and manual interaction. In this clinical study, a mobile VIP iOS application was introduced into routine post-operative orthopedic and neurosurgical care. Survey responses endorse the usefulness of this tool, as it relates to The virtual interaction provides needed virtual follow-up in instances where in-person follow-up may be limited, and enhances the subjective patient experience.

  13. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India.

    Science.gov (United States)

    Akhter, M Siddique J; Verma, R; Madhukar, K Premjeet; Vaishampayan, A Rajiv; Unadkat, P C

    2016-04-01

    A prospective observational was carried out to calculate the incidence of surgical site infections (SSI) along with the main risk factors and causative organisms in postoperative patients at a tertiary care setting in Mumbai. A total number of 1196 patients between June 2011 to March 2013 admitted to the general surgical ward or surgical ICU of our hospital were included in the study. Post laproscopy patients and organ space SSIs were excluded. Patient data were collected using a preformed pro forma and a wound Southampton score tabulated and checked repeatedly until suture removal of patient. Regular follow-up was maintained until at least 30 days postoperatively. The study showed a SSI rate of 11%. Risk factors associated with a higher incidence of SSI were found to be age (>55 years), diabetes mellitus (especially uncontrolled sugar in the perioperative period), immunocompromised patients (mainly HIV and immunosuppressive therapy patients), surgeon skill (higher in senior professors compared with junior residents), nature of the cases, (emergency surgeries), placement of drains, wound class (highest in dirty wounds), type of closure (multilayer closure), prolonged duration of hospital stay, longer duration of surgery (>2 hours), type of surgery (highest in cholecystectomy). The highest rates of causative organisms for SSIs found were Staphylococcus aureus, Escherichia coli and Klebsiella ssp. Prevention of SSIs requires a multipronged approach with particular emphasis on optimising preoperative issues, adhering religiously to strict protocols during the intraoperative period and addressing and optimising metabolic and nutritional status in postoperative period.

  14. Modifying Post-Operative Medical Care after EBV Implant May Reduce Pneumothorax Incidence.

    Directory of Open Access Journals (Sweden)

    Dominik Herzog

    Full Text Available Endoscopic lung volume reduction (ELVR with valves has been shown to improve COPD patients with severe emphysema. However, a major complication is pneumothoraces, occurring typically soon after valve implantation, with severe consequences if not managed promptly. Based on the knowledge that strain activity is related to a higher risk of pneumothoraces, we asked whether modifying post-operative medical care with the inclusion of strict short-term limitation of strain activity is associated with a lower incidence of pneumothorax.Seventy-two (72 emphysematous patients without collateral ventilation were treated with bronchial valves and included in the study. Thirty-two (32 patients received standard post-implantation medical management (Standard Medical Care (SMC, and 40 patients received a modified medical care that included an additional bed rest for 48 hours and cough suppression, as needed (Modified Medical Care (MMC.The baseline characteristics were similar for the two groups, except there were more males in the SMC cohort. Overall, ten pneumothoraces occurred up to four days after ELVR, eight pneumothoraces in the SMC, and only two in the MMC cohorts (p=0.02. Complicated pneumothoraces and pneumothoraces after upper lobe treatment were significantly lower in MMC (p=0.02. Major clinical outcomes showed no significant differences between the two cohorts.In conclusion, modifying post-operative medical care to include bed rest for 48 hours after ELVR and cough suppression, if needed, might reduce the incidence of pneumothoraces. Prospective randomized studies with larger numbers of well-matched patients are needed to confirm the data.

  15. Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

    Directory of Open Access Journals (Sweden)

    Magdy Gomaa

    2016-12-01

    Conclusion: Minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.

  16. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    Science.gov (United States)

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes. PMID:26941968

  17. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology.

    Science.gov (United States)

    French, Daniel G; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien

    2016-02-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes.

  18. [Current Status of Preoperative Professional Oral Care by Dentists for Elderly Patients Undergoing Lung Resection and Occurrence of Postoperative Pneumonia].

    Science.gov (United States)

    Hoshikawa, Yasushi; Tanda, Naoko; Matsuda, Yasushi; Katsumata, Hiroshi; Notsuda, Hirotsugu; Watanabe, Tatsuaki; Niikawa, Hiromichi; Noda, Masafumi; Sakurada, Akira; Kondo, Takashi; Okada, Yoshinori

    2016-01-01

    Pneumonia in elderly people is mainly caused by silent aspiration due to an age-related impairment of cough and swallowing reflexes. Because most of the patients with lung cancer are elderly people, we hypothesized that the age-related impairment of these protective reflexes might exist or occur in patients undergoing lung surgery, and cause postoperative pneumonia. We revealed that many elderly patients showed depressed swallowing reflex even before surgery and transient attenuation of cough reflex after surgery, and that postoperative pneumonia occurred only in the patients whose cough and/or swallowing reflex was abnormal postoperatively. Then, we prospectively showed that 30 elderly patients who received perioperative intensive oral care, including professional assessment of oral status, dental cleaning, and patient education for self-oral care by dentists, followed by intensive oral care by intensive care unit nurses, and encouragement of self-oral care by floor nurses, did not develop pneumonia after lung resection. In this study, we retrospectively reviewed the execution status of professional oral care by dentists and the occurrence of postoperative pneumonia in 159 consecutive patients aged 65 or older undergoing lung resection from 2013 to 2014. Thoracic surgeons in our institute asked dentists to provide professional oral care before lung resection only in 30.3% of the subjects in 2013, and 45.8% in 2014. Postoperative pneumonia occurred in 3 out of 76 subjects(3.9%)in 2013, and 1 out of 83(1.2%) in 2014. In 2013, 1 patient who did not receive preoperative professional oral care developed aspiration pneumonia postoperatively followed by acute exacerbation of idiopathic pulmonary fibrosis and in-hospital death. We need to make an effective system to provide preoperative professional oral care by dentists especially for elderly patients and high-risk patients before lung resection.

  19. Quality improvement of microsurgery through telecommunication--the postoperative care after microvascular transfer of intestine.

    Science.gov (United States)

    Chen, Hung-Chi; Kuo, Hsin-Chih; Chung, Kuo-Piao; Chen, Shih-Heng; Tang, Yueh-Bih; Su, Syi

    2012-02-01

    The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery. Copyright © 2012 Wiley Periodicals, Inc.

  20. Post-Operative Complications of Ventriculoperitoneal Shunt in Hydrocephalic Pediatric Patients-Nursing Care

    Directory of Open Access Journals (Sweden)

    Efstratios Athanasakis

    2011-01-01

    Full Text Available Introduction: Hydrocephalus is the most common congenital abnormality of the central nervous system ininfants. Many cases of hydrocephalic children are described since ancient times. It is characterized by excessiveaccumulation of cerebrospinal fluid in the ventricles of the brain. Its symptomatology during infanthood or earlychildhood is characterized by swelling of the head, protrusion of the forehead and brain atrophy. All thesesymptoms appear due to increased cerebrospinal fluid volume, increased intracranial pressure and dilatation ofthe ventricular walls.Aim: The aim of this paper is to describe the ventriculoperitoneal shunt complications in pediatrics patients andto point out the role of nursing stuff in the prevention of them.Methods: This include literature search on the database Medline and relevant with that issue internationalhydrocephalus organizations to identify studies regarding the complications of ventriculoperitoneal shunt and thenursing care for each complication.Results: Ventriculoperitoneal shunt is the treatment of hydrocephalic infants, rather than endoscopic thirdventriculostomy. Although the success of the ventriculoperitoneal shunt’s placement, the patients usually sufferfrom its afterwards complications. The complications involves postoperative shunt infection, shunt placementfailure, shunt obstruction – malfunction, abdominal complications – peritonitis, valve complications, slitventriclesyndrome and seizures. The role of the nursing stuff is vital, particularly in the postoperative weeks.Conclusion: A proper nursing assessment includes valid identification of complications and their prompttreatment. Also, nurses had to implement accurate nursing care, in order to prevent any complication. Finally,parental teaching from the nurses is crucial in the process of health outcomes for pediatric patient.

  1. Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Südkamp, Norbert P; König, Benjamin;

    2013-01-01

    and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools. The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation...... by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications. METHODS: This study is based on data from the prospective pelvic trauma registry introduced...... were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187×with surgical interventions) and 597 patients with sacral fractures (334×with surgical interventions). The rate of intraoperative complications was not significantly different, with 10...

  2. Time Trends and Predictors of Abnormal Postoperative Body Temperature in Infants Transported to the Intensive Care Unit

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    Hedwig Schroeck

    2016-01-01

    Full Text Available Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units. Univariate and adjusted analyses were performed to identify factors independently associated with abnormal postoperative temperatures. Results. 2,350 cases were included. 82% were normothermic postoperatively, while hypothermia and hyperthermia each occurred in 9% of cases. During the study period, hypothermia decreased from 24% to 2% (p<0.0001 while hyperthermia remained unchanged (13% in 2006, 8% in 2014, p=0.357. Factors independently associated with hypothermia were higher ASA status (p=0.02, lack of intraoperative convective warming (p<0.001 and procedure date before 2010 (p<0.001. Independent associations for postoperative hyperthermia included lower body weight (p=0.01 and procedure date before 2010 (p<0.001. Conclusions. We report an increase in postoperative normothermia rates in critically ill infants from 2006 until 2014. Careful monitoring to avoid overcorrection and hyperthermia is recommended.

  3. Predicting postoperative acute respiratory failure in critical care using nursing notes and physiological signals.

    Science.gov (United States)

    Huddar, Vijay; Rajan, Vaibhav; Bhattacharya, Sakyajit; Roy, Shourya

    2014-01-01

    Postoperative Acute Respiratory Failure (ARF) is a serious complication in critical care affecting patient morbidity and mortality. In this paper we investigate a novel approach to predicting ARF in critically ill patients. We study the use of two disparate sources of information – semi-structured text contained in nursing notes and investigative reports that are regularly recorded and the respiration rate, a physiological signal that is continuously monitored during a patient's ICU stay. Unlike previous works that retrospectively analyze complications, we exclude discharge summaries from our analysis envisaging a real time system that predicts ARF during the ICU stay. Our experiments, on more than 800 patient records from the MIMIC II database, demonstrate that text sources within the ICU contain strong signals for distinguishing between patients who are at risk for ARF from those who are not at risk. These results suggest that large scale systems using both structured and unstructured data recorded in critical care can be effectively used to predict complications, which in turn can lead to preemptive care with potentially improved outcomes, mortality rates and decreased length of stay and cost.

  4. Patient satisfaction and side effects in primary care: An observational study comparing homeopathy and conventional medicine

    Directory of Open Access Journals (Sweden)

    Thurneysen André

    2008-09-01

    Full Text Available Abstract Background This study is part of a nationwide evaluation of complementary medicine in Switzerland (Programme Evaluation of Complementary Medicine PEK and was funded by the Swiss Federal Office of Public Health. The main objective of this study is to investigate patient satisfaction and perception of side effects in homeopathy compared with conventional care in a primary care setting. Methods We examined data from two cross-sectional studies conducted in 2002–2003. The first study was a physician questionnaire assessing structural characteristics of practices. The second study was conducted on four given days during a 12-month period in 2002/2003 using a physician and patient questionnaire at consultation and a patient questionnaire mailed to the patient one month later (including Europep questionnaire. The participating physicians were all trained and licensed in conventional medicine. An additional qualification was required for medical doctors providing homeopathy (membership in the Swiss association of homeopathic physicians SVHA. Results A total of 6778 adult patients received the questionnaire and 3126 responded (46.1%. Statistically significant differences were found with respect to health status (higher percentage of chronic and severe conditions in the homeopathic group, perception of side effects (higher percentage of reported side effects in the conventional group and patient satisfaction (higher percentage of satisfied patients in the homeopathic group. Conclusion Overall patient satisfaction was significantly higher in homeopathic than in conventional care. Homeopathic treatments were perceived as a low-risk therapy with two to three times fewer side effects than conventional care

  5. [The Nutritional Care Experience of a Post-Operative Periampullary Cancer Patient With Cachexia].

    Science.gov (United States)

    Liou, Yan-Ting; Chiang, Pin-Yi; Shun, Shiow-Ching

    2016-04-01

    Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.

  6. Implant-retained mandibular overdentures versus conventional dentures: 10 years of care and aftercare.

    Science.gov (United States)

    Visser, Anita; Meijer, Henny J A; Raghoebar, Gerry M; Vissink, Arjan

    2006-01-01

    This 10-year prospective, randomized, clinical trial investigated the treatment outcome of edentulous patients treated with mandibular overdentures retained by 2 endosseous implants compared with conventional dentures in patients with or without vestibuloplasty. One hundred fifty-one edentulous patients (5 groups) with a symphyseal mandibular bone height between 8 and 25 mm participated. Sixty-two patients were treated with an overdenture retained by 2 implants (groups 1 and 3), 59 patients were treated with a conventional denture (groups 2 and 5), and 30 patients were treated with a conventional denture after preprosthetic vestibuloplasty (group 4). Patients who received conventional dentures but preferred implants later on could undergo implant surgery after 1 year of their initial treatment, but were analyzed in their original group. The prosthetic and surgical care and aftercare were scored during a 10-year evaluation period. One hundred thirty-three patients completed the 10-year follow-up evaluations. Forty-four percent of patients treated with conventional dentures switched within 10 years to implant-retained overdentures, versus 16% of the patients who were treated with conventional dentures after vestibuloplasty. On average, a greater time investment and more treatment sessions were needed in patients treated with implant-retained overdentures compared to patients treated with conventional dentures. Patients treated with an implant-retained overdenture need more treatment interventions and treatment time than patients treated with conventional dentures.

  7. A comparative study of postoperative complications of lightweight mesh and conventional prolene mesh in Lichtenstein hernia repair

    Directory of Open Access Journals (Sweden)

    Gugri Mukthinath

    2016-06-01

    Full Text Available Background: Inguinal hernia repair is the most frequently performed operation in any general surgical unit. The complications of using the mesh has been the rationale to examine the role of mesh in hernia repair in detail and to begin investigating the biocompatibility of different mesh modifications and to challenge old mesh concepts. Therefore the present study is undertaken to compare the lightweight mesh (Ultrapro with conventional prolene mesh in lichtenstein hernia repair. Methods: Thirty one patients with primary unilateral inguinal hernia was subjected either to lightweight mesh Lichtenstein's hernioplasty or standard prolene mesh Lichtenstein's hernioplasty. The patients were followed in the surgical OPD at 1 month, 6 months and 1 year for time taken to return to normal activities, chronic groin pain, foreign body sensation, seroma formation and recurrence. Results: Chronic pain among patients in standard prolene mesh group at 1 month, 6 month, and 1 year follow up was seen in 45.2%, 16% and 3.2% of the patients respectively, in light weight mesh group patients at 1 month, 6 month and 1 year follow up was 32.2%, 6.4% and none at one year respectively. Foreign body sensation in the light weight mesh group is significantly less compared to patients in standard prolene mesh group. Time taken to return to work was relatively shorter among patients in Light weight mesh group. There was no recurrence in both groups. Conclusion: Light weight mesh is an ideal choice in Lichenstein's hernioplasty whenever feasible. [Int J Res Med Sci 2016; 4(6.000: 2130-2134

  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. Intensive care unit versus hospital floor: a comparative study of postoperative management of patients with adolescent idiopathic scoliosis.

    Science.gov (United States)

    Shan, Le-Qun; Skaggs, David L; Lee, Christopher; Kissinger, Catherine; Myung, Karen S

    2013-04-03

    Patients undergoing posterior spinal instrumentation and fusion surgery for adolescent idiopathic scoliosis were admitted to the intensive care unit until two years ago, at which time we changed our protocol to admit these patients to the general hospital floor following a brief stay in a postanesthesia care unit. This study compared postoperative management on a hospital floor with that in the intensive care unit for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. A retrospective review of 124 consecutive patients with adolescent idiopathic scoliosis treated with spinal fusion from August 2007 to August 2010 was performed. Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis and posterior spinal instrumentation and fusion surgery. Of 124 patients, sixty-six were managed postoperatively in the intensive care unit and fifty-eight, on the hospital floor. The mean age at the time of surgery was fourteen years. A mean of eleven vertebral levels (range, six to fifteen levels) were fused. No significant difference between the groups was found with respect to the mean age at the time of surgery, mean weight, mean preoperative and postoperative Cobb angles, and mean number of levels fused (p ≥ 0.12). However, the use of analgesic and antianxiety medication, number of postoperative blood tests, days of hospital stay, and number of physical therapy sessions were significantly decreased in the floor group compared with the intensive care unit group (p ≤ 0.05). No patient from the floor group had to be admitted to the intensive care unit. The mean charge was $33,121 for the floor group and $39,252 for the intensive care unit group (p floor, rather than in an intensive care unit, was associated with a shorter hospital stay, fewer blood tests, less analgesic and antianxiety medication usage, and fewer physical therapy sessions at this high-volume, academic, tertiary-care children's hospital. In addition to improved patient

  10. Postoperative Care of Lumbar Disc Herniation%腰椎间盘突出症术后护理

    Institute of Scientific and Technical Information of China (English)

    胡耀芬

    2014-01-01

    目的:通过总结手术治疗腰间盘突出症术后护理体会,探讨腰椎后路术后临床护理的经验。方法回顾自2005年3月~2013年5月行腰椎后路椎间盘髓核摘除术术后护理的体会。结果采取健康护理的115例患者,均取得较满意的临床效果。%Objective To summarize the operation treatment of lumbar disc herniation postoperative nursing experience, explore the clinical nursing experience after lumbar spine surgery. Method From 2005 March to 2013:review of May for posterior lumbar discectomy in nursing care of postoperative. Results:115 cases of patients to health care, have achieved a satisfactory clinical ef ect.

  11. Doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty

    Directory of Open Access Journals (Sweden)

    Armando dos Santos Trettene

    2014-12-01

    Full Text Available Objective To identify the main doubts of caregivers of children with cleft lip and palate on postoperative care after cheiloplasty and palatoplasty. Method Cross-sectional study carried out in a reference hospital, between September and November 2012. The sample was composed of 50 individuals divided in two groups, of which 25 caregivers of children submitted to cheiloplasty, and 25 of children submitted to palatoplasty. The doubts were identified by an interview applied during the preoperative nursing consultation and were then categorized by similarity. Descriptive statistics was used for analysis of the outcomes. Results Concerning cheiloplasty, the doubts were related to feeding (36%, hygiene and healing (24% each, pain and infection (8% each. With regard to palatoplasty, the doubts were related to feeding (48%, hygiene (24%, pain (16%, bleeding (8% and infection (4%. Conclusion The study evidenced the concern of caregivers in relation to feeding and care of the postoperative wound.

  12. Audit of co-management and critical care outreach for high risk postoperative patients (The POST audit).

    Science.gov (United States)

    Story, D A; Shelton, A; Jones, D; Heland, M; Belomo, R

    2013-11-01

    Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative comanagement and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.

  13. Complications of rotator cuff surgery—the role of post-operative imaging in patient care

    Science.gov (United States)

    Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M

    2014-01-01

    When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935

  14. The wound healing trajectory and predictors with combined electric stimulation and conventional care: one outpatient wound care clinic's experience.

    Science.gov (United States)

    Zhou, Kehua; Schenk, Ronald; Brogan, Michael S

    2016-12-01

    Electric stimulation (E-stim) has been found to be an effective treatment in improving wound healing rates. However, the wound healing trajectory and its related predictors for complete wound closure (CWC) have not been reported with E-stim treatment. This was a retrospective study. Data on 159 patients treated at an outpatient wound clinic utilizing combined intervention of E-stim and conventional care were included. The Kaplan-Meier healing curve together with linear regression models depicted the percentage of patients with CWC against time. With 100, 112 and 140 days of treatment, the percentages of patients with CWC were 59·12%, 61·01% and 65·41%, respectively. Linear regression models predicted that all patients would achieve CWC by 21·55, 22·26 and 24·80 weeks, respectively. The speed for the increase in the number and percentage of patients with CWC peaked between 50-75 days of treatment. To optimize timely healing, referral to other treatment facilities or change of treatment protocol is warranted around the peak time. With the combined intervention of E-stim and conventional care, positive predictors for CWC included a shorter wound duration at initial evaluation (P = 0·005, OR = 3·10), better compliance with appointments (P = 0·007, OR = 3·38) and the diagnosis of venous leg ulcer (P = 0·001, OR = 3·88). This study provided preliminary data on wound healing trajectory and predictors with combined E-stim and conventional care. E-stim seemed to expedite wound healing; however, further research studies are needed. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  15. A comparative study of internal laser-assisted and conventional liposuction: a look at the influence of drugs and major surgery on laboratory postoperative values

    Directory of Open Access Journals (Sweden)

    Przylipiak AF

    2013-10-01

    Full Text Available Andrzej Feliks Przylipiak,1 Elżbieta Galicka,1 Magdalena Donejko,1 Marek Niczyporuk,1 Jerzy Przylipiak21Department of Aesthetic Medicine, Faculty of Pharmacy, Medical University of Bialystok, Bialystok, Poland; 2Medical Office, Bialystok, PolandBackground: Liposuction is a type of aesthetic surgery that has been performed on humans for decades. There is not much literature addressing the subject matter of pre- and post-surgery blood parameters, although this information is rather interesting. Documentation on patients who received laser-assisted liposuction treatment is particularly scarce. Until now, there has been no literature showing values of platelets, lymphocytes, and neutrophils after liposuction.Purpose: The aim of the work is to analyze and interpret values of platelets, lymphocytes and neutrophils in patient blood before and after liposuction, a surgery in which an extraordinarily large amount of potent drugs are used. Moreover, the aim is to compare values changes in patients of conventional and laser-assisted liposuction.Material and methods: We evaluated standard blood samples in patients prior to and after liposuction. This paper covers the number of platelets, lymphocytes, and neutrophils. A total of 54 patients were examined. Moreover, we compared the change in postoperative values in laser-assisted liposuction patients with the change of values in conventional liposuction patients. A paired two-sided Student's t-test was used for statistical evaluation. P < 0.005 was acknowledged to be statistically significant.Results: Values of platelets were raised both in conventional and in laser-assisted liposuction patients, but this difference was statistically non-significant and levels of platelets were still normal and within the range of blood levels in healthy patients. Values of neutrophils rose by up to 79.49% ± 7.74% standard deviation (SD and values of lymphocytes dropped by up to 12.68% ± 5.61% SD. The before

  16. [Decision on the time for post-operative extubation of maxillofacial surgery patient in the intensive care unit].

    Science.gov (United States)

    Curiel Balsera, E; Prieto Palomino, M A; Muñoz Bono, J; Arias Verdú, M D; Mora Ordóñez, J; Quesada García, G

    2009-03-01

    Evaluate moment of extubation in maxillofacial post-operative patients admitted to an intensive care unit (ICU) and analyze early complications during their stay. An observational and prospective study. Third level hospital ICU. All patients we underwent maxillofacial surgery and admitted to the ICU for immediate post-operative care from February 2007 to March 2008 were studied. Demographic and clinical data variables of the patients, anesthesic variables prior to surgery and mechanical ventilation and postoperative complications during their stay in the ICU were recorded. A total of 102 patients were collected during the study. Of these, 58 (55.8%) patients were extubated early (within the first 4 hours of admission). Global rate of complications was 12.5%. Length of mechanical ventilation was longer in patients who required cervical lymph node extraction (p = 0.0031). We found an association between complications and late extubation (p = 0.034; OR = 3.78; 95% CI, 1.16-12.31). The multivariant study showed that late extubation and surgery that required lymph node extraction are predictors of complications. In our series, late extubation and the need for cervical lymph node extraction were independent risk factors for complications in ICU. Although early extubation may be hazardous in some cases in the first hours, we have no consistent data to maintain mechanical ventilation longer than needed to recover from the anesthesia.

  17. Surgery in elderly people: preoperative, operative and postoperative care to assist healing.

    Science.gov (United States)

    Hughes, Sarah; Leary, Antonella; Zweizig, Susan; Cain, Joanna

    2013-10-01

    Surgery for elderly women is likely to increase steadily as the population of elderly people increases globally. Although increasing age increases perioperative morbidity and mortality, the functional age and physiologic reserve rather than chronological age is more important in preventing complications. Preparation for surgery, with special attention to functional capacity and activity, mental status, and existing comorbid conditions, can improve outcomes. Perioperative management must be tailored to physiologic changes of ageing, which affect respiratory, cardiac and renal function, as well as guidelines for preventing infection and thrombotic events. Of particular note is the enhanced effect of narcotic medications in elderly people, which affects intraoperative and postoperative management of pain. Prevention of postoperative delirium is accomplished through preoperative and postoperative planning. Discharge planning, particularly for frail elderly people, must start before surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. The effects of parental presence in the postanesthetic care unit on children's postoperative behavior: a prospective, randomized, controlled study.

    Science.gov (United States)

    Lardner, David R; Dick, Bruce D; Crawford, Susan

    2010-04-01

    The effects on children of parental presence in the postanesthesia care unit (PACU) have not been extensively studied. The few published studies are retrospective, nonrandomized, or lack adequate controls. They suggest that parental presence in the PACU decreases crying and negative behavior change postoperatively. We performed this prospective, randomized, controlled study to determine whether the presence of a parent affected crying behaviors in the PACU and behavior change 2 weeks postoperatively. Randomly selected patients, aged 2.0 to 8 years 11 months, ASA physical status I or II, and scheduled for elective outpatient surgery with an anticipated PACU stay of >10 minutes were randomly assigned to the parent present group (n = 150) or parent absent group (n = 150) in the PACU. All parents underwent the same preparation program. Reunification occurred once children's eyes had opened for the parent present group. In the PACU, crying was scored each minute after eye opening using a 5-point scale. Negative behavior change 2 weeks after discharge was determined using the Post Hospitalization Behavior Questionnaire. Because the anesthesia technique to be used was not determined a priori, data on the technique used were collected to ensure that groups were similar. Multiple and logistic regression techniques were used to determine predictors of crying in the PACU and behavior change 2 weeks postoperatively. Parental presence in the PACU made no difference in crying in the PACU. Negative behavior change 2 weeks postoperatively occurred more frequently in the parent absent group than the parent present group (45.8% vs 29.3%; P = 0.007). Multiple regression identified the following significant factors as predictive of larger proportion of time spent crying in the PACU (R(2) = 0.256, F[5, 273] = 15.66, P < 0.001): age <5 years (P < 0.001) and higher Children's Hospital of Eastern Ontario Pain Scale score at 15 minutes after arrival in day surgery (P < 0.001). Parental

  19. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Science.gov (United States)

    Ekerstad, Niklas; Karlson, Björn W; Dahlin Ivanoff, Synneve; Landahl, Sten; Andersson, David; Heintz, Emelie; Husberg, Magnus; Alwin, Jenny

    2017-01-01

    Objective The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting This study was conducted in a large county hospital in western Sweden. Participants The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14–0.79), ambulation (OR =0.19, 95% CI =0.1–0.37), dexterity (OR =0.38, 95% CI =0.19–0.75), emotion (OR =0.43, 95% CI =0.22–0.84), cognition (OR = 0.076, 95% CI =0.033–0.18) and pain (OR =0.28, 95% CI =0.15–0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32–0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). Conclusion Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality

  20. 普胸术后再次剖胸止血11例临床分析%Prevention of postoperative haemothorax following conventional thoracic surgery:Clinical analysis in 11 cases

    Institute of Scientific and Technical Information of China (English)

    朱少金; 丁伯应; 龚荣福; 任刚; 熊克品

    2014-01-01

    目的:总结普胸术后胸腔内大出血再次剖胸止血的临床资料,以便更好地预防和处理普胸术后胸腔内大出血。方法:对我院近5年普胸外科术后胸腔大出血并行再次剖胸止血的病例资料进行分析,寻找出血原因并总结治疗经验。结果:共11例普胸术后再次剖胸止血,痊愈10例,死亡1例,出血部位有切口肋间血管出血3例,壁层与纵隔胸膜广泛渗血1例,右下肺动脉干结扎线脱落1例,肋骨断端出血1例,支气管动脉出血1例,下肺韧带出血1例,食管床出血1例,纵隔手术创面出血1例,未能找到明确出血点1例。结论:关胸前仔细检查,严密止血是预防术后胸腔大出血的重要措施。及时果断地再次剖胸止血是治疗术后胸腔大出血的关键。%Objective:To summarize the clinical data in patients with postoperative haemothorax following conventional thoracic surgery for prevention of such incidence and approaches to management of the events.Methods:The clinical data were retrospectively examined in 11 patients required re-operation to manage the postoperative haemothorax in the past 5 years,with analysis of the causes and summary of the treatment experience .Results:Of total 11 pa-tients required second operation to manage the postoperative haemothorax,10 were successfully managed,and 1 died.The hemorrhage occurred at incision of intercostal vessels in 3,and extensive bleeding occurred in between the chest wall and mediastinal pleura in 1.One case of hemorrhage was due to dislo-cation of the ligation of the right inferior pulmonary artery,and the remaining were associated with bleeding site of rib stump(1 cases),bronchial artery bleeding(1 cases),pulmonary ligament(1 case),esophageal bed(1 case),and mediastinum operation(1 case).Another one case failed to be identified for bleeding site.Conclusion: In conventional thoracic surgery,careful confirmation and effective hemostasis may

  1. Paediatric nurses' postoperative pain management practices in hospital based non-critical care settings: a narrative review.

    Science.gov (United States)

    Twycross, Alison; Forgeron, Paula; Williams, Anna

    2015-04-01

    To investigate paediatric nurses' postoperative pain management practices with the aim of identifying the factors associated with undermanaged paediatric postoperative pain. Systematic search and review. PsychInfo, CINAHL, PubMed, EMBASE and hand searching. English peer-reviewed quantitative, qualitative, or mixed methods research articles published between 1990 and 2012 exploring registered nurses' paediatric postoperative pain management practices were included. Articles with a primary focus on nurses' pain management practices in the neonatal or paediatric intensive care units, recovery room, and/or focused on children with cognitive impairment were excluded. The search terms used were: postoperative pain; nurs*; paediatrics; pediatrics; children; pain assessment; non-pharm*; analges*. Titles and abstracts were used for initial screening. Two researchers conducted data extraction and assessment of rigour for each paper. From the initial 248 citations, 27 studies were included. Most studies were descriptive and examined relationships between personal factors and nurses' pain management practices. Observational data from four papers added insights beyond that provided in self-report studies. Two articles used experimental designs with vignettes. Data were categorised into four topics: pain assessment; pharmacological practices; non-pharmacological practices; and factors affecting practices. Despite improvements in analgesic administration over the past 20 years, practices remain suboptimal. Children's behaviour appears to influence nurses' pain assessment more than validated measures. A significant proportion of children did not have pain scores recorded in the first 24-h postoperatively. Children receive more analgesia when ordered around the clock compared to as required. However, around the clock analgesia prescription did not guarantee administration. Nurses reported using several non-pharmacological strategies routinely but some are not evidence based. The

  2. Fast track surgery accelerates the recovery of postoperative insulin sensitivity

    Institute of Scientific and Technical Information of China (English)

    YANG Dong-jie; ZHANG Chang-hua; HE Yu-long; ZHANG Sheng; HE Wei-ling; CHEN Hua-yun; CAI Shi-rong; CHEN Chuang-qi; SONG Xin-ming; CUI Ji; MA Jin-ping

    2012-01-01

    Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity.This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.Methods Controlled,randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up.Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:a fast track group (35 cases) and a conventional care group (35 cases).All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia.Clinical parameters (complication rates,return of gastrointestinal function and postoperative length of stay),stress index and insulin sensitivity were evaluated in both groups perioperatively.Reaults Sixty-two patients finally completed the study,32 cases in the fast-track group and 30 cases in the conventional care group.Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group.We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  3. Fast track surgery accelerates the recovery of postoperative insulin sensitivity.

    Science.gov (United States)

    Yang, Dong-jie; Zhang, Sheng; He, Wei-ling; Chen, Hua-yun; Cai, Shi-rong; Chen, Chuang-qi; Song, Xin-ming; Cui, Ji; Ma, Jin-Ping; Zhang, Chang-Hua; He, Yu-Long

    2012-09-01

    Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively. Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  4. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    Science.gov (United States)

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  5. Actual Situations and Problems of Postoperative Nursing Care for the Elderly who Underwent Neurosurgical Operation

    OpenAIRE

    2014-01-01

    The objective of the study is to identify nursing care and related problems involved in extending the daily life and supporting self-care of the elderly who underwent neurosurgical operation, and to determine the direction of nursing care. Subjects were six nurses who had been working in anacute-phase department for five years or longer. Collected data was analyzed by the qualitative synthesis method (KJ method). The results clarified [nursing care to enhance the treatment effect of neurosurg...

  6. Prevalence and characterization of postoperative pain in the Postanaesthesia Care Unit.

    Science.gov (United States)

    Cabedo, N; Valero, R; Alcón, A; Gomar, C

    Immediate postoperative pain occurs initially after surgery, while the patient is in the Post-Anaesthesia Recovery Unit. Very few studies assess this pain in this most immediate phase. Cross-sectional study of the prevalence and characteristics of immediate postoperative pain in patients after surgery. Between August 2014 and February 2015, a sample of 503 patients from the Post-Anaesthesia Recovery Unit was followed. Immediate postoperative pain was assessed (by the patient and the researcher) using the visual analogue scale (VAS; range 0-10) on 5 occasions after surgery. The impact of numerous factors (age, gender, type of surgery, type of anaesthesia and analgesic) on the pain, as well as variation in vital signs and the presence of side effects, were analysed. Assessment of the pain showed overall VAS values of 2.2±2.8 on all occasions. Pain was reported to be of greatest intensity 20min after the patients' arrival in the Post-Anaesthesia Recovery Unit (Pregional block techniques (with or without general anaesthesia) had lower VAS values than other general anaesthesia groups. Male patients and older patients displayed less pain than female and young patients, respectively (P<.001). Studying the characteristics of postoperative pain at such an early stage allows for improved management. It helps to predict, according to the type of surgery and the anaesthesia used, those patients in which higher VAS values may be seen and to better adapt analgesic therapy. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?

    Directory of Open Access Journals (Sweden)

    Ekerstad N

    2016-12-01

    Full Text Available Niklas Ekerstad,1,2 Björn W Karlson,3 Synneve Dahlin Ivanoff,4 Sten Landahl,5 David Andersson,6 Emelie Heintz,7 Magnus Husberg,2 Jenny Alwin2 1Department of Cardiology, NU (NÄL-Uddevalla Hospital Group, Trollhattan, 2Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, 3Department of Molecular and Clinical Medicine, Institute of Medicine, 4Centre for Ageing and Health, AGECAP, Department of Health and Rehabilitation, 5Department of Geriatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 6Division of Economics, Department of Management and Engineering, Linköping University, Linköping, 7Health Outcomes and Economic Evaluation Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206 or control group (n=202. Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3. Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by

  8. The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care.

    Science.gov (United States)

    Martin, Robert; Duvall, Ryan; Ellis, Susan; Scoggins, Charles R

    2009-03-01

    Preoperative nutritional supplementation, management of esophageal leaks, and postoperative anastomotic strictures still remain common problems in the management of esophageal cancer. Jejunal feeding tubes, total parenteral nutrition (TPN) with nasogastric suction, and repeated esophageal dilations remain the most common treatments, respectively. The aim of this study was to evaluate the use of removable silicone stents in (1) the preoperative nutritional optimization during neoadjuvant therapy, (2) the management of perioperative anastomotic leak, and (3) the management of postoperative anastomotic strictures. Review of our prospectively maintained esophageal database identified 15 patients who had removable self-expanding silicone stents placed in the management of one of these three management problems from July 2004 to August 2006. Preoperative therapy: Five patients underwent initial stent placement in preparation for neoadjuvant therapy. Dysphagia relief was seen in 100% of patients, with optimal caloric needs taken within 24 h of placement. All patients tolerated neoadjuvant therapy without delay from dehydration or malnutrition. One stent migration was found at the time of operation, which was removed without sequelae. Perioperative therapy: Five patients developed delayed (>10 days) esophageal leaks that were managed with removable esophageal stent and percutaneous drainage (in three patients). All patients had successful exclusion of the leak on the day of the procedure with resumption of oral intake on the evening of procedure. All five healed leaks without sequelae. Postoperative therapy: Five patients developed postoperative anastomotic strictures that required dilation and placement of removable esophageal stent. The median number of dilations was 1 (range 1-2), with all stents placed for approximate 3 months duration. All patients had immediate dysphagia relief after stent placement. Removable esophageal stents are novel treatment option to optimize

  9. Comparison of multi-modal early oral nutrition for the tolerance of oral nutrition with conventional care after major abdominal surgery: a prospective, randomized, single-blind trial.

    Science.gov (United States)

    Sun, Da-Li; Li, Wei-Ming; Li, Shu-Min; Cen, Yun-Yun; Xu, Qing-Wen; Li, Yi-Jun; Sun, Yan-Bo; Qi, Yu-Xing; Lin, Yue-Ying; Yang, Ting; Lu, Qi-Ping; Xu, Peng-Yuan

    2017-02-10

    Early oral nutrition (EON) has been shown to improve recovery of gastrointestinal function, length of stay and mortality after abdominal surgery; however, early oral nutrition often fails during the first week after surgery. Here, a multi-modal early oral nutrition program is introduced to promote recovery of gastrointestinal function and tolerance of oral nutrition. Consecutive patients scheduled for abdominal surgery were randomized to the multimodal EON group or a group receiving conventional care. The primary endpoint was the time of first defecation. The secondary endpoints were outcomes and the cost-effectiveness ratio in treating infectious complications. The rate of infectious-free patients was regarded as the index of effectiveness. One hundred seven patients were randomly assigned to groups. Baseline characteristics were similar for both groups. In intention-to-treat analysis, the success rate of oral nutrition during the first week after surgery in the multimodal EON group was 44 (83.0%) versus 31 (57.4%) in the conventional care group (P = 0.004). Time to first defecation, time to flatus, recovery time of bowel sounds, and prolonged postoperative ileus were all less in the multimodal EON group (P multi-modal early oral nutrition group (P multi-modal early oral nutrition program was an effective way to improve tolerance of oral nutrition during the first week after surgery, decrease the length of stay and improve cost-effectiveness after abdominal surgery. Registration number: ChiCTR-TRC-14004395 . Registered 15 March 2014.

  10. A comparison of tele-education versus conventional lectures in wound care knowledge and skill acquisition.

    Science.gov (United States)

    Haney, Marisa; Silvestri, Salvatore; Van Dillen, Christine; Ralls, George; Cohen, Ethan; Papa, Linda

    2012-03-01

    We conducted a randomized controlled study to compare conventional lectures with tele-education for delivering wound care education. Education was delivered by the two methods simultaneously to two classes. Forty-eight paramedics received a live didactic presentation and 41 paramedics received the same lecture via videoconferencing. The participants were evaluated by a multiple-choice examination and a practical test of their wound closure skills. There were no significant differences in any category of the practical skills test, and no difference in the results of the written examination: the mean total score was was 109.0 (95% CI 105.7-112.4) in the conventional lecture group and 110.3 (95% CI 106.2-114.3) in the video group (P = 0.63). In a survey at the end of the study the live lecture group rated the overall effectiveness of teaching significantly higher than the video-based group: the median scores for effectiveness of teaching were 6.0 (IQR 5.5-6.0) in the live lecture group and 4.0 (IQR 3.0-5.0) in the video group (P presentation.

  11. 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.

  12. [Protective care of children in the Czech Republic and the Convention on Children's Rights].

    Science.gov (United States)

    Dunovský, J

    2003-01-01

    Protective Care of Children is one of the oldest activities aimed at the defence and maintenance of life. It represents a set of actions, activities, and interventions directed to every child, attempting to provide sufficient defence against unfavourable effects on its existence and development. It includes also the knowledge how to prevent them. At the same time attention of workers engaged in the children care is aimed at problems and their solution of developing impairments, disabilities and abnormalities of individual children and the whole child population. It requires an ability to recognize and eliminate endogenous, exogenous or combined adverse effects causing impairments of the children's life. It means treatment and rehabilitation to recover the positive state. The most important role in all such affords have parents and the family. To estimate the level and characteristics of children preventive care in CR, the first (1997) and second (2003) report on evaluation of the Committee on the Rights of the Child and the implementation of the Convention on the Rights of the Child was used. The first evaluation concerned mainly the general problems of children; the second evaluation was focused on individual groups of children in special circumstances. As most important, the Committee found excellent level of health and educational care (though in the second evaluation it found some imperfections in education), the foundation of telephone Childline line for consultation of children in stress and preparation of several laws concerning the family and children. In both evaluations the Committee repeatedly reproached imperfections in the implementation of the most important principles of Covention--the best interest in children, no discrimination, respects to the children's opinion, the right of parents to have children and vice versa, problem of institutionalization. Next problems reproached concerned the not having founded the Coordination organ for the complex

  13. Three-dimensional treatment planning for postoperative radiotherapy in patients with node-positive cervical cancer. Comparison between a conventional and a conformal technique

    Energy Technology Data Exchange (ETDEWEB)

    Olofsen-van Acht, M.J.J.; Quint, S.; Seven, M.; Berg, H.A. van den; Levendag, P.C. [University Hospital Rotterdam (Netherlands). Dept. of Radiation Oncology; Santvoort, J.P.C. van [University Hospital Rotterdam (Netherlands). Subdivision of Clinical Physics; Logmans, A. [University Hospital Rotterdam (Netherlands). Dept. of Gynecologic Oncology

    1999-09-01

    Purpose: Reduction of irradiated small bowel volume, using a conformal three-dimensional treatment planning technique in postoperative radiotherapy of cervical cancer patients. Patients and Methods: Large gynecological treatment fields including the para-aortic nodes were analyzed in 15 patients. A conventional treatment plan with anterior and posterior (AP-PA) parallel opposed fields and a 3D 4-field conformal radiotherapy plan with a central blocking of small bowel were compared for each patient. Dose-volume histograms and dose parameters were established. Because of the tolerance constraints of the small bowel, the cumulative dose applied to the target was 48.6 Gy. Results: The mean Tumor Control Probability (TCP) values for both the conventional and the conformal technique were 0.60 and 0.61, respectively, with ranges of 0.56 to 0.67 and 0.57 to 0.66, respectively. The mean volume receiving 95% or more of the prescribed dose (V95) of the small bowel was 47.6% (32.5 to 66.3%) in the AP-PA technique and 14.9% (7.0 to 22.5%) in the conformal technique (p<0.001), indicating a significant reduction in irradiated volume of small bowel in the higher dose range. The mean Normal Tissue Complication Probability (NTCP) decreased from 0.11 to 0.03 with the conformal plan. In patients who received a pedicled omentoplasty during surgery, the mean V95 for small bowel could be reduced to 8.5% (7.0 to 9.9%). The mean median dose to the kidneys was only slightly elevated in the conformal treatment. Especially the mean dose to the right kidney in conventional vs conformal treatment was 3.3 vs 7.9 Gy. The mean near-minimum dose (D95) to the rectosigmoid decreased from 48.4 to 30.1 Gy in the conformal plan compared to the conventional plan. Conclusion: The small bowel dose can be significantly reduced with 3D treatment planning, particularly if a predicled omentoplasty is performed. This allows dose escalation to the tumor region without unacceptable toxicity for the small bowel

  14. Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery.

    Science.gov (United States)

    Graboyes, Evan M; Kallogjeri, Dorina; Saeed, Mohammed J; Olsen, Margaret A; Nussenbaum, Brian

    2017-04-01

    Postdischarge care fragmentation, readmission to a hospital other than the one performing the surgery, has not been described in head and neck cancer patients. We sought to determine the frequency, risk factors, and outcomes for head and neck cancer patients experiencing postdischarge care fragmentation. Retrospective cohort study. We analyzed patients in the 2008 to 2010 California State Inpatient Database with a 30-day unplanned readmission following head and neck cancer surgery. The frequency of postdischarge care fragmentation, patient- and hospital-level risk factors for care fragmentation, readmission diagnosis, and readmission outcomes were determined. Of 561 patients with a 30-day unplanned readmission, 210 (37.4%) were readmitted to a hospital other than the one performing the surgery. Surgical hospitalization length of stay ≥15 days (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.13-3.10) and discharge to a care facility (OR: 2.85, 95% CI: 1.77-4.58) were associated with care fragmentation. Overall, 39.8% of unplanned 30-day readmissions (223/561) were treatment complications, and 30.9% of treatment complication readmissions (69/223) occurred at a nonindex hospital. Patients with postdischarge care fragmentation had a 2.1-fold increased risk of in-hospital mortality within 30 days of readmission compared to patients readmitted to the index hospital (95% CI: 1.04-4.26). Postdischarge care fragmentation following head an neck cancer surgery is common, as 37% of readmitted patients and 31% of patients readmitted with a treatment complication are readmitted to a hospital other than the surgical hospital. Head and neck cancer patients experiencing care fragmentation are at increased risk of in-hospital mortality within 30 days of readmission. 4. Laryngoscope, 127:868-874, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  15. [Ovarian tumor in a koi carp (Cyprinus carpio): Diagnosis, surgery, postoperative care and tumour classification].

    Science.gov (United States)

    Lewisch, E; Reifinger, M; Schmidt, P; El-Matbouli, M

    2014-01-01

    Although ovarian tumour in the koi (Cyprinus carpio) does not appear to be an uncommon condition, its occurrence and therapy has rarely been reported. In the present case, the decision for surgery was based on clinical and sonographic findings of an intracoelomic mass. We used tricaine methansulfonate for the anaesthesia. Laparotomy was performed by ventral access and an ovarian tumour of 12-cm diameter was removed. The wound was sutured in two layers using Vicryl®. In addition to the application of an analgesic, an antibiotic and vitamins, the postoperative conditions the patient was kept under were adapted to support wound healing. The fish recovered uneventfully and was clinically healthy during the 16-month observation period. Based on the histological findings, the tumour was diagnosed as a thecoma. Investigations using antibodies against vimentin, cytokeratin, S 100 and glial fibrillary acidic protein (GFAP) failed to provide reliable results.

  16. Recording conventional and amplitude-integrated EEG in neonatal intensive care unit.

    Science.gov (United States)

    Neubauer, D; Osredkar, D; Paro-Panjan, D; Skofljanec, A; Derganc, M

    2011-09-01

    Neonatal electroencephalography (EEG) presents a challenge due to its difficult interpretation that differs significantly from interpretation in older children and adolescents. Also, from the technological point of view, it is more difficult to perform and is not a standard procedure in all neonatal intensive care units (NICUs). During recent years, long-term cerebral function monitoring by the means of amplitude-integrated EEG (aEEG) has become popular in NICUs because it is easy to apply, allows real-time interpretation by the neonatologist treating the newborn, and has predictive value for outcome. On the other side, to record conventional EEG (cEEG), which is still considered the gold standard of neonatal EEG, the EEG technician should not only be well trained in performing neonatal EEG but also has to adapt to suboptimal working conditions. These issues need to be understood when approaching the neonatal cEEG in NICU and the main structure of the article is dedicated to this technique. The authors discuss the benefits of the digitalization and its positive effects on the improvement of NICU recording. The technical aspects as well as the standards for cEEG recording are described, and a section is dedicated to possible artifacts. Thereafter, alternative and concomitant use of aEEG and its benefits are briefly discussed. At the end there is a section that presents a review of our own cEEG and aEEG recordings that were chosen as the most frequently encountered patterns according to Consensus statement on the use of EEG in the intensive care unit.

  17. Postoperative delirium is associated with increased intensive care unit and hospital length of stays after liver transplantation.

    Science.gov (United States)

    Bhattacharya, Bishwajit; Maung, Adrian; Barre, Kimberly; Maerz, Linda; Rodriguez-Davalos, Manuel I; Schilsky, Michael; Mulligan, David C; Davis, Kimberly A

    2017-01-01

    Delirium is increasingly recognized as a common and important postoperative complication that significantly hinders surgical recovery. However, there is a paucity of data examining the incidence and impact of delirium after liver transplantation. Retrospective case series in a tertiary care center examining all (n = 144) adult patients who underwent liver transplantation during a 6-y period. Delirium occurred in 25% of the patients with an average duration of 4.56 d. Patients who developed delirium were older (P = 0.007), had higher preoperative model for end-stage liver disease score (P = 0.019) and longer pretransplant hospital length of stay (LOS; P = 0.003). Patients with delirium were also more likely to have alcohol ingestion as an etiology of the liver failure (P = 0.033). Delirious patients had a trend toward increased ventilator days (P = 0.235) and significantly longer postoperative hospital (P = 0.001) and intensive care unit LOS (P = 0.001). Delirium was also associated with an increased frequency of hospital acquired infections including urinary tract infections (P = 0.005) and pneumonias (P = 0.001). Delirium is a common occurrence among liver transplant patients associated with increased complications and LOSs. Further prospective studies are needed to determine the specific risk factors in this complex population and to determine if delirium has an impact on long-term outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Complementary and conventional providers in cancer care: experience of communication with patients and steps to improve communication with other providers.

    Science.gov (United States)

    Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E

    2017-06-08

    Effective interdisciplinary communication is important to achieve better quality in health care. The aims of this study were to compare conventional and complementary providers' experience of communication about complementary therapies and conventional medicine with their cancer patients, and to investigate how they experience interdisciplinary communication and cooperation. This study analyzed data from a self-administrated questionnaire. A total of 606 different health care providers, from four counties in Norway, completed the questionnaire. The survey was developed to describe aspects of the communication pattern among oncology doctors, nurses, family physicians and complementary therapists (acupuncturists, massage therapists and reflexologists/zone-therapists). Between-group differences were analyzed using chi-square, ANOVA and Fisher's exact tests. Significance level was defined as p communication with their cancer patients regarding complementary therapies. While complementary therapists advised their patients to apply both complementary and conventional modalities, medical doctors were less supportive of their patients' use of complementary therapies. Of conventional providers, nurses expressed more positive attitudes toward complementary therapies. Opportunities to improve communication between conventional and complementary providers were most strongly supported by complementary providers and nurses; medical doctors were less supportive of such attempts. A number of doctors showed lack of respect for complementary therapists, but asked for more research, guidelines for complementary modalities and training in conventional medicine for complementary therapists. For better quality of care, greater communication about complementary therapy use is needed between cancer patients and their conventional and complementary providers. In addition, more communication between conventional and complementary providers is needed. Nurses may have a crucial role in

  19. Oral hygiene care of patients with oral cancer during postoperative irradiation. An alleviating effect on acute radiation mucositis

    Energy Technology Data Exchange (ETDEWEB)

    Katsura, Kouji; Masuko, Noriko; Hayashi, Takafumi [Niigata Univ. (Japan). School of Dentistry; Sugita, Tadashi; Sakai, Kunio; Tsuchida, Emiko; Matsumoto, Yasuo; Sasamoto, Ryuta

    2000-09-01

    To evaluate the effect of oral hygiene care of patients with oral cancer on alleviating acute radiation mucositis. Eighteen patients receiving postoperative radiotherapy for tongue and oral floor cancer were evaluated. Radiotherapy was given in 2 Gy per fraction, 5 times a week for a total dose of 50 Gy in most patients. Radiation field included the tongue and oral floor. During radiotherapy, 8 patients were treated by dento-maxillofacial radiologists with special concern on oral hygiene (oral hygiene group) and the remaining 10 patients were treated with routine dental care (standard medication group). Mucositis were evaluated using JCOG grade and EORTC/RTOG score by radiotherapists or dento-maxillofacial radiologists at 10 Gy intervals. Oral hygiene plans comprised motivation to maintain oral hygiene and establishing the habits of oral self care 4 times per day. Once a week, oral hygiene and oral cleaning of patients were checked by dento-maxillofacial radiologists. Oral self care included mechanical tooth brushing and a chemical mouthwash. No patients with grade 3 and score 4 mucositis were noted in the oral hygiene group. Severe mucositis occurred less frequently in the oral hygiene group than in the standard medication group. Interruption of radiotherapy due to severe mucositis did not occur in the oral hygiene group. On the other hand, interruption of radiotherapy occurred in four patients in the standard medication group, and in three it was due to severe oral pain. Our results suggested that our method of oral hygiene was more effective for alleviating acute radiation mucositis than other methods so far reported. In addition, our method is considered to be useful in preventing rampant dental caries and severe periodontitis due to the xerostomia induced by radiotherapy. (author)

  20. Postoperative spine; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Schlaeger, R. [Universitaetsspital Basel, Neurologische Klinik und Poliklinik, Basel (Switzerland); Lieb, J.M. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Shariat, K. [Neurochirurgie Koeln-Merheim, Koeln (Germany); Ahlhelm, F.J. [Kantonsspital Baden AG, Abteilung Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland)

    2014-11-15

    Approximately 15-30 % of surgical procedures involving the lumbar spine are associated with complications that require further diagnostic work-up. The choice of imaging modality for postoperative complications depends on the extent, pattern and temporal evolution of the postoperative neurological signs and symptoms as well as on the preoperative clinical status, the surgical procedure itself and the underlying pathology. The interpretation of imaging findings, in particular the distinction between postoperative complications and normally expected nonspecific postoperative imaging alterations can be challenging and requires the integration of clinical neurological information and the results of laboratory tests. The combination of different imaging techniques might help in cases of equivocal imaging results. (orig.) [German] Etwa 15-30 % der operativen Eingriffe im Bereich der lumbalen Wirbelsaeule verlaufen nicht komplikationsfrei und erfordern weiterfuehrende Abklaerungen. Die Auswahl des bildgebenden Verfahrens im Rahmen postoperativer Komplikationen haengt dabei wesentlich von der zeitlichen Entwicklung, dem Ausmass und Verteilungsmuster der neuaufgetretenen klinisch-neurologischen bzw. orthopaedischen Symptome sowie von den Ausfaellen vor dem Eingriff, der zugrundeliegenden Pathologie und der Lokalisation und Art des Eingriffs ab. Die Interpretation der bildgebenden Befunde, insbesondere die Abgrenzung postoperativer Komplikationen von natuerlicherweise zu erwartenden postoperativen Veraenderungen kann dabei eine Herausforderung darstellen. Bei unklaren Befunden kann ergaenzend zur eingehend klinisch-neurologischen und laborchemischen Bestandsaufnahme auch der kombinierte Einsatz mehrerer bildgebender Modalitaeten diagnostisch weiterhelfen. (orig.)

  1. Adherence to surgical care improvement project measures and post-operative surgical site infections.

    Science.gov (United States)

    Awad, Samir S

    2012-08-01

    Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect. Review of pertinent English-language literature. Numerous risk factors for SSI and tactics for prevention have been described, but efforts to bundle these tactics into an effective, comprehensive prevention program have been disappointing. Numerous studies now demonstrate that the Surgical Care Improvement Program (SCIP), which focused on process improvement rather than outcomes, has been ineffective despite governmental support, financial penalties for non-compliance, and consequent widespread implementation. Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.

  2. Effect of topical application of chlorhexidine for umbilical cord care in comparison with conventional dry cord care on the risk of neonatal sepsis: a randomized controlled trial.

    Science.gov (United States)

    Gathwala, Geeta; Sharma, Deepak; Bhakhri, Bhanu kiran

    2013-06-01

    To compare topical application of chlorhexidine for umbilical cord care with conventional dry care for prevention of neonatal sepsis in neonatal intensive care unit (NICU). The study was conducted in the NICU of a teaching hospital in north India between 2010 and 2011. Newborns (≥ 32 weeks of gestation and weighing ≥ 1500 g) were randomized into chlorhexidine application and dry care groups. Data regarding time of cord separation, umbilical sepsis and neonatal sepsis were recorded. One hundred forty (dry care group 70, chlorhexidine group 70) were enrolled and finally analysed. A significant difference was observed among groups in terms of time to cord separation and incidence of blood culture-proven sepsis though there was no statistical difference noted among the groups with regards to umbilical infection, probable sepsis and meningitis. Use of chlorhexidine for umbilical cord care prevents sepsis in the NICU.

  3. Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

    Directory of Open Access Journals (Sweden)

    Nancy Ames

    2017-07-01

    Full Text Available Background: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU. Methods: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. Results: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS for pain between the music and the control groups ( P  = .037. The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes. Conclusions: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients’ post-intervention experience, according to patients’ self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

  4. 肾穿刺病术后的护理%The Care of Renal Biopsy Disease Postoperative

    Institute of Scientific and Technical Information of China (English)

    王群

    2013-01-01

    目的: 探讨探究肾穿刺手术后护理的重要性。方法 选取我院2011年1月至2013年3月收治的40例患者肾脏患者进行术后护理,总结护理经验。结果 所有患者肾穿刺活检术均取得成功,术后患者出现了轻微的并发症,通过护理人员的护理,患者均痊愈出院。结论 对肾穿刺活检术后患进行精心护理,有利于手术的顺利进行,降低并发症的发生概率。%Objective To investigate to explore the renal puncture the importance of nursing after the operation. Methods Select our hospital from January 2011 to March 2013 were 40 cases of patients with kidney patients for nursing care, postoperative nursing experience were summarized. Results All patients with renal biopsy is a success, postoperative complications, patients appeared slight by nursing care, hospital patients were recovered. Conclusion On renal biopsy of postoperative care, is beneifcial to the operation smoothly, reduce the risk the occurrence of complications.

  5. Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis

    Science.gov (United States)

    Ames, Nancy; Shuford, Rebecca; Yang, Li; Moriyama, Brad; Frey, Meredith; Wilson, Florencia; Sundaramurthi, Thiruppavai; Gori, Danelle; Mannes, Andrew; Ranucci, Alexandra; Koziol, Deloris; Wallen, Gwenyth R

    2017-01-01

    Background: Music listening may reduce the physiological, emotional, and mental effects of distress and anxiety. It is unclear whether music listening may reduce the amount of opioids used for pain management in critical care, postoperative patients or whether music may improve patient experience in the intensive care unit (ICU). Methods: A total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. Results: There was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups (P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes. Conclusions: Despite the limited sample size, this study identified music listening as an appropriate intervention that improved patients’ post-intervention experience, according to patients’ self-report. Future mixed methods studies are needed to examine both qualitative patient perspectives and methodology to improve music listening in critical care units.

  6. Evaluation of incidence and severity of postoperative hypoxemia in neurosurgical patients during transportation from operation theater to surgical intensive care unit in a tertiary care unit, Kashmir, India

    Directory of Open Access Journals (Sweden)

    Abdul Waheed Mir

    2012-07-01

    Full Text Available Background:Postoperative hypoxemia during transportation from operation theater to intensive care unit is common among neurosurgical patients. Methadology: Arterial oxygen saturation (Spo2 and arterial blood gas analysis was performed postoperatively before and after shifting a group of sixty patients with ASA I and ASA II status undergoing various elective neurosurgical procedures under general anesthesia at Sheri-Kashmir Institute of Medical Sciences Srinagar , Kashmir. Statistical analysis: The data was analyzed using SPSS version 13. The chi-square test was used for categorical variables and student’s t test was used for continuous variables with normal distribution. The data was collected, compiled and statistically analyzed using analysis of variance (ANOVA. The values were expressed as mean±SD and a p value <0.05 was taken as statistically significant. Results: SpO2 before and after transporting the patients to SICU in group I was 98.90±0.45 and 86.70±3.85 respectively, whereas in group II, the SpO2 values were 98.80±0.52 and 93.95±3.99 respectively. In group III the mean SpO2 before and after transportation was 97.60±1.96 and 83.95±8.64 respectively. The difference in SpO2 in all the three groups before and after transportation was statistically significant (p<0.05. Conclusion: We recommend supplemental oxygen administration in all neurosurgical patients during transportation from operation theater to intensive care unit.

  7. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator for Postoperative Respiratory Failure (PSI 11) does not identify accurately patients who received unsafe care.

    Science.gov (United States)

    Nguyen, Michelle C; Moffatt-Bruce, Susan D; Strosberg, David S; Puttmann, Kathleen T; Pan, Yangshu L; Eiferman, Daniel S

    2016-10-01

    The Agency for Healthcare Research and Quality Patient Safety Indicator 11 is used to identify postoperative respiratory failure events and detect areas for quality improvement. This study examines the accuracy of Patient Safety Indicator 11 in identifying clinically valid patient safety events. All cases flagged for Patient Safety Indicator 11 from July 2013 to July 2015 by Agency for Healthcare Research and Quality QI Version 4.5 including International Classification of Diseases-9 codes were evaluated. Code-confirmed cases underwent independent review by 2 physicians. Inpatient electronic medical records were used to identify clinical factors for postoperative respiratory failure in each case to determine if postoperative respiratory failure was a result of unsafe care. The clinical true-positive rate and positive predictive value were calculated. A total of 166 postoperative respiratory failure cases were reviewed; 51 were recoded and reversed due to coding or documentation errors; 115 cases met the Agency for Healthcare Research and Quality definition of postoperative respiratory failure. A total of 71 (61.7%) of the 115 cases were false positives and did not reflect unsafe care, while 44 cases were true positives with a positive predictive value of 38.3%. χ(2) analysis did not reveal an association between demographics, clinical characteristics, or operative procedure with true-positive cases. Administrative coding data for Agency for Healthcare Research and Quality Patient Safety Indicator 11 do not identify accurately patients who received unsafe care when taking into account unpreventable clinical factors causing postoperative respiratory failure. The use of Agency for Healthcare Research and Quality Patient Safety Indicator 11 as a hospital performance measure should be reconsidered until inclusion and exclusion criteria are revised. Published by Elsevier Inc.

  8. Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia Intervention for Managing patient Experience (MIME). Study protocol for a cluster randomised crossover trial.

    Science.gov (United States)

    McDonall, Jo; de Steiger, Richard; Reynolds, John; Redley, Bernice; Livingston, Patricia; Botti, Mari

    2016-07-18

    Patient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes. A total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the "worst pain experienced in the past 24 h" on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission. The results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and

  9. Level of anxiety versus self-care in the preoperative and postoperative periods of total laryngectomy patients.

    Science.gov (United States)

    Almonacid, Clara Inés Flórez; Ramos, Alfredo Jurado; Rodríguez-Borrego, María-Aurora

    2016-06-14

    estimate the prevalence of anxiety in laryngectomy patients in the pre and postoperative periods and its relation with the self-care level. observational research of 40 patients with stage IV laryngeal cancer. Three observations took place: in the preoperative phase, at seven and at 14 days after the surgery; between June 2010 and December 2012. Two self-care levels were defined: self-sufficient and needing help for activities of daily living and treatment-related activities. To assess the anxiety levels, Zigmond's hospital anxiety scale (1983) was used. in the preoperative and postoperative phases, the patients presented high levels of anxiety. Concerning self-care, on average, self-sufficient patients presented lower levels of anxiety than patients who needed help to accomplish activities of daily living and activities deriving from the surgery, without significant differences. anxiety is present at all times in laryngectomy patients and the reduction of the self-care deficit seems to decrease it, without putting a permanent end to it. estimar a prevalência de ansiedade do paciente laringectomizado no pré-operatório e pós-operatório e sua relação com o nível de autocuidado. pesquisa observacional de 40 pacientes com câncer da laringe estágio IV. Foram realizadas 3 observações: no pré-operatório, a 7 e 14 dias pós-operatório, no período de junho de 2010 a dezembro de 2012. Dois níveis de autocuidado foram definidos: autossuficientes e precisar ajuda para as atividades da vida diária e relacionadas ao tratamento. Para avaliar a ansiedade, foi utilizada a escala de ansiedade hospitalar de Zigmond (1983). no pré-operatório e pós-operatório, os pacientes apresentaram níveis elevados de ansiedade. Com relação ao autocuidado, os pacientes autossuficientes apresentaram na média níveis inferiores de ansiedades que os pacientes que precisavam de ajuda para realizar as atividades da vida diária y as derivadas da cirurgia, sem chegar a ser

  10. Implant-retained mandibular overdentures versus conventional dentures : 10 years of care and aftercare

    NARCIS (Netherlands)

    Visser, A; Meijer, HJA; Raghoebar, GM; Vissink, A

    2006-01-01

    Purpose: This 10-year prospective, randomized, clinical trial investigated the treatment outcome of edentulous patients treated with mandibular overdentures retained by 2 endosseous implants compared with conventional dentures in patients with or without vestibuloplasty. Materials and Methods: One

  11. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

  12. Dose-volume histogram constrains for small intestine in postoperative transcutaneous radiotherapy of endometrial carcinoma: comparison between conventional and conformal techniques

    Directory of Open Access Journals (Sweden)

    Anela Ramić

    2013-09-01

    Full Text Available Introduction: The aim of this study was to determine the dose-volume histogram (DVH constrains of conventional and conformal transcutaneous radiotherapy for small intestine and perform their comparison.Methods: This retrospective-prospective study included patients who were treated for endometrial cancer using conventional transcutaneous radiotherapy at the Department of Radiotherapy Clinic of Oncology,Hematology and Radiotherapy, University Clinical Center Tuzla in the period from 2009 to 2011. The study was performed on patients of all ages suffering from this condition. The study involved 35 patients. DVHparameters which were analyzed are: minimum dose (Dmin, maximum dose (Dmax, medium dose (Daver of the small intestine, as well as the volume of the small intestine, which is included in 75%, 95% and 100%dose (V33,75Gy, V42,75Gy, V45Gy expressed in percentages and cubic centimeters of the affected organ. Working hypothesis was tested with paired t test. The difference between the variables at the level of p Results: DVH constrains of transcutaneous conformal radiotherapy showed signifi cantly smaller dose contribution on small intestine than DVH parameters of conventional transcutaneous radiotherapy (pConclusion: The dose contribution on small intestine was signifi cantly lower by planning three-dimensional conformal transcutaneous radiotherapy in comparison to the conventional planning.

  13. Dose-volume histogram constrains for small intestine in postoperative transcutaneous radiotherapy of endometrial carcinoma: comparison between conventional and conformal techniques

    Directory of Open Access Journals (Sweden)

    Anela Ramić

    2013-09-01

    Full Text Available Introduction: The aim of this study was to determine the dose-volume histogram (DVH constrains of conventional and conformal transcutaneous radiotherapy for small intestine and perform their comparison.Methods: This retrospective-prospective study included patients who were treated for endometrial cancer using conventional transcutaneous radiotherapy at the Department of Radiotherapy Clinic of Oncology,Hematology and Radiotherapy, University Clinical Center Tuzla in the period from 2009 to 2011. The study was performed on patients of all ages suffering from this condition. The study involved 35 patients. DVHparameters which were analyzed are: minimum dose (Dmin, maximum dose (Dmax, medium dose (Daver of the small intestine, as well as the volume of the small intestine, which is included in 75%, 95% and 100%dose (V33,75Gy, V42,75Gy, V45Gy expressed in percentages and cubic centimeters of the affected organ. Working hypothesis was tested with paired t test. The difference between the variables at the level of p <0.05 was considered statistically significant.Results: DVH constrains of transcutaneous conformal radiotherapy showed signifi cantly smaller dose contribution on small intestine than DVH parameters of conventional transcutaneous radiotherapy (p<0.0001.Conclusion: The dose contribution on small intestine was signifi cantly lower by planning three-dimensional conformal transcutaneous radiotherapy in comparison to the conventional planning.

  14. Piezoelectric device vs. conventional rotative instruments in impacted third molar surgery: relationships between surgical difficulty and postoperative pain with histological evaluations.

    Science.gov (United States)

    Rullo, Rosario; Addabbo, Francesco; Papaccio, Giampaolo; D'Aquino, Riccardo; Festa, Vincenzo Maria

    2013-03-01

    To investigate and compare the influence of surgical difficulty on postoperative pain after treatment of impacted mandibular third molars by rotatory osteotomy or Piezoelectric surgery. A prospective, randomized, split-mouth study was performed of 52 patients with bilateral and symmetrically oriented impacted mandibular third molars, who were surgically treated using a burr (Group A) on one random side of the lower jaw and a Piezoelectric device (Group B) on the contralateral side. Surgical difficulty was evaluated using a modified version of the Parant scale to categorize "simple extractions" and "complex extractions". Primary outcome parameters were the comparison of the postoperative pain evaluation rated on the Visual Analogue Scale from day 0 to day 6 postsurgery, and the assessment of differences in surgery time between the groups. Bone biopsies were taken during surgery to assess differences in bone tissue damage levels between the two different techniques. In "complex extractions" lower pain evaluation and significantly shorter surgery times were recorded when rotatory instruments were used. In "simple extractions", similar surgery times were observed for both techniques, but pain was greatest on the day of surgery when the burr was used. Bone heat osteonecrosis was observed only in the rotatory group and a high level of alkaline phosphatase was noted only in the Piezoelectric group. Pain after extraction of a mandibular third molar increases with increased surgical difficulty and especially in longer interventions. The integrity of the bony structure observed after the ultrasonic technique may favour the bone healing process. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. 53. Improved outcome of cardio-pulmonary arrest in post-operative cardiac children resuscitated in critical care setup

    Directory of Open Access Journals (Sweden)

    Hussam Hamadah

    2015-10-01

    Conclusions: The current outcome of cardio-pulmonary arrest in post-operative cardiac children has improved. Majority of cardiac arrest were successfully resuscitated with ROSC and 80% survived to discharge. The current result reflects significant improvement in the reported outcome of children who had cardio-pulmonary arrest in post-operative cardiac children in PCICU setup.

  16. International convention on World Homoeopathy Day: Integrating Homoeopathy in health care delivery

    Directory of Open Access Journals (Sweden)

    Anil Khurana

    2016-01-01

    Full Text Available An International Convention on World Homoeopathy Day was held to commemorate the 261 st birth anniversary of Dr. Samuel Hahnemann on 9 th -10 th April 2016, at Vigyan Bhawan, New Delhi, India. The theme of the Convention was "Integrating Homoeopathy in Healthcare" for achieving Universal Health Coverage (UHC as advocated by the World Health Organization (WHO. The Convention made for an ideal platform for extensive deliberations on the existing global scenario of Homoeopathy, with particular reference to India, strategy building and formulation of national policies for worldwide promotion, safety, quality, and effectiveness of medicines, evolving standards of education, international cooperation, and evidence-based practice of Homoeopathy. Organized jointly by Central Council for Research in Homoeopathy (CCRH, an autonomous research organization of Ministry of AYUSH, Government of India, and Liga Medicorum Homoeopathica Internationalis (LMHI, the Convention witnessed presentations of more than 100 papers during 21 technical sessions held in parallel in four halls, each named after homoeopathic stalwarts, viz., Hahnemann, Boenninghansen, Hering, and Kent.

  17. Postoperative handover

    DEFF Research Database (Denmark)

    Møller, Thea P; Madsen, Marlene D; Fuhrmann, Lone

    2013-01-01

    Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject to a down......Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject...

  18. Effect of screen-based computer simulation on knowledge and skill in nursing students' learning of preoperative and postoperative care management: a randomized controlled study.

    Science.gov (United States)

    Durmaz, Aylin; Dicle, Aklime; Cakan, Emre; Cakir, Şen

    2012-04-01

    Screen-based computer simulations are considered a method of skill teaching in health education. This study examined the effect of screen-based computer simulation on knowledge, skill, and the clinical decision-making process in teaching preoperative and postoperative care management to second-year students in an undergraduate school of nursing. It is a randomized controlled study. The study sample was composed of 82 students. They received education in screen-based computer simulation (n = 41) and skill laboratories (n = 41). Three instruments were used: a preoperative and postoperative care management cognitive level assessment test, skill control lists of preoperative and postoperative care management, and the Clinical Decision Making in Nursing Scale. There was not a significant difference between the students' posteducation knowledge levels (P = .421), practical deep breathing and coughing exercise education skills (P = .867), or clinical decision-making scale total and subscale scores (P = .065). However, a significant difference was found between the admission of the patient in the surgical clinic after surgery skill scores of the students (P = .04). Education provided in the screen-based computer simulation laboratory was equivalent to that provided in the skill laboratory.

  19. Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand

    Directory of Open Access Journals (Sweden)

    Van Lerberghe Wim

    2006-07-01

    Full Text Available Abstract Background In Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs, 37 private clinics and 37 private hospital OPDs. Method Analysis of the characteristics of 148 taped consultations with simulated patients. Results The family practices performed better than public hospital OPDs with regard to responsiveness, patient-centredness and cost of technical investigations (M-W U: p Conclusion In Thailand self-styled family practices, even without specific training, provide a service that is more responsive and patient-centred than conventional care, with less overmedicalization and at a lower cost. Changes in prescription practices may require deeper changes in the medical culture.

  20. Nursing care of postoperative incision pain of surgical patients%外科病人术后切口疼痛的护理

    Institute of Scientific and Technical Information of China (English)

    赵艳红; 吕永辉

    2016-01-01

    随着现代护理观念的更新,术后急性疼痛引起了护理人员的高度重视。疼痛是许多外科病人都要遇到的问题,术后疼痛对病人的生理会产生多方面的不良影响,是术后并发症和死亡率增高的相关因素之一。护理人员已将术后镇痛视为提高病人安全性、促进病人术后早日康复的重要环节,术后急性疼痛的处理已成为护理学的重要组成部分,有效的疼痛护理管理为及时控制和缓解术后疼痛提供了保障。本文对39例外科病人手术后切口观察,按卡诺夫斯荃氏的疼痛分级法,采用同源配对秩和检验,着重了解护理能否改善病人术后切口疼痛。结果表明:护理前患者普遍出现焦虑、忧郁、恐惧等表现,通过适当的心理护理,局部切口的护理和全身护理等减轻疼痛措施实施后,切口疼痛明显下降或消失,护理前后比较有显著性差异, P<0.001。大部分病人变为平静心境,甚至心情愉快,护理前后情绪变化比较有显著性差异,P<0.001.因此,加强术后病人切口疼痛的护理,是行之有效的护理方法,值得我们重视。%With the updated concept of modern nursing, postoperative acute pain caused by a caregiver's attention. Pain is the problem to be encountered in many surgical patients, postoperative pain will produce a wide range of adverse effects on the patient's physical, it is one of the relevant factors of postoperative complications and mortality. Nurses have been deemed analgesia improve patient safety, promote important aspects of the patient's speedy recovery after surgery, postoperative acute pain management has become an important part of nursing, effective pain care management for the timely control and mitigation Postoperative pain provided a guarantee. In this paper, cut to observe the patient after surgery exception 39, Tsuen Graves by Kano's pain grading method, using homologous pairing rank

  1. Homeopathic and conventional treatment for acute respiratory and ear complaints: A comparative study on outcome in the primary care setting

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    Fischer Michael

    2007-03-01

    Full Text Available Abstract Background The aim of this study was to assess the effectiveness of homeopathy compared to conventional treatment in acute respiratory and ear complaints in a primary care setting. Methods The study was designed as an international, multi-centre, comparative cohort study of non-randomised design. Patients, presenting themselves with at least one chief complaint: acute (≤ 7 days runny nose, sore throat, ear pain, sinus pain or cough, were recruited at 57 primary care practices in Austria (8, Germany (8, the Netherlands (7, Russia (6, Spain (6, Ukraine (4, United Kingdom (10 and the USA (8 and given either homeopathic or conventional treatment. Therapy outcome was measured by using the response rate, defined as the proportion of patients experiencing 'complete recovery' or 'major improvement' in each treatment group. The primary outcome criterion was the response rate after 14 days of therapy. Results Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H and 720 conventional (C treatment. The majority of patients in both groups reported their outcome after 14 days of treatment as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing. In the per-protocol set (H: 576 and C: 540 patients similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019. Further subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C: 84.5% and adults (H: 85.6%; C: 86.6%. The unadjusted odds ratio (OR of the primary outcome criterion was 1.40 (0.89–2.22 in children and 0.92 (0.63–1.34 in adults. Adjustments for demographic differences at baseline did not significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon homeopathic

  2. Integrating Complementary and Alternative Medicine Into Conventional Health Care System in Developing Countries

    DEFF Research Database (Denmark)

    Mishra, Shiva Raj; Neupane, Dinesh; Kallestrup, Per

    2015-01-01

    Complementary and alternative medicine has been a part of human life and practices since the beginning of time. The role of complementary and alternative medicine for the health of humans is undisputed particularly in light of its role in health promotion and well-being. This article discusses ways...... through which complementary and alternative medicine can be promoted and sustained as an integrated element of health care in developing countries. We specifically present the exemplary of Amchi traditional doctors of Northern Himalayas...

  3. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

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    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  4. 对白内障患者的手术前、后康复护理体会%Experience of preoperative and postoperative rehabilitation care to cataract patients

    Institute of Scientific and Technical Information of China (English)

    王丽霞; 秦迎新; 攸连秀

    2003-01-01

    @@ BACKGROUND:Preoperative and postoperative rehabilitation care is very important to the cataract patients under operation, especially if the patients affected with the other kinds of senile disease or if they are old patients.

  5. [Postoperative hypothyroidism].

    Science.gov (United States)

    Olifirova, O S; Trynov, N N

    2015-01-01

    There is a number of factors such as the thyroidectomy and limiting subtotal thyroid resection against the background of euthyroidism and initial hypothyroidism (in any extent of operation) which leads to the prediction of early postoperative hypothyroidism origin during 10 days of the postoperative peri- od. The early postoperative hypothyroidism is accompanied by activation processes of lipid peroxide oxidation and at the same time by reduction of antioxidant protection.

  6. Postoperative hyperkalemia.

    Science.gov (United States)

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

  7. Cost-utility analysis of cardiac rehabilitation after conventional heart valve surgery versus usual care

    DEFF Research Database (Denmark)

    Hansen, Tina Birgitte; Zwisler, Ann Dorthe; Berg, Selina Kikkenborg

    2017-01-01

    and monthly psycho-educational consultations or to usual care. Costs were measured from a societal perspective and quality-adjusted life years were based on the EuroQol five-dimensional questionnaire (EQ-5D). Estimates were presented as means and 95% confidence intervals (CIs) based on bootstrapping. Costs...... and effect differences were presented in a cost-effectiveness plane and were transformed into net benefit and presented in cost-effectiveness acceptability curves. Results No statistically significant differences were found in total societal costs (-1609 Euros; 95% CI: -6162 to 2942 Euros) or in quality......Background While cardiac rehabilitation in patients with ischaemic heart disease and heart failure is considered cost-effective, this evidence may not be transferable to heart valve surgery patients. The aim of this study was to investigate the cost-effectiveness of cardiac rehabilitation following...

  8. Comparison of Robotic vs. Standard Surgical Procedure on Postoperative Nursing Care of Women Undergoing Total Abdominal Hysterectomy.

    Science.gov (United States)

    Best, Janie; Day, Luanne; Ingram, Lori; Musgrave, Barbara; Rushing, Holli; Schooley, Brenda

    2014-01-01

    This exploratory study was conducted to determine if the postoperative course is different for women undergoing robotic-assisted total abdominal hysterectomy (TAH) compared to women undergoing traditional (open) TAH. This study adds to the evidence regarding potential benefits and complications of robotic-assisted gynecologic surgery, and identifies specific areas for further research.

  9. 148例剖腹产产妇术后护理体会%The Nursing Experience of Postoperative Care in Caesarean Section 148 Patients

    Institute of Scientific and Technical Information of China (English)

    郑红梅

    2016-01-01

    目的:探讨剖腹产手术患者术后护理干预的方法与效果。方法选取我院收治的148例剖腹产产妇,随机分为两组,对照组给予常规术后护理,观察组给予整体护理干预,观察并比较两组产妇的护理效果。结果观察组下床时间(28.3±2.1)h,住院时间(5.2±1.7)d,对照组下床时间(39.1±2.4)h,住院时间(7.8±1.5)d,两组比较,差异有统计学意义(P<0.05);观察组并发症发生率为2.7%,低于对照组的12.2%(χ2=4.81,P=0.03)。结论对剖腹产手术患者提供术后整体护理干预,能够有效缩短下床时间与住院时间,降低术后并发症发生率。%Objective Discussion the methods and results of postoperative care in caesarean section patients.Methods 148 cases of caesarean section,which randomly divided into two groups, control group received routine postoperative care, and study group was overall nursing intervention. The effects of care were compared in two groups.Results Bed time in study group was (28.3±2.1) hours, shorter than control group (5.2±1.7) hours,P<0.05), hospital stay in study group was (39.1±2.4) days, shorter than control group (7.8±1.5)days,P<0.05, and incidence of postoperative complications in study group was 2.7%, lower than control group 12.2%(χ2=4.81,P=0.03).ConclusionFor caesarean section patients with postoperative whole nursing can effectively shorten bed time and hospital stays, reduced the incidence of postoperative complications.

  10. Postoperative Delirium

    Science.gov (United States)

    Marcantonio, Edward R.

    2013-01-01

    Delirium (acute confusion) complicates 15% to 50% of major operations in older adults and is associated with other major postoperative complications, prolonged length of stay, poor functional recovery, institutionalization, dementia, and death. Importantly, delirium may be predictable and preventable through proactive intervention. Yet clinicians fail to recognize and address postoperative delirium in up to 80% of cases. Using the case of Ms R, a 76-year-old woman who developed delirium first after colectomy with complications and again after routine surgery, the diagnosis, prevention, and treatment of delirium in the postoperative setting is reviewed. The risk of postoperative delirium can be quantified by the sum of predisposing and precipitating factors. Successful strategies for prevention and treatment of delirium include proactive multifactorial intervention targeted to reversible risk factors, limiting use of sedating medications (especially benzodiazepines), effective management of postoperative pain, and, perhaps, judicious use of antipsychotics. PMID:22669559

  11. Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review.

    Science.gov (United States)

    Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E; Musial, Frauke; Salamonsen, Anita

    2016-09-08

    Communication between different health care providers (conventional and complementary) and cancer patients about their use of complementary therapies affects the health and safety of the patients. The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients. Systematic searches in six medical databases covering literature from 2000 to 2015 were performed. The studies were accessed according to the level of evidence and summarized into different risk situations. Qualitative content analysis was used to analyze the text data, and the codes were defined before and during the data analysis. Twenty-nine papers were included in the primary analysis and five main themes were identified and discussed. The main risk situations identified were 1. Differences in treatment concepts and philosophical values among complementary and conventional health care providers. 2. Adverse effects from complementary products and herbs due to their contamination/toxicity and interactions with conventional cancer treatment. 3. Health care physicians and oncologists find it difficult to recommend many complementary modalities due to the lack of scientific evidence for their effect. 4. Lack of knowledge and information about complementary and conventional cancer treatments among different health care providers. The risk of consuming herbs and products containing high level of toxins is a considerable threat to patient safety (direct risk). At the same time, the lack of scientific evidence of effect for many complementary therapies and differences in treatment philosophy among complementary and conventional health care providers potentially hinder effective communication about these threats with mutual patients (indirect risk). As such, indirect risk may pose an additional risk to patients who want to combine complementary therapies with

  12. Polyurethane cuffed versus conventional endotracheal tubes: Effect on ventilator-associated pneumonia rates and length of Intensive Care Unit stay

    Directory of Open Access Journals (Sweden)

    P Suhas

    2016-01-01

    Full Text Available Background and Aims: Ventilator-associated pneumonia (VAP is a major cause of morbidity and mortality among patients in the Intensive Care Units (ICUs and results in added healthcare costs. One of the methods of preventing VAP is to use polyurethane (PU-cuffed endotracheal tube (ETT. This study compares the incidence of VAP and length of ICU stay in patients intubated with conventional polyvinyl chloride (PVC ETT and PU-cuffed ETT. Methods: Eighty post-laparotomy patients who were mechanically ventilated for >48 h in the ICU were included in this randomised controlled trial. Patients with moderate to severe pre-existing lung conditions were excluded from the study. Patients in group PVC (n = 40 were intubated with conventional PVC-cuffed ETT and those in group PU (n = 40 with PU-cuffed ETT. VAP was defined as a Clinical Pulmonary Infection Score of >6 with a positive quantitative endotracheal culture in patients on ventilator for >48 h. Results: Overall VAP rates were 23.75%. Thirteen (32.5% patients in group PVC and six (15% patients in group PU developed VAP. ICU stay was significantly lesser in patients intubated with PU-cuffed ETT (group PU (median, 6 days; range: 4–8.5 compared to patients intubated with conventional ETT (group PVC (median, 8; range: 6–11. Conclusion: No statistically significant reduction in the incidence of VAP could be found between the groups. The length of ICU stay was significantly lesser with the use of ultra thin PU-cuffed ETTs.

  13. Early kangaroo mother care vs. conventional method in stabilizing low birth weight infant: physiologic parameters (preliminary report

    Directory of Open Access Journals (Sweden)

    Rulina Suradi

    2006-12-01

    Full Text Available Background Kangaroo mother care (KMC has been accepted as an effective method in nursing low birth weight infant (LBWI. However, the application of this method in the early life of infants has not been studied in Indonesia. Objective To evaluate some physiologic parameters of LBWI treated with early KMC compared to conventional method. Methods This was a randomized clinical-trial, which compared early KMC to conventional method in stabilizing LBWI in the first 4 hours of life. All LBWI (birth weight 1500-2499 g bom at Cipto Mangunkusumo Hospital and Budi Kemuliaan Matemity Hospital Jakarta were recruited consecutively in the period of November 2001 until March 2002. The inclusion criteria were spontaneous delivery, APGAR scores 13t and 5th minute 37, and parental consent. Results Sixty-four subjects distributed evenly into early KMC group and control group. One subject in the KMC group and three subjects in the control group were excluded due to respiratory distress. The mean birth weight was 2091 (SO 299.4 g in the KMC group and 2184 (SO 214.9 g inthe control group. The mean gestational-age in both groups was 35.6 (SO 3.0 weeks. There were no statistical differences in mean temperature (P=0.281, heart rate (P=0.956, and respiratory rate (P=0.898 between the two groups during the first 4 hours of life. We found a larger proportion of infants reaching the temperature of 36.5QC in the KMC group, especially at one hour (49% vs. 7%; the difference of proportion was 0.42 (95%CI 0.22 to 0.61. Conclusion Early KMC method is proved to be as safe as conventional method in stabilizing healthy LBWI.

  14. The Role of Dual-Trained Conventional/Complementary Physicians as Mediators of Integration in Primary Care

    Directory of Open Access Journals (Sweden)

    Eran Ben-Arye

    2010-01-01

    Full Text Available A growing number of physicians study complementary and alternative medicine (CAM. Limited data are available on perspectives of physicians with dual training in conventional medicine and CAM, on issues of communication and collaboration with CAM practitioners (CAMPs. Questionnaires were administered to primary care physicians employed in the largest health maintenance organization (HMO in Israel and to MD and non-MD CAM practitioners employed by a CAM-related agency of the same HMO. Data for statistical analysis were available from 333 primary care physicians (PCPs and 241 CAM practitioners. Thirty-one of the 241 CAMPs were dual-trained physicians employed in a CAM-related agency as practitioners and/or triage-consultants. Dual trained physicians and CAMPs shared similar attitudes and supported, more so than PCPs, collaborative physician–CAM practitioner teamwork in clinical practice, medical education and research. Nevertheless, dual trained physicians supported a physician-dominant teamwork model (similar to the PCPs’ approach in contrast to non-MD CAM practitioners who mainly supported a co-directed teamwork model. Compared to PCPs and non-MD CAM practitioners, dual trained physicians supported significantly more a medical/referral letter as the preferred means of doctor–CAM practitioner communication. Dual trained physicians have a unique outlook toward CAM integration and physician–practitioner collaboration, compared to non-MD CAM practitioners and PCPs. More studies are warranted to explore the role of dual trained physicians as mediators of integration.

  15. Comparison of intensity-modulated radiotherapy with conventional conformal radiotherapy for postoperative retroperitoneal soft tissue; Etude theorique d'une radiotherapie postoperatoire avec modulation d'intensite d'un sarcome retroperitoneal

    Energy Technology Data Exchange (ETDEWEB)

    Musat, E.; Kantor, G.; Caron, J.; Lagarde, P.; Laharie, H.; Angles, J.; Gilbeau, L. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Stoeckle, E. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Chirurgie, 33 - Bordeaux (France); Bui, B.N. [Centre Regional de Lutte Contre le Cancer, Institut Bergonie, Dept. de Medecine, 33 - Bordeaux (France)

    2004-08-01

    External postoperative radiation therapy for retroperitoneal sarcoma is an example of treatment using large fields for complex shaped volumes of irradiation, Prescribed dose is limited by tolerance of adjacent organs at risk (OAR). From a recent case treated by conventional conformal radiotherapy (3D-CRT), we evaluate the benefit of five theoretical IMRT plans. Criteria used are calculated from DVH related to delineated PTV and OAR, IMRT should permit to enhance the prescribed dose without increasing dose in the OAR (especially residual kidney, spinal cord and small bowel). This theoretical study show the feasibility of a dose escalation from a treatment dose of 45 Gy delivered by 3D-CRT up to a planning dose of 54 Gy calculated by IMRT with: - for the PTV: an improvement of the dose homogeneity about 5% (range 2 %) and moreover the coverage factor (CF) about 13% (range 9 6%); - for the OAR: an improvement of the protection factor (PF) about 20% (range 11-24%); - and thus an improved conformity index (CI = CF x PF) about 25% (range 15-32%). (author)

  16. Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

    Science.gov (United States)

    Boitor, Mădălina; Martorella, Géraldine; Arbour, Caroline; Michaud, Cécile; Gélinas, Céline

    2015-06-01

    Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

  17. Postoperative Spine Infections

    Science.gov (United States)

    Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele

    2015-01-01

    Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication. PMID:26605028

  18. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India

    Directory of Open Access Journals (Sweden)

    Nutanbala N Goswami

    2011-01-01

    Full Text Available Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85% isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%, was the predominant organism. S. aureus was sensitive to rifampicin (89.58%, levofloxacin (60.42%, and vancomycin (54.17%. Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%, gatifloxacin (51.35%, and meropenem (51.35%. Escherichia coli was sensitive to levofloxacin (72.41% and ciprofloxacin (62.07%. Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%, levofloxacin (63.16%, gatifloxacin (63.16%, and linezolid (56.52%. Proteus mirabilis was sensitive to ciprofloxacin (75% and linezolid (62.50. Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14% followed by levofloxacin (50%. Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

  19. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study

    Science.gov (United States)

    Fenaux, Pierre; Mufti, Ghulam J; Hellstrom-Lindberg, Eva; Santini, Valeria; Finelli, Carlo; Giagounidis, Aristoteles; Schoch, Robert; Gattermann, Norbert; Sanz, Guillermo; List, Alan; Gore, Steven D; Seymour, John F; Bennett, John M; Byrd, John; Backstrom, Jay; Zimmerman, Linda; McKenzie, David; Beach, C L; Silverman, Lewis R

    2014-01-01

    Summary Background Drug treatments for patients with high-risk myelodysplastic syndromes provide no survival advantage. In this trial, we aimed to assess the effect of azacitidine on overall survival compared with the three commonest conventional care regimens. Methods In a phase III, international, multicentre, controlled, parallel-group, open-label trial, patients with higher-risk myelodysplastic syndromes were randomly assigned one-to-one to receive azacitidine (75 mg/m² per day for 7 days every 28 days) or conventional care (best supportive care, low-dose cytarabine, or intensive chemotherapy as selected by investigators before randomisation). Patients were stratified by French–American–British and international prognostic scoring system classifications; randomisation was done with a block size of four. The primary endpoint was overall survival. Efficacy analyses were by intention to treat for all patients assigned to receive treatment. This study is registered with ClinicalTrials.gov, number NCT00071799. Findings Between Feb 13, 2004, and Aug 7, 2006, 358 patients were randomly assigned to receive azacitidine (n=179) or conventional care regimens (n=179). Four patients in the azacitidine and 14 in the conventional care groups received no study drugs but were included in the intention-to-treat efficacy analysis. After a median follow-up of 21·1 months (IQR 15·1–26·9), median overall survival was 24·5 months (9·9–not reached) for the azacitidine group versus 15·0 months (5·6–24·1) for the conventional care group (hazard ratio 0·58; 95% CI 0·43–0·77; stratified log-rank p=0·0001). At last follow-up, 82 patients in the azacitidine group had died compared with 113 in the conventional care group. At 2 years, on the basis of Kaplan-Meier estimates, 50·8% (95% CI 42·1–58·8) of patients in the azacitidine group were alive compared with 26·2% (18·7–34·3) in the conventional care group (p<0·0001). Peripheral cytopenias were the most

  20. Early Thiopurines Versus Conventional Step-Care Therapy for Modifying the Disease Course of Early Crohn's Disease

    Science.gov (United States)

    Qiu, Yun; Chen, Bai-Li; Mao, Ren; Zhang, Sheng-Hong; He, Yao; Zeng, Zhi-Rong; Chen, Min-Hu

    2015-01-01

    Abstract The impact of thiopurines (TP) on the long-term outcome of early Crohn disease (CD) is still controversial. The present study designed as a comparison of conventional step-care to alternative treatment paradigms for disease progression. This longitudinal cohort study examined the established CD patients from a university-based inflammatory bowel disease referral center. Outcomes of mucosal healing (MH), CD-related surgery or hospitalization, and clinical remission were compared based on timing of initiation of TP therapy. The cumulative incidence of events was estimated by Kaplan–Meier method. One-hundred ninety patients with early CD were included. After a median follow-up of 57 months (interquartile range, 31.3–76.2), 29 patients undergone abdominal surgeries, 48 patients hospitalized, and 68 patients experienced clinical flares. A higher cumulative proportion of patients in the top-down (TD) group achieving MH than both the accelerated step-up (AC) group and conventional management (CM) group at month 36 (78.8% vs 39.9% and 42.2%, respectively; P = 0.001). There was a trend, albeit not significant, for an increased proportion of patients free of CD-related intestinal surgery in the TD group at month 60 (P = 0.16). However, among secondary outcomes, an early TP-based AC or TD strategy was not associated with improvement in clinical remission rates compared with a CM strategy at month 60 (P = 0.79). No significant difference was observed between early TP and CM for rates of MH, CD-related intestinal surgery or hospitalization, and clinical remission. Both AC and CM strategy were minimally effective for disease modification. TD strategy has the potential of achieving higher rates MH. Our results support the TD strategy in patients with early CD at risk for a disabling course. PMID:26252273

  1. Postoperative Care Experience of Patients With Gastric and Duodenal Ulcer Perforation%胃十二指肠溃疡患者穿孔术后护理体会

    Institute of Scientific and Technical Information of China (English)

    吕凤芹

    2015-01-01

    Objective Postoperative care experience of patients with gastric and duodenal ulcer perforation is to be summarized. Methods Selected 41 patients of gastric and duodenal ulcer perforation who were received and treated in hospital from February 2013 to February 2014;patients in study group were given care intervention,while patients in control group were given conventional treatment and then compared treatment efficacy between two groups. Results Patients’mastery of health knowledge and the score of patients’life quality and their satisfaction with treatment in study group were a bit higher than counterparts in control group;besides,patients’hospitalization days in study group was less than that in control group,there was a treatment differential between two groups and such a differential had statistic value(P<0.05). Conclusion Strengthening postoperative care of patients with gastric and duodenal ulcer perforation is conducive to patients’recovery and shortening their treatment course.%目的:总结胃十二指肠溃疡穿孔术后护理体会。方法选取2013年2月~2014年2月间我院收治的胃十二指肠溃疡穿孔患者41例,实验组给予护理干预,对照组给予传统护理,对比两组患者护理效果。结果实验组健康知识、生命质量、满意度评分相对较高,住院时间与并发症少于对照组,两组患者护理效果差异有统计学意义(P<0.05)。结论加强胃十二指肠溃疡患者穿孔术后护理能够促进患者病情恢复,缩短康复进程,切实可行。

  2. Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair.

    Science.gov (United States)

    Beg, Kisha A; Haq, Anwarul; Amanullah, Muneer; Laique, Sobia N; Sadqani, Saleem; Aslam, Nadeem; Rehmat, Amina Wali; Hasan, Babar S

    2015-01-01

    After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively. Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (>2 days). Odds ratios were calculated, and regression was performed. Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O(2) saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%). Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support. © 2015 Wiley Periodicals, Inc.

  3. On-site veterinary medical evaluation and care of working dogs and horses at the 2012 Republican National Convention.

    Science.gov (United States)

    Chatfield, Jenifer A; Dewell, Reneé; Miranda, Astrid J; Wilcox, Stefania; Vannieuwenhoven, Ty J

    2015-09-01

    To describe on-site veterinary medical care for working dogs and horses deployed for the 2012 Republican National Convention (RNC) in Tampa, Fla, August 24 to 30, 2012. Retrospective case series. 130 dogs and 45 horses. Data collected included breed, age, history, task assignment, reason for evaluation, and physical examination findings. A patient encounter report was recorded each time an animal was seen by veterinary staff for a physical evaluation. 46 of the 130 (35%) dogs and all 45 (100%) horses underwent at least 1 on-site veterinary evaluation, for a total of 478 patient encounters. The most common reason for an on-site veterinary evaluation was a wellness check (446 patient encounters). On the basis of veterinary recommendations, 1 dog and 4 horses were removed from continued service for the duration of the event. In addition, 1 dog and 1 horse were removed from active service for 12 to 24 hours but allowed to return to service for the duration of the event following a veterinary reevaluation. Results suggested that working dogs and horses deployed for large planned events face different health concerns, compared with concerns previously reported for animals deployed following disasters. Pre-event planning and training of handlers and riders may have helped reduce the number of health concerns, particularly health concerns related to high heat.

  4. Can postoperative process of care utilization or complication rates explain the volume-cost relationship for cancer surgery?

    Science.gov (United States)

    Ho, Vivian; Short, Marah N; Aloia, Thomas A

    2017-08-01

    Past studies identify an association between provider volume and outcomes, but less is known about the volume-cost relationship for cancer surgery. We analyze the volume-cost relationship for 6 cancer operations and explore whether it is influenced by the occurrence of complications and/or utilization of processes of care. Medicare hospital and inpatient claims for the years 2005 through 2009 were analyzed for 6 cancer resections: colectomy, rectal resection, pulmonary lobectomy, pneumonectomy, esophagectomy, and pancreatic resection. Regressions were first estimated to quantify the association of provider volume with costs, excluding measures of complications and processes of care as explanatory variables. Next, these variables were added to the regressions to test whether they weakened any previously observed volume-cost relationship. Higher hospital volume is associated with lower patient costs for esophagectomy but not for other operations. Higher surgeon volume reduces costs for most procedures, but this result weakens when processes of care are added to the regressions. Processes of care that are frequently implemented in response to adverse events are associated with 14% to 34% higher costs. Utilization of these processes is more prevalent among low-volume versus high-volume surgeons. Processes of care implemented when complications occur explain much of the surgeon volume-cost relationship. Given that surgeon volume is readily observed, better outcomes and lower costs may be achieved by referring patients to high-volume surgeons. Increasing patient access to surgeons with lower rates of complications may be the most effective strategy for avoiding costly processes of care, controlling expenditure growth. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. 51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

    Directory of Open Access Journals (Sweden)

    Hussam Hamadah

    2015-10-01

    Conclusions: Bed side critical care US assessment of diaphragms is a simple tool that can be easily learn and performed by PCICU intensivist. The tool can help in early detection of diaphragm motion abnormality related to cardiac surgery. Early detection can help putting management plan that may involve need for surgery or require prolong positive invasive and non-invasive ventilator support.

  6. 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.

    Science.gov (United States)

    van der Meij, Eva; Huirne, Judith Af; Bouwsma, Esther Va; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter Kg; Geomini, Peggy Maj; Consten, Esther Cj; Schraffordt Koops, Steven E; van Kesteren, Paul Jm; Stockmann, Hein Bac; Ten Cate, A Dorien; Davids, Paul Hp; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus Jhj; Bonjer, H Jaap; Anema, Johannes R

    2016-12-21

    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, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social participation, self-rated health

  7. Comparison of Trunk Stabilization Exercises Using a Gym Ball and Conventional Back Care Exercises for Patients With Chronic Lower Back Pain

    Directory of Open Access Journals (Sweden)

    Ahmed

    2016-04-01

    Full Text Available Background The trunk muscles are vital for the maintenance of spinal stability. Training of specific muscles surrounding the lumbar spine, which provide dynamic and segmental stability, is one of the major goals in the management of patients with chronic low back pain (LBP. However, more investigation of lumbar stabilization training using a ball is required before making any strong conclusions about its efficacy. Objectives The aim of this study was to compare the effect of trunk stabilization exercises and conventional back care exercises for patients with chronic LBP. Patients and Methods Thirty male subjects with chronic LBP were randomly assigned to two groups. The experimental group received trunk stabilization exercise using a gym ball whereas the control group received conventional back care exercises for six weeks. The abdominal muscle endurance, pain intensity, and functional disability were measured using pressure biofeedback, visual analogue scale (VAS, and modified Oswestry disability questionnaire (MODQ, respectively. All the measurements were taken at baseline and during week two, four and six. Results The results of the study demonstrated significant improvements in abdominal muscle endurance and reduction in VAS and MODQ score of both groups (P = 0.001. The trunk stabilization exercise group showed greater gains in abdominal muscle endurance during weeks two to six compared to the conventional back care exercise group (P < 0.05. In addition, the trunk stabilization exercise group showed greater reduction in the VAS score (P = 0.035 and MODQ score (P = 0.001 at week six compared to the conventional back care exercise group. Conclusions The trunk stabilization exercises are more effective than conventional back care exercises in the rehabilitation of patients with chronic LBP.

  8. Postoperative astigmatism.

    Science.gov (United States)

    Swinger, C A

    1987-01-01

    With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.

  9. Intravenous patient-controlled analgesia for acute postoperative pain

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Haroutiunian, Simon

    2011-01-01

    Intravenous patient-controlled therapy is used routinely in postoperative care in much of the developed world. Intravenous patient-controlled analgesia results in higher patient satisfaction than conventional administration of analgesics, although it appears to have no advantage over conventional...... analgesia in terms of adverse effects and consumption of opioids. Standard orders and nursing procedure protocols are recommended for patients receiving intravenous patient-controlled analgesia to monitor treatment efficacy and development of adverse effects. Some subgroups of patients need special...... consideration. For example, opioid-tolerant patients need higher postoperative opioid doses to achieve satisfactory analgesic effect. In patients with renal or hepatic insufficiency, the elimination of some opioids may be substantially impaired, and the optimal opioid should be selected based on its...

  10. Postoperative spinal column; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Kaefer, W. [Westpfalzklinikum GmbH, Standort II, Abteilung fuer Wirbelsaeulenchirurgie, Kusel (Germany); Heumueller, I. [Westpfalzklinikum GmbH, Standort II, Institut fuer Radiologie II, Kusel (Germany); Harsch, N.; Kraus, C.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2016-08-15

    As a rule, postoperative imaging is carried out after spinal interventions to document the exact position of the implant material. Imaging is absolutely necessary when new clinical symptoms occur postoperatively. In this case a rebleeding or an incorrect implant position abutting a root or the spinal cord must be proven. In addition to these immediately occurring postoperative clinical symptoms, there are a number of complications that can occur several days, weeks or even months later. These include the failed back surgery syndrome, implant loosening or breakage of the material and relapse of a disc herniation and spondylodiscitis. In addition to knowledge of the original clinical symptoms, it is also important to know the operation details, such as the access route and the material used. In almost all postoperative cases, imaging with contrast medium administration and corresponding correction of artefacts by the implant material, such as the dual energy technique, correction algorithms and the use of special magnetic resonance (MR) sequences are necessary. In order to correctly assess the postoperative imaging, knowledge of the surgical procedure and the previous clinical symptoms are mandatory besides special computed tomography (CT) techniques and MR sequences. (orig.) [German] In der Regel erfolgt bei spinalen Eingriffen eine postoperative Bildgebung, um die exakte Lage des Implantatmaterials zu dokumentieren. Unbedingt notwendig ist die Bildgebung, wenn postoperativ neue klinische Symptome aufgetreten sind. Hier muessen eine Nachblutung bzw. inkorrekte, eine Wurzel oder das Myelon tangierende Implantatlage nachgewiesen werden. Neben diesen direkt postoperativ auftretenden klinischen Symptomen gibt es eine Reihe von Komplikationen, die erst nach mehreren Tagen, Wochen oder sogar nach Monaten auftreten koennen. Hierzu zaehlen das Failed-back-surgery-Syndrom, die Implantatlockerung oder -bruch, aber auch ein Rezidivvorfall und die Spondylodiszitis. Neben der

  11. Comparative effectiveness of homoeopathic vs. conventional therapy in usual care of atopic eczema in children: long-term medical and economic outcomes.

    Directory of Open Access Journals (Sweden)

    Stephanie Roll

    Full Text Available BACKGROUND: One in five children visiting a homeopathic physician suffers from atopic eczema. OBJECTIVES: We aimed to examine the long-term effectiveness, safety and costs of homoeopathic vs. conventional treatment in usual medical care of children with atopic eczema. METHODS: In this prospective multi-centre comparative observational non-randomized rater-blinded study, 135 children (48 homoeopathy, 87 conventional with mild to moderate atopic eczema were included by their respective physicians. Depending on the specialisation of the physician, the primary treatment was either standard conventional treatment or individualized homeopathy as delivered in routine medical care. The main outcome was the SCORAD (SCORing Atopic Dermatitis at 36 months by a blinded rater. Further outcomes included quality of life, conventional medicine consumption, safety and disease related costs at six, 12 and 36 months after baseline. A multilevel ANCOVA was used, with physician as random effect and the following fixed effects: age, gender, baseline value, severity score, social class and parents' expectation. RESULTS: The adjusted mean SCORAD showed no significant differences between the groups at 36 months (13.7 95% CI [7.9-19.5] vs. 14.9 [10.4-19.4], p = 0.741. The SCORAD response rates at 36 months were similar in both groups (33% response: homoeopathic 63.9% vs. conventional 64.5%, p = 0.94; 50% response: 52.0% vs. 52.3%, p = 0.974. Total costs were higher in the homoeopathic versus the conventional group (months 31-36 200.54 Euro [132.33-268.76] vs. 68.86 Euro [9.13-128.58], p = 0.005. CONCLUSIONS: Taking patient preferences into account, while being unable to rule out residual confounding, in this long-term observational study, the effects of homoeopathic treatment were not superior to conventional treatment for children with mild to moderate atopic eczema, but involved higher costs.

  12. The OPERA trial - comparison of early nasal high flow oxygen therapy with standard care for prevention of postoperative hypoxemia after abdominal surgery: study protocol for a multicenter randomized controlled trial.

    Science.gov (United States)

    Futier, Emmanuel; Paugam-Burtz, Catherine; Constantin, Jean-Michel; Pereira, Bruno; Jaber, Samir

    2013-10-18

    Respiratory support following postoperative extubation is of major importance to prevent hypoxemia and subsequent respiratory failure and reintubation. High-flow nasal cannula oxygen (HFNC) delivers a flow-dependent positive airway pressure and improves oxygenation by increasing end-expiratory lung volume. Whether application of HFNC may have therapeutic advantages over conventional oxygen therapy for respiratory support in the early postextubation surgical period remains to be established. The Optiflow for prevention of post-extubation hypoxemia after abdominal surgery (OPERA) trial is an investigator-initiated multicenter randomized controlled two-arm trial with assessor-blinded outcome assessment, randomizing 220 patients with intermediate to high risk of pulmonary complications after abdominal surgery to receive HFNC or conventional oxygen therapy following extubation, stratified by the presence of epidural analgesia and center. The primary outcome measure is the percentage of patients with postoperative hypoxemia one hour after tracheal extubation. Secondary outcome measures are postoperative pulmonary complications, need for noninvasive ventilation and intubation for respiratory failure. The OPERA trial is the first randomized controlled study powered to investigate whether early application of HFNC following extubation after abdominal surgery prevents against postoperative hypoxemia and pulmonary complications. ClinicalTrials.gov Identifier: NCT01887015.

  13. Postoperative nutrition practices in abdominal surgery patients in a tertiary referral hospital Intensive Care Unit: A prospective analysis

    Directory of Open Access Journals (Sweden)

    Tejaswini Arunachala Murthy

    2016-01-01

    Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.

  14. 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

    Science.gov (United States)

    Huirne, Judith AF; Bouwsma, Esther VA; van Dongen, Johanna M; Terwee, Caroline B; van de Ven, Peter M; den Bakker, Chantal M; van der Meij, Suzan; van Baal, W Marchien; Leclercq, Wouter KG; Geomini, Peggy MAJ; Consten, Esther CJ; Schraffordt Koops, Steven E; van Kesteren, Paul JM; Stockmann, Hein BAC; ten Cate, A Dorien; Davids, Paul HP; Scholten, Petrus C; van den Heuvel, Baukje; Schaafsma, Frederieke G; Meijerink, Wilhelmus JHJ; Bonjer, H Jaap; Anema, Johannes 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, return to normal activities and work after surgery is hampered, leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption. Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures, leading to accelerated recovery and to a reduction in costs in comparison to usual care. Methods This is a multicenter randomized, single-blinded, controlled trial. At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy, inguinal hernia surgery, or laparoscopic adnexal surgery for a benign indication will be included. Patients will be randomized to an intervention or control group. The intervention group will have access to an innovative, perioperative eHealth care program. This intervention program consists of a website, mobile phone app, and activity tracker. It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery. The control group will receive usual care and will have access to a nonintervention (standard) website consisting of the digital information brochure about the surgical procedure being performed. Patients are asked to complete questionnaires at 5 moments during the first 6 months after surgery. The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning item bank version 1.2. Secondary outcomes include social

  15. [Postoperative medical icterus].

    Science.gov (United States)

    Cerf, M

    1978-06-01

    The onset of jaundice following a surgical operation sometimes raises difficult problems. It is rarely due to hemolysis, infective hepatitis or decomposated cirrhosis of the liver. One should seek as a routine hepatitis due to halotane. However the most frequent cause is "benign postoperative cholestasis". This variety of jaundice presents in the form of an icterus due to conjugated bilirubine with often a large increase in alkaline phosphatase levels. The ocurse is variable. Almost always due to severe surgical or septic trauma, accompanied by shock and/or anoxia, it raises difficult diagnostic problems. The clinical and physiopathological aspects of benign postoperative cholestasis are recalled. One should remember, above all, that this is not an autonomous clinical entity but the sign of local or general complications which should be sought carefully.

  16. Nursing care of 1 cases of laryngeal carcinoma complicated with postoperative pharyngealfistula%1例喉癌术后并发咽瘘的护理

    Institute of Scientific and Technical Information of China (English)

    蒋艳兰

    2015-01-01

    The pharyngeal fistula refers to saliva storage in subcutaneous incision tissue, the formation of abscess cavity ulceration to skin incision, the hypopharyngeal and esophagealcavity is communicated with the skin into the sinus road, and saliva or food through the sinusto the skin to overflow, skin fistula formation, is one of the complications after total laryngectomy in laryngeal carcinoma. to make the patients get better treatment effect, the need for patient characteristics, well care of the. in this paper, combined with specific cases,how to care for the postoperative laryngeal fistula patients, to provide references for practice.%咽瘘是指唾液贮积于皮下切口下组织,形成脓腔破溃至皮肤切口,使下咽、食管腔与皮肤相通成窦道路,并且唾液或食物经此窦道向皮肤外溢,形成皮肤瘘,是喉癌全喉切除术后并发症之一。要想使此类患者得到更好的治疗效果,需要针对患者的特点,对其进行精心的护理。本文结合具体病例,简述如何对喉癌术后并发咽瘘患者进行护理,以期为实践提供参考依据。

  17. Institutional Care of Children in Low- and Middle-Income Settings: Challenging the Conventional Wisdom of Oliver Twist

    OpenAIRE

    Braitstein, Paula

    2015-01-01

    Whether institutions or extended families are better suited to care for orphans depends on the specific circumstances. Reported rates of traumatic experiences among orphans and vulnerable children are high in both institutions and extended families; improving the quality of care for such children should be the paramount priority in all settings.

  18. Effects of Social Reinforcement Contingent on Conventional or Unconventional Responses on Generalized Creativity by Older Adults in Residential Care

    Science.gov (United States)

    Polenick, Courtney Allyn; Flora, Stephen Ray

    2012-01-01

    The effects of social praise contingent on either usual (conventional) or unusual (unconventional) responses during an object uses task were assessed on measures of generalized creativity in two novel, unrelated tasks. Participants were 20 older adults, ages 63 to 89 years (M = 80.90), who were recruited from a joint skilled nursing and assisted…

  19. Cuidados imediatos no pós-operatório de cirurgia cardíaca Immediate post-operative care following cardiac surgery

    Directory of Open Access Journals (Sweden)

    Paulo Ramos David João

    2003-11-01

    center for Cardiology and Heart Surgery in the state of Paraná and neighboring states. The improvement of conditions for diagnosis, training of the clinical and surgical teams, better equipped ICU with more modern monitoring, training of ICU personnel from all areas to handle the post-operative requirements of patients submitted to heart surgery, an adequate hospital structure with advanced care in all pediatric and paramedic specialties have resulted in marked improvement in relation to previous years in terms of the results of surgical interventions in children with congenital or acquired heart disease, especially newborns and young babies with complex heart problems. CONCLUSION: Children with heart diseases, especially complex conditions, should be receive care at reference centers that can provide global care before, during and after the surgery.

  20. 延伸性护理对子宫内膜癌患者术后生存质量的影响%Effect of extended nursing care on the postoperative quality of life of patients with endometrial cancer

    Institute of Scientific and Technical Information of China (English)

    董秀梅; 张庆梅

    2012-01-01

    To discuss the effect of extended nursing care on the; postoperative quality of life; of patients with endometrial cancer. Methods: 80 patients were randomly divided into an observation group ( n = 45) and a control group ( n = 35 ). The conventional discharge health education was conducted by the traditional nursing mode in the control group and the extended nursing intervention was continuously given to the patients after discharge in the observation group. The questionnaire survey was conducted to understand the demands of patients and their families for nursing care; after discharge;, and the corresponding extended nursing program was formulated by analyzing patients'conditions and the factors influencing their postoperative;quaiality of life;. The; euality of life; se-ale; maede; by European Organization for Research and Treatment of cancer [ EORTC - C30 ( V3. 0 ) ] was used to evaluate the; quality of life; of the; patients in both groups at discharge; and 6 months after discharge;. Re;sults: The; scores of somatic function, role; function, cognitive; function, social function , ge;ne;ral he;aith status, pain, nause;a and vomiting of the; patie;nts we;re; be;tte;r and lower in the; obse;rvation group than the; control group 6 months after discharge (P<0.05). Conclusion: The; quality of life; of patients with e;nelome;trial caneel is positively correlated to the; implementation of e;xte;nele;el nursing program.%目的:探讨延伸性护理对子宫内膜癌患者术后生存质量的影响.方法:将80例患者随机分为观察组45例和对照组35例,对照组患者采用传统护理服务模式进行常规出院宣教,观察组患者出院后接受延伸性护理干预.采用问卷调查法了解患者及家属出院后的护理需求,并根据患者病情分析影响其术后生存质量的诸多因素,制订相应的延伸性护理计划.采用欧洲研究治疗组织癌症患者生存质量测定量表\\[EORTC-C30(V3.0)\\]测评两

  1. Management of recurrent postoperative fungal endophthalmitis

    Directory of Open Access Journals (Sweden)

    Anand Vinekar

    2014-01-01

    Full Text Available Aim: To report the management of recurrent postoperative fungal endophthalmitis (POFE after failed pars plana vitrectomy (PPV and antifungal therapy. Settings and Design: Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series. Materials and Methods: Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ′Anatomical success′ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ′Functional success′ was defined as an attached retina and a best corrected visual acuity of better than 20/400. Results: Of the six cases of POFE, five were culture positive [Aspergillus flavus (1, Aspergillus fumigatus (2, Candida albicans (1 and Candida glabrata (1] and one was smear positive for yeast. All recurred (mean recurrences, 4 despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re - PPV (median follow-up, 37 months. Pre-study defined criteria for successful ′anatomical′ and ′functional′ outcomes were achieved in 83.3% and 50% respectively. Conclusion: This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.

  2. A new ball game: the United Nations Convention on the Rights of Persons with Disabilities and assumptions in care for people with dementia.

    Science.gov (United States)

    Smith, Anita; Sullivan, Danny

    2012-09-01

    The United Nations Convention on the Rights of Persons with Disabilities is a powerful international instrument which imposes significant responsibilities on signatories. This column discusses changes in the definition of legal capacity which will have significant impacts on decision-making related to people with dementia. Various restrictions and limitations on personal freedoms are discussed in light of the Convention. The main focus is on challenges to existing paradigms of substitute decision-making, which are in wide use through a guardianship model. Under Art 12 of the Convention, moves to supported decision-making will result in significant changes in ensuring the rights of people with dementia. There are challenges ahead in implementing supported decision-making schemes, not only due to tension with existing practices and legislation, but also the difficulty of developing and resourcing workable schemes. This is particularly so with advanced dementia, which is acknowledged as a pressing issue for Australia due to effective health care, an ageing population and changing expectations.

  3. 126例漏斗胸患儿胸腔镜辅助行Nuss手术的术后护理%Postoperative care of 126 children with pectus excavatum receiving Nuss procedure with thoracoscope

    Institute of Scientific and Technical Information of China (English)

    诸纪华; 李忠丽; 朱红梅

    2012-01-01

    This paper introduces the nursing care of 126 children with pectus excavatum after Nuss procedure with thoracoscope. The key points in nursing were intensive observation of illness condition,early detection and treatment of postoperative complications such as pneumothorax and pleura] effusion,postoperative pain management,respiratory care,instruction on rehabilitation training and discharge education. All the children underwent Nuss procedure successfully without severe postoperative complications. Three cases underwent secondary Nuss procedure and the other patients recovered well within the six months to two years of follow-up period.%报告了126例漏斗胸患儿在胸腔镜辅助下行Nuss手术的术后护理.护理重点包括:严密观察病情,及早发现和处理气胸、胸腔积液等并发症,做好疼痛管理、呼吸道护理,正确指导患儿进行康复训练,并做好出院宣教,以防支架移位.本组均顺利完成手术,无严重并发症发生.随访6个月至2年,除3例行二次Nuss术外,其余漏斗胸畸形矫治满意.

  4. Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance.

    Science.gov (United States)

    Rouhe, Hanna; Salmela-Aro, Katariina; Toivanen, Riikka; Tokola, Maiju; Halmesmäki, Erja; Saisto, Terhi

    2015-05-01

    Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. Randomized controlled trial. A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester. Finland, data from obstetrical patient records and questionnaires. Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand (n = 240). All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005). Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Recovery room nurses' knowledge regarding postoperative airway ...

    African Journals Online (AJOL)

    Adele

    patients. Aim: To determine the knowledge of recovery room nurses regarding postoperative airway emergencies in adult patients in private hospitals ..... sia nursing care, as well as current research findings and new technologies in this field.

  6. Cuidados intensivos para pacientes em pós-operatório de cirurgia bariátrica Intensive care of postoperative patients in bariatric surgery

    Directory of Open Access Journals (Sweden)

    Giselle Domingues Sanches

    2007-06-01

    surgeries has raised the number of obese patients in the ICU. It is important to know the physiopathology of obesity and to treat its particularities during the postoperative care. Such as pulmonary restriction, that causes an increase in pulmonary complications, coronary artery disease and thromboembolic events. CONCLUSIONS: The number of patients that undergo to bariatric surgery has increased; therefore, the number of obese patients in the ICU has also risen. Different physiological events and complications in obese patients are challenges to clinical practice. The knowledge of obese physiopathology helps in the managing routine procedures and complications after bariatric surgery.

  7. Unsatisfactory rate in liquid-based cervical samples as compared to conventional smears: A study from tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Nalini Gupta

    2016-01-01

    Full Text Available Background: Developed countries adopted liquid-based cytology (LBC cervical cytology, partly because of its lower proportions of unsatisfactory (U/S/inadequate samples. This study was carried out to evaluate effect on the rate of U/S samples after introduction of LBC in our laboratory. Materials and Methods: An audit of U/S cervical samples was performed, which included split samples (n = 1000, only conventional Pap smear (CPS smears (n = 1000, and only LBC samples (n = 1000. The smears were reviewed by two observers independently, and adequacy for the samples was assessed as per The Bethesda System 2001. The reasons for U/S rate in split samples were categorized into various cytologic and/or technical reasons. Results: U/S rate was far less in only LBC samples (1.2% as compared to only CPS (10.5% cases. Cases in the satisfactory but limited category were also less in only LBC (0.4% as compared to only CPS (3.2% samples. The main reasons for U/S smears in split samples were low cell count (37.2% in CPS; 58.8% in LBC. The second main reason was low cellularity with excess blood and only excess blood in CPS samples. Conclusion: There was a significant reduction of U/S rate in LBC samples as compared to CPS samples, and the difference was statistically significant. The main cause of U/S samples in LBC was low cellularity indicating a technical fault in sample collection. The main cause of U/S rate in CPS was low cellularity followed by low cellularity with excess blood. Adequate training of sample takers and cytologists for the precise cell count to determine adequacy in smears can be of great help in reducing U/S rate.

  8. Unsatisfactory rate in liquid-based cervical samples as compared to conventional smears: A study from tertiary care hospital

    Science.gov (United States)

    Gupta, Nalini; Bhar, Vikrant S.; Rajwanshi, Arvind; Suri, Vanita

    2016-01-01

    Background: Developed countries adopted liquid-based cytology (LBC) cervical cytology, partly because of its lower proportions of unsatisfactory (U/S)/inadequate samples. This study was carried out to evaluate effect on the rate of U/S samples after introduction of LBC in our laboratory. Materials and Methods: An audit of U/S cervical samples was performed, which included split samples (n = 1000), only conventional Pap smear (CPS) smears (n = 1000), and only LBC samples (n = 1000). The smears were reviewed by two observers independently, and adequacy for the samples was assessed as per The Bethesda System 2001. The reasons for U/S rate in split samples were categorized into various cytologic and/or technical reasons. Results: U/S rate was far less in only LBC samples (1.2%) as compared to only CPS (10.5%) cases. Cases in the satisfactory but limited category were also less in only LBC (0.4%) as compared to only CPS (3.2%) samples. The main reasons for U/S smears in split samples were low cell count (37.2% in CPS; 58.8% in LBC). The second main reason was low cellularity with excess blood and only excess blood in CPS samples. Conclusion: There was a significant reduction of U/S rate in LBC samples as compared to CPS samples, and the difference was statistically significant. The main cause of U/S samples in LBC was low cellularity indicating a technical fault in sample collection. The main cause of U/S rate in CPS was low cellularity followed by low cellularity with excess blood. Adequate training of sample takers and cytologists for the precise cell count to determine adequacy in smears can be of great help in reducing U/S rate. PMID:27382408

  9. Post-operative urinary retention.

    Science.gov (United States)

    Steggall, Martin; Treacy, Colm; Jones, Mark

    Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

  10. Mental Health Care Bill, 2013 and United Nations Convention on the rights of persons with disability: Do they go hand in hand?

    Directory of Open Access Journals (Sweden)

    Santosh K Chaturvedi

    2015-01-01

    Full Text Available This article is an effort to examine how far the proposed Mental Health Care Bill (MHCB, 2013 addresses the issues raised under the United Nations Convention on the Rights of Persons with Disability (UNCRPD. This was performed by examining different documents and publications related to the proposed MHCB, 2013 and position statements and views expressed by different stakeholders. Although the proposed MHCB, 2013 is far advanced for its time, there are some gaps in its alignment with the UNCRPD. However, the proposed Rights of Persons with Disability Bill (RPWDB, 2014 addresses many of the issues pertaining to the UNCRPD. Thus, the essence of the UNCRPD is covered jointly by the MHCB, 2013 and the RPWDB, 2014.

  11. EFFICACY OF HYOSCINE BUTYL BROMIDE SUPPOSITORY FOR POSTOPERATIVE PAIN RELIEF

    National Research Council Canada - National Science Library

    Soniya C. Alphonse; Acka Priya Varghese

    2017-01-01

    .... MATERIALS AND METHODS The study is a prospective randomized controlled study conducted at a tertiary care hospital to study the effect of Hyoscine Butyl Bromide Suppositories for postoperative...

  12. Additive Complex Ayurvedic Treatment in Patients with Fibromyalgia Syndrome Compared to Conventional Standard Care Alone: A Nonrandomized Controlled Clinical Pilot Study (KAFA Trial

    Directory of Open Access Journals (Sweden)

    Christian S. Kessler

    2013-01-01

    Full Text Available Background. Fibromyalgia (FMS is a challenging condition for health care systems worldwide. Only limited trial data is available for FMS for outcomes of complex treatment interventions of complementary and integrative (CIM approaches. Methods. We conducted a controlled, nonrandomized feasibility study that compared outcomes in 21 patients treated with Ayurveda with those of 11 patients treated with a conventional approach at the end of a two-week inpatient hospital stay. Primary outcome was the impact of fibromyalgia on patients as assessed by the FIQ. Secondary outcomes included scores of pain intensity, pain perception, depression, anxiety, and quality of sleep. Follow-up assessments were done after 6 months. Results. At 2 weeks, there were comparable and significant improvements in the FIQ and for most of secondary outcomes in both groups with no significant in-between-group differences. The beneficial effects for both treatment groups were partly maintained for the main outcome and a number of secondary outcomes at the 6-month followup, again with no significant in-between-group differences. Discussion. The findings of this feasibility study suggest that Ayurvedic therapy is noninferior to conventional treatment in patients with severe FMS. Since Ayurveda was only used as add-on treatment, RCTs on Ayurveda alone are warranted to increase model validity. This trial is registered with NCT01389336.

  13. Prevention of postoperative ileus

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammato...

  14. 胃癌术后肠内营养支持治疗的护理%Gastric Cancer Postoperative Enteral Nutrition Support Nursing Care

    Institute of Scientific and Technical Information of China (English)

    房孝红

    2014-01-01

    Objective To explore the postoperative patients with gastric cancer. Methods The complications of enteral nutrition in patients with the implementation of 54 cases of postoperative gastric cancer and given the prevention and nursing measures. Results The early postoperative enteral nutrition in patients with mild abdominal pain occurred in 8 cases, abdominal distension, diarrhea, 3 cases of nausea, vomiting, plugging in 2 cases, and regurgitation in 1 case. Conclusion In patients with gastric cancer early enteral nutrition support is safe, ef ective way of nutritional support after operation.%目的探讨胃癌术后早期肠内营养支持治疗的护理及并发症的预防。方法对54例胃癌术后实施肠内营养的患者观察其并发症的发生并给予相应的预防和护理措施。结果术后早期肠内营养的患者发生轻度腹痛、腹胀、腹泻8例,恶心、呕吐3例,堵管2例,返流1例,所有患者经过对症处理,并发症得到了解决,无吻合口瘘、腹膜炎发生,肠内营养顺利进行。结论胃癌患者术后早期肠内营养支持是术后营养支持的安全、有效途径,做好相应的护理,能减少并发症的发生,减轻患者痛苦,降低患者经济负担,使患者尽快恢复健康。

  15. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial).

    Science.gov (United States)

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max; Tobias, Jeffrey S; Joseph, David J; Saunders, Christobel; Brew-Graves, Chris; Potyka, Ingrid; Morris, Stephen; Vaidya, Hrisheekesh J; Williams, Norman R; Baum, Michael

    2016-01-01

    BACKGROUND Based on our laboratory work and clinical trials we hypothesised that radiotherapy after lumpectomy for breast cancer could be restricted to the tumour bed. In collaboration with the industry we developed a new radiotherapy device and a new surgical operation for delivering single-dose radiation to the tumour bed - the tissues at highest risk of local recurrence. We named it TARGeted Intraoperative radioTherapy (TARGIT). From 1998 we confirmed its feasibility and safety in pilot studies. OBJECTIVE To compare TARGIT within a risk-adapted approach with whole-breast external beam radiotherapy (EBRT) over several weeks. DESIGN The TARGeted Intraoperative radioTherapy Alone (TARGIT-A) trial was a pragmatic, prospective, international, multicentre, non-inferiority, non-blinded, randomised (1 : 1 ratio) clinical trial. Originally, randomisation occurred before initial lumpectomy (prepathology) and, if allocated TARGIT, the patient received it during the lumpectomy. Subsequently, the postpathology stratum was added in which randomisation occurred after initial lumpectomy, allowing potentially easier logistics and a more stringent case selection, but which needed a reoperation to reopen the wound to give TARGIT as a delayed procedure. The risk-adapted approach meant that, in the experimental arm, if pre-specified unsuspected adverse factors were found postoperatively after receiving TARGIT, EBRT was recommended. Pragmatically, this reflected how TARGIT would be practised in the real world. SETTING Thirty-three centres in 11 countries. PARTICIPANTS Women who were aged ≥ 45 years with unifocal invasive ductal carcinoma preferably ≤ 3.5 cm in size. INTERVENTIONS TARGIT within a risk-adapted approach and whole-breast EBRT. MAIN OUTCOME MEASURES The primary outcome measure was absolute difference in local recurrence, with a non-inferiority margin of 2.5%. Secondary outcome measures included toxicity and breast cancer-specific and non

  16. Seeking Help for Mental Health Problems Outside the Conventional Health Care System: Results From the European Study of the Epidemiology of Mental Disorders (ESEMeD)

    Science.gov (United States)

    Sevilla-Dedieu, Christine; Kovess-Masféty, Viviane; Haro, Josep Maria; Fernández, Anna; Vilagut, Gemma; Alonso, Jordi

    2014-01-01

    Objective In certain countries, it is not uncommon to turn to professionals outside the conventional health care system for psychological problems. As this situation is not well documented in Europe, we assessed use of nonconventional care for mental health in 6 European countries. Method A cross-sectional survey was conducted in representative samples of, noninstitutionalized adults in 6 European countries. Participants (n = 8796) completed a survey, which included, among other items, the Composite International Diagnostic Interview 3.0 and in-depth questions about lifetime consultations for mental health problems. Results Among the respondents (n = 2928) who reported having already sought help in their lifetime for psychological problems (20.0%), 8.6% turned to complementary and alternative medicine (CAM) providers, such as chiropractors and herbalists, and a similar proportion (8.4%) to religious advisers such as ministers, priests, or rabbis. Only a small proportion (2.9%) consulted only these professionals for their problems. CAM providers were more frequently used in the Netherlands (13.5%) and Germany (9.4%), while religious advisers were more often consulted in Italy (12.6%) and Germany (11.6%). Multivariate analyses confirmed differences between countries and revealed that people turning to religious advisers tended to be older, foreign born, and with alcohol problems, whereas those consulting CAM providers were younger, wealthier, and more frequently depressed. Conclusions In Europe, patients who turn to CAM therapists and those who seek help from religious advisers for psychological problems are not exactly the same. In addition, these professionals are not consulted frequently in most countries, and are almost always associated with more traditional follow-up when used. PMID:20840806

  17. [The Convention on the Rights of the Child in Action: the Hospital Garrahan's experience through mainstreaming the rights approach into health care].

    Science.gov (United States)

    Schön, Andrea; Hammermüller, Erica; Di Tommaso, Viviana; Bagari, Gabriela

    2015-06-01

    Daily practice shows the lack of knowledge that health workers have about child rights, in terms of learning about local and international regulations and frameworks, as well as the persistence of paternalistic attitudes towards children and adolescents that attend health care services. The Convention on the Rights of the Child founded a new paradigm to consider the child as a subject of rights. To report the experience of professional training for the mainstreaming of child rights in the Hospital J. P. Garrahan. Courses for all areas of the institution were implemented. Teaching procedures and assessment criteria were defined through the formulation and implementation of projects, interdisciplinary work, professional accreditation and progressive institutionalization. Five training courses were held since 2009. 201 students were enrolled, 50.2% of which finished. The level of satisfaction with the proposal in terms of knowledge and expectations showed satisfactory results. The challenges and opportunities in the implementation are discussed. Incorporating the human rights approach implies an institution cultural change. The continuing education in the rights of children will contribute to achieving this goal.

  18. Gastric tube reconstruction by laparoscopy-assisted surgery attenuates postoperative systemic inflammatory response after esophagectomy for esophageal cancer.

    Science.gov (United States)

    Tsujimoto, Hironori; Ono, Satoshi; Sugasawa, Hidekazu; Ichikura, Takashi; Yamamoto, Junji; Hase, Kazuo

    2010-12-01

    Conventional open procedures have been supplanted in part by less invasive approaches, such as laparoscopic surgery developed for treating gastrointestinal malignancies. However, it is unclear whether laparoscopy-assisted gastric tube reconstruction (LAGT) can attenuate the postoperative systemic inflammatory response after esophagectomy for esophageal cancer. We investigated the postoperative clinical course of the systemic inflammatory response syndrome (SIRS) in patients who underwent an esophagectomy for esophageal cancer by LAGT (LAGT group) and gastric tube reconstruction by conventional open surgery (Open group). Compared with the Open group, the LAGT group had a significantly shorter operative time (539.6 min vs. 639.8 min), shorter duration of postoperative mechanical ventilation (1.1 days vs. 2.8 days), and shorter length of stay in the intensive care unit (2.1 days vs. 4.4 days). The LAGT group also had a significantly shorter SIRS duration (1.4 days vs. 2.7 days), a significantly lower incidence of SIRS, and a smaller number of positive SIRS criteria. Throughout the investigation period, the postoperative white blood cell count was lower in the LAGT group than in the Open group. Additionally, in the LAGT group, the heart rate was lower on each postoperative day (POD), and the respiratory rate was significantly lower on postoperative days (PODs) 1 and 4. There was no difference in postoperative oxygenation, morbidity, and mortality between the groups. The C-reactive protein level on PODs 3 and 4 was significantly lower in the LAGT group than in the Open group. Laparoscopy-assisted gastric tube reconstruction significantly attenuates postoperative SIRS, and it is therefore a potentially less invasive surgical procedure.

  19. Minimally invasive compared to conventional approach for coronary artery bypass grafting improves outcome

    Directory of Open Access Journals (Sweden)

    Jitumoni Baishya

    2017-01-01

    Full Text Available Introduction: Minimally invasive (MI cardiac surgery is a rapidly gaining popularity, globally as well as in India. We aimed to compare the outcome of MI to the conventional approach for coronary artery bypass graft (CABG surgery. Methods: This prospective, comparative study was conducted at a tertiary care cardiac surgical center. All patients who underwent CABG surgery via MI approach (MI group from July 2015 to December 2015 were enrolled and were compared against same number of EuroSCORE II matched patients undergoing CABG through conventional mid-sternotomy approach (CON group. Demographic, intra- and post-operative variables were collected. Results: In MI group, duration of the surgery was significantly longer (P = 0.029. Intraoperative blood loss lesser (P = 0.002, shorter duration of ventilation (P = 0.002, shorter Intensive Care Unit stay (P = 0.004, shorter hospital stay (P = 0.003, lesser postoperative analgesic requirements (P = 0.027, and lower visual analog scale scores on day of surgery (P = 0.032 and 1 st postoperative day (P = 0.025. No significant difference in postoperative blood loss, blood transfusion, or duration of inotrope requirement observed. There was no conversion to mid-sternotomy in any patients, 8% of patients had desaturation intraoperatively. There was no operative mortality. Conclusion: MI surgery is associated with lesser intraoperative blood loss, better analgesia, and faster recovery.

  20. Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Bhanu P. Kolasani

    2016-12-01

    Full Text Available Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute. Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed. Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52% were the most commonly prescribed category followed by analgesics (19.60% and Intravenous fluids (13.53%. Metronidazole (27.02% was the most commonly prescribed antimicrobial, Diclofenac (68.04% was the commonly prescribed analgesics and Ringer lactate (38.81% was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%, antiemetic was Ondansetron (76.39%. Majority of drugs (72.54% were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM was 82.16%. Injection (57.78% was the most common drug formulation. Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial

  1. Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan

    NARCIS (Netherlands)

    El Baz, Noha; Middel, Berrie; van Dijk, Jitse P.; Boonstra, Piet W.; Reijneveld, Sijmen A.

    2009-01-01

    The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass

  2. Similar clinical outcome after unicompartmental knee arthroplasty using a conventional or accelerated care program: a randomized, controlled study of 40 patients

    DEFF Research Database (Denmark)

    Borgwardt, Lotte; Zerahn, Bo; Bliddal, Henning

    2009-01-01

    . Patients in the A program were treated with NSAID and paracetamol postoperatively. Opiates were used in both groups in the case of breakthrough pain. The patients were considered ready for discharge when they were able to climb stairs to the second floor within 5 min. RESULTS: The median length of stay...

  3. Chronic Postoperative Roseomonas Endophthalmitis▿

    OpenAIRE

    Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; WU, WEI-CHI; CHEN, TUN-LU

    2008-01-01

    We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

  4. Chronic postoperative Roseomonas endophthalmitis.

    Science.gov (United States)

    Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; Wu, Wei-Chi; Chen, Tun-Lu

    2009-01-01

    We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

  5. Mechanisms of postoperative pain

    Institute of Scientific and Technical Information of China (English)

    YUE Yun

    2007-01-01

    @@ The practice of modern anaesthesiology has extended into perioperative medicine. Due to their expertise in analgesic drug pharmacology and peripheral nerve blocking, anaesthesiologists have pioneered in the management of acute postoperative pain. Effective postoperative analgesia reduces the incidence of postoperative chronic pain, improves the functioning of organs following surgery and shortens the hospital stay.1,2 Although a variety of analgesic techniques and preventative approaches are at the disposal of modem aneasthesiologists, including patient controlled epidural analgesia (PCEA), patient controlled intravenous analgesia, multimodal analgesia and pre-empty analgesia.Despite this array of strategies, these predominantly opioid based techniques are still limited by side-effects such as vomiting, nausea, itching and urinary retention.To optimize further the management of acute postoperative pain, basic mechanisms of postoperative pain must be explored and new treatments must continue to be developed.

  6. [Characteristics of postoperative peritonitis].

    Science.gov (United States)

    Lock, J F; Eckmann, C; Germer, C-T

    2016-01-01

    Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

  7. [Postoperative biliary peritonitis].

    Science.gov (United States)

    Kurbonov, K M; Daminova, N M; Mukhiddinov, N D

    2008-01-01

    An analysis of results of surgical treatment of 91 patients with postoperative biliary peritonitis has shown that frequency of postoperative biliary peritonitis depended on the volume and character of operative interventions, as well as on technical errors made at the preoperative period and during operation. The presence of latent hepatic insufficiency made for the development of polyorganic insufficiency, had negative influence on the course of the disease and might be one of the causes of high postoperative lethality (up to 23.1%) in this category of patients.

  8. Coronary artery bypass graft (CABG) surgery patients in a clinical pathway gained less in health-related quality of life as compared with patients who undergo CABG in a conventional-care plan.

    Science.gov (United States)

    El Baz, Noha; Middel, Berrie; van Dijk, Jitse P; Boonstra, Piet W; Reijneveld, Sijmen A

    2009-06-01

    The aim of this study is to determine the difference between clinical pathway (CP) and conventional care in terms of health-related quality of life (HRQoL) domains, depression and anxiety, as well as to determine the relative contribution of CP towards an improved HRQoL after coronary artery bypass graft (CABG). A longitudinal quasi-experimental pre-test/post-test design was used to study and compare clinical outcome, HRQoL depression and anxiety for CP versus conventional-care patients after CABG. HRQoL was measured by using Sf-36, while depression and anxiety were measured by using hospital anxiety and depression scale. Length of stay and patient complications were derived from the hospital database. We found that implementing a CP decreased hospital delay from 2.50 (+/-7.19) to 1.80 (+/-1.60), which was statistically significant P = 0.002. We also found that patients in the conventional-care plan improved more than patients in the CP in HRQoL. Outcomes in favour of patients in the conventional-care trajectory were based on the difference between small effect sizes (ES) (> or =0.20 or =0.50 0.80). The aim of designing and implementing pathways is to decrease length of stay and costs, while maintaining quality of care and improving patient outcomes. Our findings suggest that these aims were not fulfilled in this CABG pathway. We recommend that when designing a CP, all patient-related characteristics, risk indicators, along with physiological status, be taken into consideration.

  9. Impact of post-operative radiation on coronary arteries in patients of early breast cancer: A pilot dosimetric study from a tertiary cancer care center from India

    Directory of Open Access Journals (Sweden)

    S Roy

    2015-01-01

    Full Text Available Background: The significant impact of postoperative radiotherapy (PORT on cardiac morbidity in patients of early breast cancer (EBC undergoing breast-conserving surgery has been shown in different studies. The present study was conducted to assess the impact of surgery and the side of involvement on radiation dose to left anterior descending artery (LAD and Left circumflex coronary artery (LCx. Materials And Methods: Totally, 58 patients of EBC were randomly chosen for this dosimetric study and planned with tangential field technique without intensity modulation (IM. Heart, LAD, and LCx (n = 55 were contoured. Dose volume histograms were analyzed to determine the Dmax (maximum dose and Dmean (mean dose of LAD and LCx. Student's t-test was used for comparative analysis of the means. Results: The mean Dmax of LAD for left (L EBC was 3.17 Gray (Gy while for right (R EBC it was 0.86 Gy (P = 0.007; 95% C.I, 1.14–3.48. The mean Dmean of LAD for L-EBC and R-EBC were 1.97 Gy and 0.79 Gy, respectively (P = 0.029; 95% C.I, 0.77–1.60. The mean-Dmax of LCx for patients with L-EBC (2.9 Gy; range: 1.2–4.35 Gy was statistically higher than that for R-EBC (1.3 Gy; range: 0.7–3.2 Gy (P = 0.045. The mean-Dmean of LCx for L-EBC (2.1 Gy; range: 0.6–3.6 Gy was also significantly higher than that of L-EBC (0.9 Gy; range: 0.7–2.1 Gy (P = 0.03. There was no significant impact of the pattern of surgery on LAD dose, but significance was noted for LCx dose parameters (P = 0.04 and 0.08 for m-Dmax and m-Dmean of LCx. Conclusion: This pilot dosimetric study confirms the assumption that patients with left-sided EBC are at higher risk of developing long-term cardiac morbidity when treated with PORT due to increased dose to LAD.

  10. Postoperative peritoneale adhaerencer

    DEFF Research Database (Denmark)

    Jendresen, Marianne Bille; Qvist, Niels

    2008-01-01

    Postoperative adhesions occur after most surgical intraabdominal procedures, and small bowel obstruction is a common complication. Research has focused on the pathophysiology of adhesion formation and on the development of prophylactic barriers and drugs. The present paper provides a resume...

  11. Clinical nursing path after endoscopic submucosal dissection reduces the risk of postoperative complications

    Institute of Scientific and Technical Information of China (English)

    Xia Bai; Jun-Ping Wang; Lan Ming; Ya-Jie Xu; Xia Sun

    2016-01-01

    Objective: To investigate the effect of the nursing path on postoperative complications after endoscopic submucosal dissection (ESD). Method: Patients' nursing paths for ESD were established based on a systematic analysis of relevant literature, previous clinical procedures and consultation with chief physicians from a gastroenterology department. Forty patients were divided into the observation or control group and were assigned to follow the nursing path or the conventional path after an ESD, respectively. Next, the incidence of postoperative complications of these two groups was measured, primarily assessing the occurrences of bleeding, perforation, infection, and anxiety. Results: The incidence of complications after ESD in the observation group was remarkably lower than that of the control group (P Conclusion: The nursing path for ESD has a positive role in reducing certain frequent complications that occur after ESD, particularly infection and anxiety;in addition, the nursing path optimizes nursing care in patients with gastrointestinal stromal tumor.

  12. 小儿先天性心脏病体外循环的术后护理%Postoperative Nursing Care for Children With Congenital Heart Disease After Extracorporeal Circulation

    Institute of Scientific and Technical Information of China (English)

    杨敏

    2015-01-01

    Objective To observe the effect of postoperative nursing care of children with congenital heart disease after extracorporeal circulation. Methods 200 cases of children with congenital heart disease patients in our hospital adopt the postoperative nursing after extracorporeal circulation,observed the complications. Results After surgery nursing,a total of 21 cases appeared complications,mainly include lung infection and secondary intubation,yat Po,etc.,they al recovered after effective nursing measures. Conclusion The nursing method in vitro for heart surgery nursing has very good effect, can reduce the occurrence of complications,improve the effect of surgical treatment.%目的:观察小儿先天性心脏病体外循环的术后护理效果。方法选取我院诊治的小儿先天性心脏病患者200例,全部采用体外循环手术的术后护理方法进行护理,观察患儿出现的并发症情况。结果在手术护理后,共有21例患儿出现了并发症,主要有肺部感染、二次插管、逸博等,采取了有效的措施后得到了很好的恢复。结论采用体外护理方式对于心脏病手术后的护理具有非常好的效果,可以减少并发症的出现,提升手术治疗的效果。

  13. The postoperative stomach

    Energy Technology Data Exchange (ETDEWEB)

    Woodfield, Courtney A. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Levine, Marc S. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)]. E-mail: marc.levine@uphs.upenn.edu

    2005-03-01

    Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients.

  14. Preoperative Alcohol Consumption and Postoperative Complications

    DEFF Research Database (Denmark)

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2013-01-01

    .30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...... complications, prolonged stay at the hospital, and admission to intensive care unit....

  15. 优质护理对减少泌尿外科患者术后泌尿道感染的疗效%Effect of High Quality Nursing Care of Postoperative Urinary Tract Infection in Patients With Reduce Urology

    Institute of Scientific and Technical Information of China (English)

    李晓芬

    2016-01-01

    Objective To study the quality of nursing to reduce the incidence of urinary tract infection after urological surgery patients. Methods In our hospital from January 2014 to May 2015,a total of 264 cases of patients as the research object,were randomly divided into treatment group and control group, respectively,using high quality care and routine nursing care,compared two groups the incidence of urinary tract infection after nursing. Results The experimental group the incidence of urinary tract infection(8.33%)was lower than the control group(27.27%),P < 0.05,the difference was statistical y significant. Conclusion High quality care for urological surgery patients postoperative nursing is beneficial to reduce the incidence of urinary tract infection.%目的:研究优质护理对降低泌尿外科患者术后泌尿道感染发生率的效果。方法以我院2014年1月~2015年5月的患者共264例作为本次的研究对象,随机分为治疗组和对照组,分别使用优质护理和常规护理进行护理,比较护理后两组泌尿道感染的发生率。结果实验组泌尿道感染发生率(8.33%)低于对照组(27.27%),P <0.05,差异具有统计学意义。结论优质护理用于泌尿外科患者的术后护理有利于减少泌尿道感染的发生率。

  16. 非小细胞肺癌术后三维适形放疗与常规放疗结果比较%Comparison of postoperative three-dimensional conformal radiotherapy with conventional radiotherapy for non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    戴洪海; 周宗玫; 张红星; 殷蔚伯; 姬巍; 王绿化; 欧广飞; 梁军; 冯勤付; 肖泽芬; 陈东福; 吕纪马

    2009-01-01

    目的 回顾性比较非小细胞肺癌术后三维适形放疗(3DCRT)和常规放疗的疗效、失败模式及副反应.方法 分析3年余接受术后放疗的ⅠB~ⅢB期非小细胞肺癌患者162例,其中86例采用3DCRT,76例采用常规放疗.结果 总随访率91.5%,3DCRT和常规放疗的中位随访时间分别为29.4个月和33.8个月.3DCRT和常规放疗的1、2、3年无局部进展生存率分别为97.5%、83.2%、83.2%和84.3%、76.0%、65.6%(χ2=5.46,P=0.019),总生存率、无疾病进展生存率和无远转生存率均相似;总局部区域失败率分别为14.5%和33.3%(χ2=7.70 P=0.006),远处转移率两组相似.2~3级放射性肺炎发生率3DCRT显著低于常规放疗(11.6%:23.7% χ2=4.10,P=0.043).结论 术后放疗采用3DCRT技术比常规放疗技术能提高局部控制率,降低放疗相关副反应发生率.%Objective To compare postoperative three-dimensional conformal radiotherapy (3DCRT) and conventional radiotherapy (CR) in patients with non-small-cell lung cancer (NSCLC). Methods From Nov. 2002 to Mar. 2006,162 patients with stage ⅠB~ⅢB NSCLC receiving postoperative radiotherapy in our department were restrospetcively analyzed. Among them,86 received 3DCRT and 76 re-ceived CR. The survival outcome, pattern of failure and treatment-related side effects in both groups were an-alyzed. Results The median follow-up was 29.4 months in the 3DCRT group and 24 months in the CR group. The 1-,2- and 3-year local-regional free survival was 97.5% ,83.2% and 83.2% in 3DCRT group, and 84.3% ,76.0% and 65.6% in CR group(χ2= 5.46, P = 0.019), respectively. No statistically signifi-cant difference was found in the overall survival, disease-free survival or distant metastasis-free survival be-tween the two groups. The local-regional failure rate was statistically different between the two groups (14.5% vs 33.3% ,χ2 =7.70,P =0.006). The incidence of distant metastasis in the two groups was simi-lar. Radiation pneumonitis of NCI

  17. Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications.

    Science.gov (United States)

    Tsujimoto, Hironori; Takahata, Risa; Nomura, Shinsuke; Yaguchi, Yoshihisa; Kumano, Isao; Matsumoto, Yusuke; Yoshida, Kazumichi; Horiguchi, Hiroyuki; Hiraki, Shuichi; Ono, Satoshi; Yamamoto, Junji; Hase, Kazuo

    2012-05-01

    Less invasive operations such as laparoscopic surgery have been developed for treating gastrointestinal malignancies. However, the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS-e) with regard to postoperative morbidity and mortality remains controversial. We investigated the postoperative clinical course of patients who underwent esophagectomy for esophageal cancer in terms of systemic inflammatory response syndrome (SIRS) induced by VATS-e (VATS-e group) or conventional open surgery (OS group) combined with laparoscopic gastric tube reconstruction. Compared with the OS group (n = 27), the VATS-e group (n = 22) had a greater thoracic operation time (VATS-e versus OS, 181 ± 56 vs 143 ± 45 minutes, respectively), and lesser duration of stay in the intensive care unit (17 ± 2 vs 32 ± 21 hours, respectively). The VATS-e group also had a lesser SIRS duration (1.5 vs 4.3 days), a lesser incidence of SIRS, a lesser number of positive SIRS criteria, and lesser serum interleukin-6 levels immediately after operation and on postoperative day (POD) 1. The heart rate in the VATS-e group was less than that in the OS group on POD 3. The respiratory rate in the VATS-e group was significantly less than that in the OS group on PODs 3, 5, and 7. Although no difference was observed in the frequencies of postoperative complications between the 2 groups, the VATS-e group had less postoperative pneumonia. VATS-e attenuates postoperative SIRS, and is therefore a potentially less invasive operative procedure. Copyright © 2012 Mosby, Inc. All rights reserved.

  18. 几丁多糖面膜在激光术后创面护理的临床评价%Clinical analysis with SACCHACHITIN facial masks for postoperative laser care

    Institute of Scientific and Technical Information of China (English)

    栾琪; 孙静; 李强; 刘玲; 王竞; 刘斌; 高天文

    2011-01-01

    Objective To evaluate the clinical effect and safety using SACCHACHITIN facial masks for treating postoperative laser care. Methods By means of a study of half-face control.a total of fifteen subjects received by Er: YAG fractional laser once were treated by SACCHACHITIN facial masks at 0 days,1 days,3 days and 7 days after laser operation, respectively. After treatment, they were followed up to assess the clinical effect and adverse reaction. Results After the treatment of SACCHACHITIN facial masks.the reduction of subjective symptoms and acceleration of wound healing were statistically significant.And no adverse reactions occurred in all subjects. Conclusion The use of SACCHACHITIN facial masks is a safe.effective and very valuable strategy for postoperative laser care.%目的:评价几丁多糖面膜在点阵激光术后创面护理中的临床疗效和安全性.方法:纳入面部行Er:YAG点阵激光治疗后的受试者15例,采用单侧脸自身对照策略,治疗后即刻给予冰几丁多糖面膜冷敷,观察该面膜对激光术后皮肤炎症反应抑制和主观症状缓解的临床疗效,同时检测其不良反应.结果:所有激光术后受试者经过几丁多糖面膜治疗后,无论主观症状的缓解,还是皮损恢复病程的缩短,均明显优于对照侧,整个治疗过程并无严重不良反应发生.结论:几丁多糖面膜用于激光术后护理是一种具有确切疗效、安全的治疗策略.

  19. 食管切除术后的重症监护治疗%Postoperative Intensive Care Treatment after Esophageal Resection

    Institute of Scientific and Technical Information of China (English)

    Dirk L.Stippel; K.Tobias E.Beckurts

    2004-01-01

    The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers and amiodarone. Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly successful in the therapy of these leakages. Microbiological surveillance and specific antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.

  20. Imaging the post-operative meniscus

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni P. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom)]. E-mail: andoni.toms@nnuh.nhs.uk; White, Lawrence M. [Department of Medical Imaging, University of Toronto, Mount Sinai Hospital and the University Health Network, 600 University Avenue, Toronto, Ont., M5G 1X5 (Canada); Marshall, Thomas J. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom); Donell, Simon T. [Institute of Health, University of East Anglia, Norwich, Norfolk NR4 7TJ (United Kingdom)

    2005-05-01

    Considerable developments have occurred in meniscal surgery, and consequently in the imaging of post-operative menisci, over the last 15 years. A drive to preserve meniscal physiologic function for as long as possible, in order to delay osteoarthrosis, has resulted in limited partial meniscectomies, meniscal repairs and meniscal transplants. Each of these techniques affects the imaging appearance of the meniscus, reducing the accuracy of conventional MRI in predicting recurrent tears. The specificity of conventional MRI can be improved by employing at least two T2-weighted sequences, but this still leaves a shortfall in sensitivity. In an attempt to increase the diagnostic accuracy of cross-sectional imaging, MR arthrography (MRA) and CT arthrography (CTA), have been applied to the post-operative meniscus. Sensitivities and specificities for these two techniques approach 90% in predicting recurrent meniscal tears. In the setting of clinical symptoms and gross meniscal deficiency, meniscal allografts are being transplanted with increasing frequency. In these transplants meniscal degeneration, fragmentation and separation are common findings, but the role of imaging in the management of these patients has not yet been well defined. This review explores the imaging techniques available for the evaluation of the post-operative meniscus, their strengths and weaknesses, and the reasons that they may find a place in a rational strategy for imaging of the symptomatic post-operative knee.

  1. Evaluation of adjusted central venous blood gases versus arterial blood gases of patients in post-operative paediatric cardiac surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2015-01-01

    Full Text Available Background and Aims: Central venous catheters are in situ in most of the intensive care unit (ICU patients, which may be an alternative for determining acid-base status and can reduce complications from prolonged arterial cannulation. The aim of this study was to examine the reliability between adjusted central venous blood gas (aVBG and arterial blood gas (ABG samples for pH, partial pressure of carbon-di-oxide (pCO2, bicarbonate (HCO3−, base excess (BE and lactates in paediatric cardiac surgical ICU. Methods: We applied blood gas adjustment rule, that is aVBG pH = venous blood gas (VBG pH +0.05, aVBG CO2 = VBG pCO2 - 5 mm Hg from the prior studies. In this study, we validated this relationship with simultaneous arterial and central venous blood obtained from 30 patients with four blood sample pairs each in paediatric cardiac surgical ICU patients. Results: There was a strong correlation (R i.e., Pearson's correlation between ABG and aVBG for pH = 0.9544, pCO2 = 0.8738, lactate = 0.9741, HCO3− = 0.9650 and BE = 0.9778. Intraclass correlation co-efficients (ICCs for agreement improved after applying the adjustment rule to venous pH (0.7505 to 0.9454 and pCO2 (0.4354 to 0.741. Bland Altman showed bias (and limits of agreement for pH: 0.008 (−0.04 to + 0.057, pCO2: −3.52 (–9.68 to +2.65, lactate: −0.10 (−0.51 to +0.30, HCO3−: −2.3 (–5.11 to +0.50 and BE: −0.80 (−3.09 to +1.49. Conclusion: ABG and aVBG samples showed strong correlation, acceptable mean differences and improved agreement (high ICC after adjusting the VBG. Hence, it can be promising to use trend values of VBG instead of ABG in conjunction with a correction factor under stable haemodynamic conditions.

  2. 心胸外科患者术后疼痛的护理%Cardiothoracic Surgery Patients and Nursing Care of Postoperative Pain

    Institute of Scientific and Technical Information of China (English)

    文红英

    2012-01-01

      目的分析针对性护理干预对心胸外科患者术后疼痛的效果.方法取本院心胸外科2011年7月至2012年5月接受手术治疗的术后疼痛患者112例,随机均分为观察组和对照组.比较2组患者接受不同护理方法后的疼痛评分、负面情绪评分、护理满意度等情况.结果观察组患者接受针对性干预措施后其疼痛评分明显低于对照组患者(P<0.05);负面情绪评分明显低于对照组患者(P<0.05);对于护理的满意度情况明显高于对照组患者(P<0.05).结论使用针对性疼痛干预措施可以有效减少患者疼痛及抑郁情绪,提高护理满意度.%  Objective: to analyze the cardiothoracic surgical patients with pain nursing effect. Methods Choose 112 patiens who had accept cardiothoracic surgery at2011.7-2012.5 month as the cases, randomly divided into observation group and control group. Comparison of two groups undergoing different ways of nursing at the pain score, negative mood scores, satisfaction with nursing care. Results The pain score of the patients in the observation group was significantly lower than that of control group (P<0.05); negative mood scores were significantly lower than those in control group (P<0.05); the nursing satisfaction were significantly higher than those in control group (P<0.05). Conclusion The use of targeted interventions can be effective in reducing pain in patients with pain and depressive mood, improve nursing satisfaction.

  3. 优质护理对肛瘘患者术后疼痛和护理满意度的影响%Efficacy of high quality nursing on postoperative pain and care satisfaction of patients with anal fistula

    Institute of Scientific and Technical Information of China (English)

    张英

    2013-01-01

    Objective To investigate the efficacy of high quality nursing towards on postoperative pain and nursing satisfaction of patients with anal fistula patents.Methods Forty-six cases of anal fistula were randomly divided into control group and experiment group,with 22 cases in control group and 24 cases in experimental group.The patients in control group were given anal fistula routine nursing while the patients in experimental group were given high-quality care additionally and nurses who are in charge of them.The patients obtained responsibility system for overall care from his responsible nurse with psychological interventions,environmental interventions,reasonable methods to stop the pain,etc.Visual Analogue Scale/Score (VAS) were graded at 6 h after the operation and 4 times in the following 3 days.The patients in the two groups were given pain assessment in order to compare the degree of pain and conduct survey of nursing satisfaction degree before discharge.Results There was no significant difference in the pain degree at 6 h after the operation (P > 0.05).The pain degree of experimental group were significantly lower than that in the control group (P < 0.05) in the following 1-3 days after operation.Conclusions The implementation of high-quality care in patients with anal fistula can significantlv reduce postoperative pain and improve patients' satisfaction degree with care work.%目的 探讨优质护理对肛瘘患者术后疼痛和护理满意度的影响.方法 将46例肛瘘患者随机分为对照组和实验组,对照组22例,实验组24例.对照组行肛瘘患者常规护理.实验组在肛瘘常规护理基础上采取优质护理,让护士分管患者,对患者进行责任制整体护理,责任护士对患者实施心理干预、环境干预、合理止痛等全方位护理服务.术后采用视觉模拟评分法(VAS)进行疼痛评分,分别于术后6h、术后第1~3天连续评分4次,对两组患者进行疼痛评估,比

  4. Prevention and nursing care of postoperative complications in oral surgery%口腔外科手术常见并发症术后预防及护理措施

    Institute of Scientific and Technical Information of China (English)

    王珏

    2016-01-01

    目的:观察和分析口腔外科手术常见并发症的术后预防及护理措施。方法:对切口感染、术后出血以及呼吸道阻塞这几类并发症情况的术后预防及护理途径进行研究。结果:部分患者会在口腔外科手术治疗后出现手术部位感染、出血以及窒息等危害性严重的并发症状情况,医护人员应当有效地对这些并发症进行预防与护理,除了需要关注手术治疗的实际效果,更需要密切关注手术部位随时可能出现的并发症情况。在本次临床护理治疗的过程中,110例口腔外科手术治疗患者的并发症情况均得到有效控制,仅有部分患者在疾病预防与护理的过程中出现了轻微的感染,在后续的康复治疗过程中病症情况得到了有效控制。结论:在我国口腔外科的临床手术治疗过程中,医护人员除了需要关注手术治疗的实际效果,更需要密切关注手术部位随时可能出现的并发症情况,通过安全有效的预防及护理工作,切实保证临床手术治疗的安全性。%Objective: To observe and analyze the prevention and nursing care of postoperative complications in oral surgery. Methods: To study the methods of prevention and nursing of postoperative complications such as wound infection, bleeding and respiratory obstruction.Results:some patients will be treated with oral surgery after surgical site infection, bleeding and asphyxia and other serious complications, medical personnel should be effective to prevent these complications and care, in addition to the practical effect of surgical treatment, but also need to pay close attention to the surgical site may occur at any time. In the course of clinical nursing care, 110 cases of oral surgery treatment of patients with complications were effectively controlled, only some patients in the disease prevention and care process has been a slight infection, in the follow-up of the rehabilitation

  5. Implementation of Regional and International HIV and AIDS Prevention, Treatment, Care and Support Conventions and Declarations in Lesotho, Malawi and Mozambique

    Science.gov (United States)

    Kalanda, Boniface; Mamimine, Patrick; Taela, Katia; Chingandu, Louis; Musuka, Godfrey

    2010-01-01

    The governments across the world have endorsed numerous international Conventions and Declarations (C&Ds) that enhance interventions to reduce the impact of HIV and AIDS. The objective of this study was to assess the extent to which the governments of Lesotho, Malawi and Mozambique have implemented HIV and AIDS international and regional…

  6. Implementation of Regional and International HIV and AIDS Prevention, Treatment, Care and Support Conventions and Declarations in Lesotho, Malawi and Mozambique

    Science.gov (United States)

    Kalanda, Boniface; Mamimine, Patrick; Taela, Katia; Chingandu, Louis; Musuka, Godfrey

    2010-01-01

    The governments across the world have endorsed numerous international Conventions and Declarations (C&Ds) that enhance interventions to reduce the impact of HIV and AIDS. The objective of this study was to assess the extent to which the governments of Lesotho, Malawi and Mozambique have implemented HIV and AIDS international and regional…

  7. 2例新生儿骶尾部畸胎瘤术后伤口感染的护理%Nursing care of post-operative wound infection of two neonates′s sacrococcygeal teratoma

    Institute of Scientific and Technical Information of China (English)

    张英娜; 董建英; 程莉萍; 柯艳; 王瑞娟

    2016-01-01

    To summarize the nursing intervention of the post-operative wound infection of two neonates with sacrococcygeal teratoma .The concept of wet healing was employed .The usage of the most appropriate dressing combined with appropriate antibiotic ,pain management,tubing nursing, baby′s position, skin care and sufficient nurtrition were the key of recovery .The two cases were both discharged satisfactorily .%总结2例新生儿骶尾部畸胎瘤术后伤口感染的护理体会,应用湿性愈合理念,使用最适宜的伤口敷料,结合合理的抗生素使用、正确的疼痛、管道护理,体位护理,皮肤护理及充足的营养支持,2例患儿的护理效果满意,均顺利痊愈出院。

  8. Perception of risk and communication among conventional and complementary health care providers involving cancer patients' use of complementary therapies: a literature review

    National Research Council Canada - National Science Library

    Stub, Trine; Quandt, Sara A; Arcury, Thomas A; Sandberg, Joanne C; Kristoffersen, Agnete E; Musial, Frauke; Salamonsen, Anita

    2016-01-01

    .... The aim of this study was to examine the qualitative research literature on the perception of and communication about the risk of complementary therapies between different health care providers and cancer patients...

  9. Comparison of permeatal medial placement of graft without raising the tympano-meatal flaps to conventional methods of myringoplasty: An experience at tertiary care hospital in Pakistan.

    Science.gov (United States)

    Niazi, Saleem Asif; Hassan, Zaheer Ul; Atif, Khaula; Ullah, Saeed

    2016-01-01

    To compare the results of permeatal approach without raising the tympano-meatal flap to end-aural or post-aural approach in myringoplasty. This Quasi-experimental study was carried out in CMH (Combined Military Hospital) Peshawar, from August 2006 to July 2013. Three hundred fifty patients of chronic suppurative otitis media (CSOM) with dry central; small, medium and large perforations were selected. They were divided into two groups depending upon the type of approach. In Group-A (n-200); permeatal approach without raising tympano-meatal flap was used; while in Group-B (n-150) end-aural or post-aural approach was used. Subjects were followed up for two years; graft take was checked regularly by examinations of ear under microscope. Data was collected on structured Performa and analysed by SPSS-17. Male and female were 74% and 26% respectively; Age ranged from 15 to 46 Years. There was no significant difference in the graft success at the end of two years in Group-A(80%) and Group-B(85%) (p-0.261). Type of approach had a significant impact on duration of surgery(p<0.001) and post-operative recovery time(p<0.001). The permeatal approach and end-aural/post-aural approach had almost equal graft success rates, but former is more useful as it causes lesser morbidity, decreased post-operative hospital stay and reduced operative time. It is under-utilized and should be employed more frequently.

  10. Primary closure for postoperative mediastinitis in children.

    Science.gov (United States)

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  11. 胆道闭锁患儿肝移植术后的监护与治疗%Postoperative intensive care of biliary atresia patients treated with living donor liver transplantation

    Institute of Scientific and Technical Information of China (English)

    邓玉华; 郭春宝; 张明满; 李英存

    2011-01-01

    目的 回顾分析22例胆道闭锁患儿(23例次,其中1例行再次肝移植)肝移植术后的重症监护管理经验,探讨并发症的发生率以及病原菌与患儿并发症预后之间的联系.方法 统计分析22例平均体重<8.8 kg的婴幼儿在ICU的相关临床资料,包括药物的使用情况(肾上腺素能激动剂、抗高血压药、利尿剂、镇静止痛药)及主要并发症(排异反应11例,外科并发症16例,感染18例)的诊断、评估及治疗,其中抗生素的选用主要根据药敏试验结果决定.结果 最常见的术后并发症包括感染(18例)、消化道出血(3例)、血管并发症(4例).1例死于原发性无功能肝,11例出现排异反应.最常见的病原微生物包括表皮葡萄球菌(7例),不动杆菌属(6例),铜绿假单胞菌(7例).ICU平均住院时间为10 d,机械通气平均时间37.6 h.多巴酚丁胺、前列腺素E1、多巴胺的平均使用时间分别为3.3 d,7.5 d,8.8 d.术后胃肠外营养的平均起始时间为12 h,进食起始时间平均72 h.结论 术后监护是保证婴幼儿肝移植成功的关键之一.%Objective To summarize experience of pediatric intensive care and explore the incidence of complications, the involved pathogens among liver recipients to determine the effective strategies for preventing complications. Methods Between June 2006 and July 2009, 35 children under the age of 14 yr received 35 liver transplantations (LTs) performed at the center. A retrospective review of 22 infants weighing 8. 8 kg or less underwent 23 transplants was conducted. Indication for transplantation was biliary atresia. Central venous pressure and arterial blood pressure were monitored continuously and fluid monitoring was performed every 2 hours in the first postoperative week. Blood loss, ascites, and intraoperative transudate loss were primarily replaced with 5% albumin and crystalloids to maintain a central venous pressure between 4 and 6 cm H2O. Oral food intake was allowed as

  12. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  13. Postoperative upper airway problems

    African Journals Online (AJOL)

    QuickSilver

    2003-06-09

    Jun 9, 2003 ... REVIEW ARTICLE. Southern African Journal of Anaesthesia & Analgesia - May 2003. 12. Postoperative upper airway problems way. A number of factors, some avoidable, influence the incidence ... debilitating pain, inability to swallow and temporary voice changes, and are a ..... decrease airway resistance.

  14. Postoperative incentive spirometry use.

    Science.gov (United States)

    Hassanzadeh, Hamid; Jain, Amit; Tan, Eric W; Stein, Benjamin E; Van Hoy, Megan L; Stewart, Nadine N; Lemma, Mesfin A

    2012-06-01

    The authors hypothesized that the use of incentive spirometry by orthopedic patients is less than the recommended level and is affected by patient-related factors and type of surgery. To determine its postoperative use, the authors prospectively surveyed all patients in their institution's general orthopedic ward who had undergone elective spine surgery or total knee or hip arthroplasty during a consecutive 3-month period in 2010, excluding patients with postoperative delirium or requiring a monitored bed. All 182 patients (74 men, 108 women; average age, 64.5 years; range, 32-88 years; spine group, n=55; arthroplasty group, n=127), per protocol, received preoperative spirometry education by a licensed respiratory therapist (recommended use, 10 times hourly) and reinforcement education by nurses. Patients were asked twice daily (morning and evening) regarding their spirometry use during the previous 1-hour period by a registered nurse on postoperative days 1 through 3. All data were collected by the same 2 nurses using the same standardized questionnaire. Spirometry use was correlated with surgery type, postoperative day/time, and patient's age and sex. Student's t test, Spearman test, and one-way analysis of variance were used to compare differences (PSpirometry use averaged 4.1 times per hour (range, 0-10 times). No statistical correlations were found between spirometry use and age. Sex did not influence spirometry use. The arthroplasty group reported significantly higher use than did the spine group: 4.3 and 3.5 times per hour, respectively. Mean use increased significantly between postoperative days 1, 2, and 3.

  15. Valoración de la actividad de una Unidad de Dolor Agudo Postoperatorio por los cuidadores del paciente quirúrgico Assessment of the activity of an Acute Postoperative Pain Unit by the staff taking care of surgical patients

    Directory of Open Access Journals (Sweden)

    F. Caba

    2004-12-01

    al 19% de los facultativos; p=0,01. El aspecto mejor valorado de la UDAP fue la mejora en el control del dolor postoperatorio; el peor, la comunicación entre los profesionales y, la sugerencia más referida, la de intentar mejorarla. Conclusiones: El papel de la UDAP es muy bien comprendido en nuestro hospital por los cuidadores del paciente quirúrgico y aunque su actividad es unánimemente percibida como útil y necesaria, existen problemas de integración y comunicación, especialmente con la enfermería de planta. La identificación de situaciones como esta mediante estudios de opinión sobre su actividad, puede ser útil para dirigir mejoras en el funcionamiento de las Unidades de Dolor Agudo con modelos organizativos similares al nuestro.Objective: An Acute Postoperative Pain Unit (APPU staffed by nurses and supervised by the Service of Anesthesiology was created in our center in 2.000. The aim of this study was to assess how the staff taking care of surgical patients perceive its activity. Material and method: The Service of Anesthesiology and Resuscitation and the Post-Anesthetic Recovery Unit (PARU maintain an APPU staffed by nurses that provides planned and protocolized management of postoperative pain to more than 1.000 patients/year undergoing the most aggressive and painful surgical procedures in a second-level hospital. Nurses and doctors taking care of the patients were requested to anonymously and voluntarily answer a written questionnaire with 15 questions (12 close-ended questions grouped in 4 categories and 3 open-ended questions that assessed several aspects of their activity. Results: Out of 168 questionnaires handed out, 87 questionnaires returned were considered (52%, 48 from doctors and 39 from nurses. The role of the APPU was well or very well understood by 97% of the responders and its activity was perceived rather unanimously as useful, effective and necessary by 98, 93 and 97%, respectively. Treatment indications were considered

  16. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for total abdominal hysterectomy: a randomized trial.

    NARCIS (Netherlands)

    Lakeman, M.; Kruitwagen, R.F.P.M.; Vos, M.C.; Roovers, J.P.

    2008-01-01

    STUDY OBJECTIVE: To compare the effects of bipolar vessel sealing versus conventional clamping and suturing in women undergoing total abdominal hysterectomy. DESIGN: A randomized controlled trial was performed. Patients were randomized to vessel sealing or conventional surgery. Postoperative pain wa

  17. Prevention of postoperative ileus

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammatory...... mediators. We update evidence on the advances in the prevention and treatment on PI. As single interventions, continuous thoracic epidural analgesia with local anesthetics and minimally invasive surgery are the most efficient interventions in the reduction of PI. The effects of pharmacological agents have...... generally been disappointing with the exception of cisapride and the introduction of the new selective peripherally acting m-opioid antagonists. Presently, introduction of a multi-modal rehabilitation programme (including continuous epidural analgesia with local anesthetics, early oral feeding and enforced...

  18. 心理干预在妇科肿瘤术后护理中的效果分析%The Analysis of the Effect of Psychological Intervention in the Post-operative Care of Gynecologic Oncology

    Institute of Scientific and Technical Information of China (English)

    曹静威; 李玉凤; 刘世新

    2012-01-01

      目的:探讨心理干预在妇科肿瘤术后护理中的效果.方法:选取笔者所在医院2009年11月-2012年1月入院治疗的84例妇科肿瘤患者为研究对象,针对不同干预前后的各项数据进行比较分析.结果:心理干预在妇科肿瘤术后护理中的效果较好,临床效果显著.两组患者手术前未实施心理干预时的焦虑、抑郁(SAS,SDS)评分比较差异无统计学意义(P>0.05).两组患者手术后实施不同干预后的焦虑、抑郁(SAS,SDS)平均得分组间比较,心理干预组优于非干预对照组,差异具有统计学意义(P0.05,the difference was without statistical significance.The anxiety,depression(SAS,SDS),the average score results after the implementation of different interventions in the two groups of patients after surgery for the two groups were compared,the psychological intervention group was better than the non-intervention control group, P<0.05,there was statistical significant difference.Conclusion:In the process of post-operative care of gynecologic oncology,psychological intervention can achieve better clinical results.It has an important clinical significance and role.

  19. Keratophakia--postoperative astigmatism.

    Science.gov (United States)

    Swinger, C A; Troutman, R C; Forman, J S

    1987-01-01

    Forty-nine cases of primary keratophakia and 13 cases of secondary keratophakia were analyzed for postoperative astigmatism. For primary cases, the surgically induced astigmatism was 1.55 D, whereas for secondary cases it was 0.19 D (insignificant). There was a tendency for both procedures to induce against-the-rule astigmatism, and both procedures were found capable of producing irregular astigmatism.

  20. Diagnosis, prevention and management of postoperative pulmonary edema.

    Science.gov (United States)

    Bajwa, Sj Singh; Kulshrestha, A

    2012-07-01

    Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

  1. The Postoperative Pain Assessment Skills Pilot Trial

    Directory of Open Access Journals (Sweden)

    Michael McGillion

    2011-01-01

    Full Text Available BACKGROUND/OBJECTIVES: Pain-related misbeliefs among health care professionals (HCPs are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs have been effectively used to improve HCPs’ assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method – deteriorating patient-based simulation (DPS – versus SPs for improving HCPs’ pain knowledge and assessment skills.

  2. Nurse practitioners in postoperative cardiac surgery: are they effective?

    Science.gov (United States)

    Goldie, Catherine L; Prodan-Bhalla, Natasha; Mackay, Martha

    2012-01-01

    High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role. To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital. Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction. Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.

  3. Postoperative Review 4538 Cases of Abortion and Abortion Care Effect After Evaluation%4538例人工流产术后回顾与流产后关爱服务效果评价

    Institute of Scientific and Technical Information of China (English)

    石莹; 何耀娟; 郭芝亮

    2015-01-01

    目的:探究流产后关爱服务( Post-abortion care, PAC)对人工流产妇女术后护理效果,为医院的PAC工作提供参考。方法于2013年在医院行人工流产术的女性中随机选取4538例进行回顾与分析。随机分组法分为观察组(2269)例,对照组(2269)例。对照组实施常规护理,观察组实施相关PAC护理。结果观察组妇女重复流产率(6.39%)、高危流产率(4.58%)显著低于对照组妇女重复流产率(12.74%)、高危流产率(10.45%)。观察者未避孕(0.57%)、常规避孕(22.21%)均显著低于对照组未避孕(2.47%)、常规避孕(34.51%)。观察者高效避孕(28.29%)显著高于对照组高效避孕(10.18%),差异均有统计学意义(P<0.05)。结论 PAC能更有效地减少女性的重复流产,提高流产后女性的有效避孕率。保障女性生殖健康,值得临床推广。%Objective To explore the abortion after care service ( Post - abortion Care, PAC) postoperative nursing effect of artificial abortion women, provide reference for hospital work of PAC. Methods In 2013, the author on the hospital do abortion sur-gery in women randomly selected from 4538 cases of review and analysis. Random grouping method was divided into observation group (n=2269), the control group (n= 2269). Implementation of the control group, routine nursing group in the PAC care. Results The group of women repeated spontaneous abortion rate (6. 39%), high-risk abortion rate (4. 58%) was significantly lower than the control group (12. 74%), (10. 45%). Observer not contraception (0. 57%), regular contraceptives (22. 21%) were significantly lower than the control group (2. 47%), (34. 51%). Observer efficient contraceptives (28. 29%) was significantly higher than con-trol group (10. 18%), which was statistically significant differences (P< 0. 05). Conclusion PAC can more effectively reduce a woman′s repeated miscarriages, improve the effective contraceptive use women after the abortion. Protect the female

  4. Head-to-head comparison of intensive lifestyle intervention (U-TURN) versus conventional multifactorial care in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Ried-Larsen, Mathias; Christensen, Robin; Hansen, Katrine B

    2015-01-01

    is that intensive lifestyle changes are equally effective as standard diabetes care, including pharmacological treatment in maintaining glycaemic control (ie, glycated haemoglobin (HbA1c)) in patients with T2D. Furthermore, we expect that intensive lifestyle changes will decrease the need for antidiabetic...... medications. METHODS AND ANALYSIS: The study is an assessor-blinded, parallel group and a 1-year randomised trial. The primary outcome is change in glycaemic control (HbA1c), with the key secondary outcome being reductions in antidiabetic medication. Participants will be patients with T2D (T2D duration

  5. Evaluation of the postoperative breast.

    Science.gov (United States)

    Mendelson, E B

    1992-01-01

    With widespread use of mammography for breast cancer screening, the number of surgical procedures has also increased. Overlapping with radiographic signs of malignancy, including masses, areas of asymmetric density and architectural distortion, microcalcifications, and skin thickening, postsurgical changes may make mammographic evaluation difficult. After tumor excision and irradiation where breast alterations are more profound and prolonged, the task of distinguishing recurrent tumor from scarring or fat necrosis is even more challenging. Mammograms after breast conservation therapy for carcinoma or after cosmetic surgery require correlation with physical findings and the surgical procedures that were performed. Responses of tissue to lumpectomy and radiation, such as breast edema and skin thickening, are most pronounced 6 to 12 months after treatment, gradually resolving within 1 to 3 years. Carefully tailored mammographic studies will promote the dual goal of early detection of local tumor recurrence and avoidance of misinterpreting postoperative and irradiation changes as malignancy. Sequential examinations should begin with a postoperative preradiation mammogram for residual carcinoma, particularly when microcalcifications have been present, followed by the baseline postradiation examination at 6 months with the next study 6 months later (1 year after initial treatment). Mammograms of the treated breast may be performed at intervals of 6 months until radiographic stability has been recognized. Annual studies thereafter are suggested. The contralateral, unaffected breast should be evaluated mammographically according to screening guidelines or clinical concerns. Mammograms performed after cosmetic and reconstructive procedures should be correlated with the surgical techniques and clinical history. Modified views for silicone implants can maximize visualization of breast parenchyma. Ultrasonography is a useful complement to mammography in demonstrating the

  6. Investigation of the supportive care for postoperative patients with colorectal cancer%结直肠癌患者术后支持性照顾需求调查研究

    Institute of Scientific and Technical Information of China (English)

    王海蓉; 栗晓坤

    2014-01-01

    目的:全面了解结直肠癌患者术后支持性照顾需求,为护理人员开展健康指导提供依据,也为护理管理者开展培训和继续教育提供方向。方法选择2012年3-7月在山西省肿瘤医院通过病理检查确诊的结直肠癌接受手术的161例患者,在澳大利亚Bonevski设计的癌症患者支持性照顾需求调查问卷的基础上增加未保肛患者适用的造口支持需求维度进行问卷调查,观察结直肠癌患者术后支持性照顾需求各维度的需求率和得分情况。结果患者6个维度平均需求率为79.12%,平均未满足率为78.63%。患者心理需求得分为(2.71±0.56)分,照顾与支持需求得分为(2.66±0.46)分,生理及日常生活需求为(2.25±0.67)分,健康信息需求得分为(1.94±0.67)分,性需求得分为(1.88±1.25)分,造口需求得分为(0.66±1.18)分。术后支持性照顾需求各维度得分比较差异有统计学意义(F=867.81, P<0.05)。结论护理人员应全面了解患者的需求,及时调整护理服务内容。护理管理者应根据患者需求进行护士的继续教育工作,才能有利于护理学科的发展。%Objective To get a comprehensive understanding of the supportive care needs of postoperative patients with colorectal cancer , and to provide the basis to carry out health guidance for nursing staff.Methods Totals of 161 patients with colorectal cancer were chosen from March to July , 2012.Based on the Australian Bonevski ’ s supportive care needs survey ( SCNS ) , a self-design questionnaire including six demand dimensions and seventy items was used in the research .Results The mean rate of need of the six dimensions was 79.12%and the unsatisfied need rate was 78.63%.The score of mental need , need of care and support , need of physical and daily life , need of the healthcare information , the need of sexual life and the need of stoma

  7. 神经外科患者麻醉恢复期恶心呕吐的情况分析及护理%Incidence and nursing of postoperative nausea and vomiting following neurosurgery in the postanesthesia care unit

    Institute of Scientific and Technical Information of China (English)

    侯春梅; 张雪梅; 王会文; 韩如泉

    2012-01-01

    Objective To analyze incidence and nursing strategies of postoperative nausea and vomiting after different neurosurgery in the postanesthesia care unit (PACU).Methods 5 078 adult patients who had undergone neurosurgery enrolled into PACU were retrospectively investigated. The incidence and nursing strategies of postoperative nausea and vomiting were analyzed.Results The overall incidence of PONV following neurosurgery was 15.7% (798 cases).The incidence of PONV in patients undergoing craniopharyngioma was 28.4% ( 25/88),ventricular tumor 26.7% (35/131 ),infratentorial craniotomy 24.2% ( 157/650),intracranial aneurysm and arteriovenous malformation 20.8% (87/4 i 8 ),supratentorial tumor 19.3% (297/1 535 ),epilepsy 15.8% ( 16/101 ),transsphenoidal surgery of pituitary tumor 8.8% ( 88/991 ),spinal cord tumor 8.4%(52/619) and others 7.5% respectively.Conclusions The overall incidence of PONV in PACU following neurosurgery was approximately 16%.These results indicate that the incidence of PONV following neurosurgery is different and craniopharyngioma,ventricular tumor and posterior fossa tumor are high risk for PONV.Nursing strategies for the prevention of PONV following neurosurgery are required.%目的 探讨不同神经外科手术患者麻醉恢复期恶心呕吐的发生情况及护理对策.方法 回顾性分析5078例神经外科手术患者的临床资料,对其麻醉恢复期恶心呕吐的发生情况及护理对策进行总结.结果 5078例神经外科患者中,麻醉恢复期发生恶心呕吐798例,发生率为15.7%.其中颅咽管瘤组28.4%(25/88)、脑室肿瘤组26.7% (35/131)、后颅窝肿瘤组24.2% (157/650)、脑血管病组20.8%(87/418)、幕上肿瘤组19.3%(297/1535)、癫痫组15.8%( 16/101)、经蝶垂体瘤组8.8%(88/991)、脊髓肿瘤组8.4%(52/619).全部病例经及时治疗和护理均得到有效控制.结论 神经外科不同部位的手术患者麻醉恢复期恶心呕吐的发生情况不

  8. 9136例PACU患者术后并发症的发生原因及分析%Causes of Postoperative Complications of 9 136 Patients in the Post-anaesthesia Care Unit

    Institute of Scientific and Technical Information of China (English)

    兰培丽; 裴凌

    2011-01-01

    Objective To analyze the causes and incidences of complications in the post-anaesthesia care unit (PACU) and their correlations to the preventive treatments. Methods From January 2007 to December 2009,9 136 patients were selected to observe variable complications and their incidences as well as the treatments and prognoses. The causes were analyzed so as to estimate the correlation to the prophylactic factors. Results The incidences of different complications were variable. The total incidence was 9.8%(307/9,136).The retention time in PACU ranged from 15 minutes to 7 hours. Most of the patients went to ward or ICU safely after tracheal extubation while part of them went to ICU with endotracheal tube. The most common complications were hypertention,arrythmia,hypotention,postoperative nausea and vomitting( PONV ), restlessness,low degree of blood oxygen saturation, respiratory inhibition and abnormal body temperature (hyperthermia or hypothermia). Conclusion Senile (over 80 years old),ASA graded Ⅰ to Ⅲ ,preoperative coexisted dieases,poor preoperative estimation caused by man-made factors,thrombolysis in the bedridden patients,obesity,overdose or unindividualization of anesthetics in induction and maintainance period,alveolar hypoventilation and hypothermia were correlated to the retention time in PACU and complications in recovery period. It's very important to emphasize the preoperative visiting and assessment,strengthen intraoperative management,and improve postoperative monitoring and treatnent in PACU.%目的 分析麻醉后恢复室(PACU)患者术后并发症的发生原因及预防处理措施的相关性,进一步明确PACU的重要意义.方法 选择2007年1月至2009年12月PACU患者9 136例,观察各种并发症的发生率及其处理和预后,分析原因并探讨其与预防因素的相关性.结果 9 136例PACU患者中发生术后并发症者895例(9.8%.PACU停留时间为15 min~7 h不等.大部分患者清醒并达到气管拔管指征后

  9. Postoperative conversion disorder.

    Science.gov (United States)

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Postoperative extradural hematomas.

    Science.gov (United States)

    Pichierri, Angelo; Ruggeri, Andrea; Donnarumma, Pasquale; Delfini, Roberto

    2013-01-01

    Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

  11. Prediction of difficult intubations using conventional indicators; Does rapid sequence intubation ease difficult intubations? A prospective randomised study in a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Gangadharan Lakshmi

    2011-01-01

    Full Text Available Background : Endotracheal intubations performed in the Emergency Department. Aims : To assess whether conventional indicators of difficult airway can predict a difficult intubation in the Emergency Setting and to investigate the effect of rapid sequence intubation (RSI on ease of intubation. Settings and Design : A prospective randomized study was designed involving 60 patients requiring intubation, over a period of 4 months. Materials and Methods : Demographic profile, details of methods used, airway assessment, ease of intubation, and Cormack and Lehane score were recorded. Airway assessment score and ease of intubation criteria were devised and assessed. Statistical Analysis : Descriptive statistical analysis was carried out. Chi-square/2 × 2, 2 × 3, 3 × 3, Fisher Exact test have been used to find the significance of study parameters on categorical scale between two or more groups. Results : Patients with a Mallampatti score of three or four were found to have worse laryngoscopic views (Cormack-Lehane score, 3 or 4. Of all airway indicators assessed, an increased Mallampatti score was found to have significant correlation with increased difficulty in intubation. The use of RSI was associated with better laryngoscopic views, and easier intubations. Conclusions : An airway assessment using the Mallampatti score is invaluable as a tool to predict a difficult airway and should be performed routinely if possible. RSI aids intubation ease. If not otherwise contraindicated, it should be performed routinely for all intubations in the ED.

  12. Outcomes associated with postoperative delirium after cardiac surgery.

    Science.gov (United States)

    Mangusan, Ralph Francis; Hooper, Vallire; Denslow, Sheri A; Travis, Lucille

    2015-03-01

    Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P nursing facility (P cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery. ©2015 American Association of Critical-Care Nurses.

  13. COMPARITIVE STUDY BETWEEN STAPLED HEMORRHOIDOPEXY AND CONVENTIONAL HEMORRHOIDECTOMY

    Directory of Open Access Journals (Sweden)

    Sudhir

    2014-03-01

    Full Text Available AIM: The aim of the study was to compare the results of stapled haemorroidopexy and open haemorrhoidectomy. METHODS: The study population consisted of 60 patients who were admitted with hemorrhoids to a Medical college hospital providing primary, secondary and tertiary care. Patients were allocated to both groups on random basis. The main outcome measures were, time taken for each surgical procedure, the intra- operative bleeding, Post- operative pain (visual analog scale, time taken for first defecation after operation, Duration of hospital stay and Time taken to return to work. Follow up was conducted for minimum period of 6 months. RESULTS: Stapled v/s conventional haemorrhoidectomy was associated with significantly reduced operating time (30.13±5.97 v/s 47.67±8.28 minutes; p= 0.001, Less blood loss during stapled v/s open haemorrhoidectomy (12.33 ml and 21.83 ml; p = 0.001, Reduced post-operative pain scores (Visual Anolog Score on the first 4 post-operative days (day 1: 4.63 v/s 5.70, day 2: 2.70 v/s 4.57, day 3: 1.83 v/s 3.70 and day 4: 1.2 v/s 3.10, where 0 indicates no pain and 10, maximum pain; p ≤ 0.001, Patients who underwent stapled haemorrhoidectomy passed stools earlier (22.10±3.75 hrs. and 26.03±3.77 hrs: p ≤ 0.001 than conventional group. Reduced number of hospital stay in stapled group (3.83±0.87 v/s 6.70±1.82 days: p≤0.001 compared to conventional group. Anal stricture noted in two patients in stapled group compared to 4 patients in open group. CONCLUSIONS: Stapled haemorroidopexy is associated with reduced operating time, less blood loss during surgery, reduced post-operative pain, less number of hospital admission days, early return to work. It is a safe and effective procedure for haemorrhoids; it may become a gold standard procedure for haemorrhoids in future

  14. Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions

    Directory of Open Access Journals (Sweden)

    Harald J. Hamre

    2014-01-01

    Full Text Available Children with acute respiratory or ear infections (RTI/OM are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A- or conventional (C- treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P<0.001; unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56; after adjustment for demographics and morbidity 6.33 (3.17–12.64. Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

  15. Postoperative metabolic acidosis following the minimally invasive radiofrequency maze procedure

    Directory of Open Access Journals (Sweden)

    Raymond Patrick Hom

    2016-01-01

    Full Text Available Purpose: Atrial fibrillation (AF is the most common arrhythmia treated in the world. While medical treatment with antiarrhythmic drugs remains the primary treatment modality, symptomatic refractory AF often requires treatment with a catheter or surgical ablation. One minimally invasive therapy is the Mini-Maze procedure, which utilizes epicardial radiofrequency ablation via a subxiphoid approach to rid the heart of arrhythmogenic atrial foci without a median sternotomy or cardiopulmonary bypass. The goal of this retrospective cohort study was to identify clinical factors associated with metabolic acidosis following the Mini-Maze procedure. Materials and Methods: After Institutional Review Board approval, we studied patients undergoing the Mini-Maze procedure, off-pump coronary artery bypass grafting or patients conventional Cox-Maze on cardiopulmonary bypass. The first base deficit value obtained in the Intensive Care Unit was used as a measure of metabolic acidosis. Using logistic regression with Akaike information criteria, we analyzed preoperative, intraoperative, and postoperative data to determine the factors associated with changes in base deficit. Results: A multivariable model using stepwise selection demonstrated that diabetes mellitus and weight were associated with a decrease in the base deficit by 2.87 mEq/L (95% CI: −5.55-−0.19 and 0.04 mEq/L (95%CI: −0.08, 0.004, respectively. Furthermore, creatinine was associated with a 1.57 mEq/L (95% CI: 0.14, 2.99 increase in the base deficit. Conclusion: The Mini-Maze procedure was not associated with postoperative metabolic acidosis. Instead, nondiabetic patients and patients with higher creatinine were associated with greater base deficits after undergoing cardiac surgery.

  16. Acute pain control and accelerated postoperative surgical recovery

    DEFF Research Database (Denmark)

    Kehlet, H

    1999-01-01

    Postoperative pain relief continues to demand our awareness, and surgeons should be fully aware of the potential physiologic benefits of effective dynamic pain relief regimens and the great potential to improve postoperative outcome if such analgesia is used for rehabilitation. To achieve...... to recent knowledge within surgical pathophysiology. Such efforts must be expected to lead to improved quality of care for patients, with less pain and reduced morbidity leading to cost efficiency....

  17. Clinical Practice Guidelines for postoperative period of thoracic surgery.

    Directory of Open Access Journals (Sweden)

    Frank Carlos Alvarez Li

    2009-03-01

    Full Text Available Clinical Practice Guidelines for postoperative period of thoracic surgery. It is the period between the suture of the surgical wound and the total rehabilitation of the patient, which usually occurs in the Intensive Care Unit. This document includes a review and update of the main aspects such as classification, postoperative treatment, stressing the actions to face any complication. It includes assessment guidelines focused on the most important aspects to be accomplished.

  18. Postoperative cardiac arrest in children with congenital heart abnormalities

    OpenAIRE

    2013-01-01

    BACKGROUND The exact survival rates and markers of survival after postoperative cardiac arrest in children with congenital heart abnormalities are unknown. METHODS In this one-year study, we identified children younger than seven years of age with postoperative cardiac arrest in our pediatric cardiac intensive care unit database. Parameters from perioperative, pre-arrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and non-survivors afte...

  19. Cold therapy in the management of postoperative cesarean section pain.

    Science.gov (United States)

    Amin-Hanjani, S; Corcoran, J; Chatwani, A

    1992-07-01

    Sixty-two patients were randomized to receive either localized cold therapy to the cesarean section incision or routine postoperative care. Evaluation of the amount of analgesia requested, infection rate, and length of hospital stay did not show a significant difference between the two groups. There is no objective evidence to show that the use of cold therapy in postoperative cesarean section pain relief is beneficial.

  20. 髋部骨折术后并发应激性溃疡患者的预防及护理%Prevention and nursing care of patients with stress ulcer complicated with postoperative hip fracture

    Institute of Scientific and Technical Information of China (English)

    黄健

    2015-01-01

    目的:探讨髋部骨折术后并发应激性溃疡的预防及护理措施。方法:选择68例髋部骨折术后并发应激性溃疡患者,并对其进行治疗和护理,然后分析其综合资料,根据整体状况对患者进行预防护理,并总结出护理的要点。结果:观察组中患者髋部骨折术后并发应激性溃疡护理有效率显著高于对照组,两组比较差异具有统计学意义( P<0.05)。结论:治疗髋骨骨折术后应激性溃疡时,采取有效的综合护理措施能够术后减少并发应激性溃疡发生的情况,给患者的生命安全提供了保证,同时对患者的预后也有益处。%Objective To investigate the prevention and nursing measures of hip racture patients complicated with stress ul-cer. Method 68 cases complicated with stress ulcer in patients with hip fracture patients were selected,and treatment and nursing on it,then analysis the data,according to the overall situation of preventive care for patients,and summarize the nursing points. Results The observation group patients with hip fracture complicated with stress ulcercare effective rate was much higher than that of control group. There was signifi-cant difference( P<0. 05). Conclusion Postoperative stress ulcer in treatment of fractures of hip,taking comprehensive nursing measures can effectively reduce the postoperativestress ulcer with occurrence,provide a guarantee,to the life safety of patients at the same time,but also ben-eficial to the prognosis of the patients.

  1. A comparative study on intraoperative mitomycin-c augmented external dacryocystorhinostomy with conventional dacryocystorhinostomy

    Directory of Open Access Journals (Sweden)

    Bharoti Sarmah Puzari

    2016-09-01

    Results: In our study we have observed that majority of cases were in 21-30 years age group with female preponderance (male vs female; 35% vs 75%. Chronic dacryocystitis was seen in majority of cases (70% followed by mucocele (26.67% and lacrimal fistula (3.33%. Major difficulties encountered during surgery and postoperatively were almost identical in both the groups. There was no case of abnormal mucosal bleeding, mucosal necrosis, delayed wound healing in patients which underwent DCR with mitomycin C use. Post-operative care and follow up were done identically in both the groups. It was seen that a total success rate of 80% was achieved in conventional group where as 96.67% success was achieved in MMC group at the end of 6 months. In case of scar prone conditions like lacrimal fistula mitomycin C use has shown to be efficacious in maintaining patency of the system after surgery. Conclusions: Distinctly higher success rate have been achieved in patients undergoing DCR with intra-operative MMC as compared to patients undergoing conventional DCR. Use of intraoperative mitomycin C can be considered safe and simple but very effective modification of conventional external DCR. [Int J Res Med Sci 2016; 4(9.000: 3879-3883

  2. Takotsubo Cardiomyopathy Occurring in the Postoperative Period.

    Science.gov (United States)

    Deniz, Süleyman; Bakal, Ömer; İnangil, Gökhan; Şen, Hüseyin; Özkan, Sezai

    2015-02-01

    Takotsubo cardiomyopathy simulates acute myocardial infarction, and it is characterised by reversible left ventricular failure. A case of Takotsubo cardiomyopathy diagnosed after emergency angiography performed in a patient with evidence of acute myocardial infarction in the postoperative period will be described in this report. Transurethral resection of a bladder tumour (TUR-BT) was performed in a 92-year-old male patient by the urology clinic. The patient was transferred to the post-anaesthesia care unit after the operation. An echocardiography was performed because of the sudden onset of dyspnoea, tachycardia (140-150 beats per minute, rhythm-atrial fibrillation) and ST-segment elevation on electrocardiography (ECG) at the first postoperative hour, and midapical dyskinesia was detected at the patient. An immediate angiography was performed due to suspicion of acute coronary syndrome. Patent coronary arteries and temporary aneurysmatic dilatation of the apex of the heart were revealed by angiography. As a result of these findings, the patient was diagnosed with Takotsubo cardiomyopathy by the cardiology service. The patient was discharged uneventfully following 10 days in the intensive care unit. Aneurysm of the apex of the left ventricle and normal anatomy of the coronary arteries in the angiography have diagnostic value for Takotsubo cardiomyopathy. Diuretics (furosemide) and beta-blockers (metoprolol) are commonly used for the treatment of Takotsubo cardiomyopathy. Even though Takotsubo cardiomyopathy is a rare and benign disease, it should be kept in mind in patients suspected for acute myocardial infarction in the postoperative period.

  3. Postoperative circadian disturbances

    DEFF Research Database (Denmark)

    Gögenur, Ismail

    2010-01-01

    An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention...... has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where...... night after minimally invasive surgery. The core body temperature rhythm was disturbed after both major and minor surgery. There was a change in the sleep wake cycle with a significantly increased duration of REM-sleep in the day and evening time after major surgery compared with preoperatively...

  4. Postoperative circadian disturbances

    DEFF Research Database (Denmark)

    Gögenur, Ismail

    2010-01-01

    in patients with lower than median pain levels for a three days period after laparoscopic cholecystectomy. In the series of studies included in this thesis we have systematically shown that circadian disturbances are found in the secretion of hormones, the sleep-wake cycle, core body temperature rhythm......An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention...... has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where...

  5. A pilot plant study using conventional and advanced water treatment processes: Evaluating removal efficiency of indicator compounds representative of pharmaceuticals and personal care products.

    Science.gov (United States)

    Zhang, Shuangyi; Gitungo, Stephen; Axe, Lisa; Dyksen, John E; Raczko, Robert F

    2016-11-15

    With widespread occurrence of pharmaceuticals and personal care products (PPCPs) in the water cycle, their presence in source water has led to the need to better understand their treatability and removal efficiency in treatment processes. Fifteen indicator compounds were identified to represent the large number of PPCPs reported worldwide. Criteria applied to determine the indicator compounds included PPCPs widely used, observed at great frequency in aqueous systems, resistant to treatment, persistent in the environment, and representative of classes of organics. Through a pilot plant investigation to understand the optimal combination of unit process for treating PPCPs, 12 treatment trains with their additive and synergistic contributions were investigated; processes included dissolved air flotation (DAF), pre- and intermediate-ozonation with and without H2O2, intermediate chlorination, dual media filtration, granular activated carbon (GAC), and UV/H2O2. Treatment trains that achieved the greatest removals involved 1. DAF followed by intermediate ozonation, dual media filtration, and virgin GAC; 2. pre-ozonation followed by DAF, dual media filtration, and virgin GAC; and, 3. DAF (with either pre- or intermediate oxidation) followed by dual media filtration and UV/H2O2. Results revealed significant removal efficiencies for virgin GAC (preceded by DAF and intermediate ozonation) and UV/H2O2 with an intensity of 700 mJ/cm(2), where more than 12 of the compounds were removed by greater than 90%. Reduced PPCP removals were observed with virgin GAC preceded by pre-ozonation and DAF. Intermediate ozonation was more effective than using pre-ozonation, demonstrating the importance of this process targeting PPCPs after treatment of natural organic matter. Removal efficiencies of indicator compounds through ozonation were found to be a function of the O3 rate constants (kO3). For compounds with low O3 rate constants (kO3 < 10 M(-1)s(-1)), H2O2 addition in the O3 reactor

  6. 舒适护理与常规护理对食道癌患者术后生活质量及睡眠的影响比较%Comparative effects of the quality of life and sleep of comfort care and routine care to postoperative esophageal cancer patients

    Institute of Scientific and Technical Information of China (English)

    刘晓燕; 张凌; 巫宗霞; 卢怀美

    2014-01-01

    目的:比较舒适护理与常规护理对食道癌患者术后生活质量及睡眠的影响.方法:选择2012年50例食道癌患者给予常规护理,列为对照组,2013年50例食道癌患者给予舒适护理列为观察组,比较两组患者护理干预后生活质量及睡眠情况.结果:①观察组干预后生活质量评分、睡眠质量指数较对照组改善明显,比较差异有统计学意义(均 P<0.05);②观察组睡眠改善有效率为86%,明显高于对照组的54%,比较差异有统计学意义(P<0.05).结论:舒适护理对提高食管癌患者术后生活质量,改善睡眠有明显的效果.%Objective:Comparative ef ects of the quality of life and sleep of comfort care and routine care to postoperative esophageal cancer patients.Methods:Selected in January 2012 January-December 50 cases of esophageal cancer were treated with routine care,as a control group,2013 January- December 50 cases of esophageal cancer were treated with comfort care as the observer group,the two groups were compared quality of life and sleep nursing intervention situations.Result:① observation group after the intervention quality of life scores,sleep quality index improved significantly compared with the control group,the dif erence was statistical y significant (P<0.05);② sleep improve the ef ective observation group was 86%,significantly higher than the 54% ,the dif erence was statistical y significant (P <0.05).Conclusion:Comfort Care to improve the quality of life of patients with esophageal cancer surgery,improving sleep had a significant ef ect.

  7. Immediate post-operative responses to transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Nielsen, Susanne; Lisby, Karen H.;

    2015-01-01

    Background:Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients.Aims:The aim of our study was to describe the post-operati......, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.......-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age.Methods:A prospective, comparative observational study triangulating nurse assessment...... and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years.Results:After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion...

  8. Imaging of postoperative middle ear cholesteatoma

    Energy Technology Data Exchange (ETDEWEB)

    Khemani, S.; Singh, A. [Department of Otolaryngology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom); Lingam, R.K., E-mail: raviklingam@yahoo.co.uk [Department of Radiology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom); Kalan, A. [Department of Otolaryngology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom)

    2011-08-15

    Cholesteatoma is often treated surgically using canal wall-preserving techniques. Clinical and otoscopic diagnosis of residual or recurrent disease after this form of surgery is unreliable and thus radiological imaging is often used prior to mandatory 'second-look' surgery. Imaging needs to be able to differentiate residual or recurrent disease from granulation tissue, inflammatory tissue or fluid within the middle ear cavity and mastoid cavity. High-resolution computed tomography (HRCT), conventional magnetic resonance imaging (MRI), and delayed contrast MRI have all been used in detecting postoperative cholesteatoma. Although delayed contrast MRI performs better than HRCT and conventional MRI, the sensitivities and specificities of these different imaging methods are relatively poor. Diffusion-weighted MRI (DWI and, in particular, non-echo planar DWI) has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. In this review we provide examples of postoperative imaging appearances following cholesteatoma surgery and we review the relevant literature with an emphasis on studies evaluating the diagnostic accuracy of DWI.

  9. Study Protocol Evaluating the Use of Bowel Stimulation Before Loop Ileostomy Closure to Reduce Postoperative Ileus: A Multicenter Randomized Controlled Trial.

    Science.gov (United States)

    Garfinkle, Richard; Trabulsi, Nora; Morin, Nancy; Phang, Terry; Liberman, Sender; Feldman, Liane; Fried, Gerald; Boutros, Marylise

    2017-05-12

    Postoperative ileus is the most commonly observed morbidity following ileostomy closure. Studies have demonstrated that the defunctionalized bowel of a loop ileostomy undergoes a series of functional and structural changes, such as atrophy of the intestinal villi and muscular layers, which may contribute to ileus. A single-center study in Spain demonstrated that preoperative bowel stimulation via the distal limb of the loop ileostomy decreased postoperative ileus, length of stay, and time to gastrointestinal function. A multicenter randomized controlled trial involving patients from Canadian institutions was designed to evaluate the effect of preoperative bowel stimulation before ileostomy closure on postoperative ileus. Stimulation will include canalizing the distal limb of the ileostomy loop with an 18Fr Foley catheter and infusing it with a solution of 500mL of normal saline mixed with 30g of a thickening-agent (Nestle© Thicken-Up©). This will be performed 10 times over the three weeks prior to ileostomy closure on an outpatient clinic setting by a trained Enterostomal Therapy nurse. Surgeons and the treating surgical team will be blinded to their patient's group allocation. Data regarding patient demographics, operative, and postoperative variables will be collected prospectively. Primary outcome will be postoperative ileus, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, that either a) requires nasogastric tube insertion; or b) is associated with 2 of the following: nausea/vomiting, abdominal distension, and the absence of flatus, on or after post-operative day 3. Secondary outcomes will include length of stay, time to tolerating a regular diet, time to first passage of flatus or stool, and overall morbidity. A cost-analysis will be performed to compare the costs of conventional care to conventional care plus preoperative stimulation. This manuscript discusses the potential benefits of preoperative

  10. Postoperative mortality after inpatient surgery: Incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2008-09-01

    Full Text Available Karamarie Fecho1, Anne T Lunney1, Philip G Boysen1, Peter Rock2, Edward A Norfleet11Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 2Department of Anesthesiology, University of Maryland, Baltimore, MD, USAPurpose: This study determined the incidence of and identified risk factors for 48 hour (h and 30 day (d postoperative mortality after inpatient operations.Methods: A retrospective cohort study was conducted using Anesthesiology’s Quality Indicator database as the main data source. The database was queried for data related to the surgical procedure, anesthetic care, perioperative adverse events, and birth/death/operation dates. The 48 h and 30 d cumulative incidence of postoperative mortality was calculated and data were analyzed using Chi-square or Fisher’s exact test and generalized estimating equations.Results: The 48 h and 30 d incidence of postoperative mortality was 0.57% and 2.1%, respectively. Higher American Society of Anesthesiologists physical status scores, extremes of age, emergencies, perioperative adverse events and postoperative Intensive Care Unit admission were identified as risk factors. The use of monitored anesthesia care or general anesthesia versus regional or combined anesthesia was a risk factor for 30 d postoperative mortality only. Time under anesthesia care, perioperative hypothermia, trauma, deliberate hypotension and invasive monitoring via arterial, pulmonary artery or cardiovascular catheters were not identified as risk factors.Conclusions: Our findings can be used to track postoperative mortality rates and to test preventative interventions at our institution and elsewhere.Keywords: postoperative mortality, risk factors, operations, anesthesia, inpatient surgery

  11. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J

    1995-01-01

    Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded...

  12. Risk factors for postoperative complications in robotic general surgery.

    Science.gov (United States)

    Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

    2017-03-01

    The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

  13. Conventional mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Tobias Joseph

    2010-01-01

    Full Text Available The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU. Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas.

  14. Postoperative management of the exotic animal patient.

    Science.gov (United States)

    Pollock, Christal

    2002-01-01

    Careful postoperative management is crucial for the success of any orthopedic surgical repair. The special needs of the exotic animal must be met during the immediate postoperative period and during hospitalization. Many exotic animals require a quiet, stress-free environment and careful attention to housing parameters, such as perching, temperature, and visual security. To provide adequate pain relief in these patients, analgesia should be given before, during, and after surgery. The drugs most often used for pain relief are NSAIDs and opioid analgesics. After surgery, monitor the healing process carefully with regular examinations and radiographs while remaining vigilant for potential problems such as osteomyelitis or nonunion. Physical therapy prevents the development of fracture disease, which includes joint or ligament contracture and bone or muscle mass loss. Because physical therapy affords the patient full use of the affected limb, it is considered a helpful practice in all patients. Physical therapy, however, is critical for free-ranging exotic animals that will be released back into the wild, such as birds of prey.

  15. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  16. 成年患者神经外科手术麻醉恢复期恶心呕吐的情况分析%Incidence of postoperative nausea and vomiting following neurosurgical procedures in postanesthesia care unit

    Institute of Scientific and Technical Information of China (English)

    王会文; 侯春梅; 张雪梅; 韩如泉

    2012-01-01

    目的 通过回顾性分析,探讨不同神经外科手术成年患者麻醉恢复期恶心呕吐的发生情况.方法 2009年5月至2011年3月麻醉恢复室( PACU)收治的神经外科术后成年患者5 078例,按肿瘤部位和手术种类分组.观察并记录患者恶心呕吐的发生情况.结果 5 078例患者中,发生术后恶心呕吐798例,发生率为15.7%.其中颅咽管瘤组占28.4%(25/88)、脑室肿瘤组26.7%(35/131)、后颅窝肿瘤组24.2%(157/650)、脑血管病组20.8% (87/418)、幕上肿瘤组19.3%(297/1535)、癫痫组15.8%(16/101)、经蝶窦垂体瘤组8.9% (88/991)、脊髓肿瘤组8.4%(52/619)及其他手术组7.5%(41/545).结论 神经外科不同部位手术患者术后恶心呕吐的发生情况不同,需针对不同的病种严密观察及时处理.%Objective To study the incidence of postoperative nausea and vomiting(PONV) after different neurosurgical procedures in the postanesthesia care unit (PACU).Methods 5 078 adult patients who had undergone neurosurgical procedures enrolled into PACU were divided nine groups.The incidence of PONV were recorded and treated.Results The overall incidence of PONV following neurosurgical procedures was 15.7%.The incidence of PONV in patients undergoing craniopharyngioma、ventricular tumor、infratentorial craniotomy、intracranial aneurysm and arteriovenous malformation、supratentorial tumor、epilepsy、transsphenoidal surgery of pituitary tumor、spinal cord tumor and others was 28.4% 、26.7%、24.2% 、20.8%、19.3%、15.8%、8.9%、8.4% and 7.5%,respectively.Conclusions The overall incidence of PONV in PACU following neurosurgical procedures is approximately 16%.The incidence of PONV following neurusurgical procedures is different and craniopharyngioma、ventricular tumor and posterior fossa tumor are high risk factors for PONV.Strategies for the prevention of PONV following neurusurgical procedures are required.

  17. Reyanbao combined with acupoint massage rehabilitation research in nursing care of postoperative breast cancer%热奄包配合穴位按摩在乳腺癌术后康复护理中的应用研究

    Institute of Scientific and Technical Information of China (English)

    谭秀卿; 聂广杰; 伍丽容; 肖曙娴; 温威; 吴祖培; 陈宇宁

    2013-01-01

    Objective: To study the Reyanbao combined with acupointmassage in the rehabilitation nursing and clinical significance in breastcancer after operation. Methods:102 cases of breast cancer were randomly divided into the treatment group of 51 cases, 51 cases in the control group. Control group of routine nursing group, the treatment group is on the basis of routine care on the first postoperative daystarted Reyanbao fomentation on upper limbs and related acupoints with acupuncture point massage. Shoulder pain degree of change were observed at different time points, two groups of patients the extent of the changes, shoulder function of upper arm swel ing arm circumferencemeasurements. Results:of the two patients in the pain of shoulder jointat different time points (t=7.58,t=12.63, t=11.59). The activity of the shoulder joint function (X2=35.62, X2=25.13 X2=26.51), arm circumference (t=6.58, t=8.63, the degree of recovery of t=10.39),indexes, the difference was statistical y significant (P< 0.01). Conclusion:Reyanbao combined with acupoint massage in breast cancer after operation can reduce the shoulder pain, shoulder joint function make theactivities more flexible, can reduce the swel ing in arms, worth in clinical promotion.%目的:研究热奄包配合穴位按摩在乳腺癌术后康复护理中的作用及其临床意义。方法:102例乳腺癌患者随机分为治疗组51例,对照组51例。对照组是常规护理组,治疗组是在常规护理的基础上于术后第一天开始进行热奄包热敷于患侧上肢相关穴位及配合穴位按摩。分别观察两组患者不同时间点的肩关节疼痛变化程度、肩关节功能活动变化程度、上臂肿胀臂围的测量等。结果:两组患者在不同时间点的肩关节疼痛症状(t=7.58,t=12.63,t=11.59)。肩关节功能活动(X2=35.62,X2=25.13 X2=26.51),上臂臂围恢复程度(t=6.58,t=8.63,t=10.39),各项指标比较,差异有统计学意义(P<0.01)。结论:热奄包配

  18. [Management of postoperative chylothorax].

    Science.gov (United States)

    Smati, B; Sadok Boudaya, M; Marghli, A; Mestiri, T; Baccari, S; Hantous, T; Djilani, H; Kilani, T

    2006-04-01

    A chylothorax can occur following any intrathoracic procedure. It is generally straightforward to make the diagnosis but optimal management can be problematic. Between 1995 and 2002, three women and one man aged from 13 to 58 years were treated for chylothorax after thoracic surgery. Their initial illnesses were a right pulmonary hydatid cyst associated with hepatic disease, a tumour of the posterior mediastinum, an oesophageal carcinoma and metastases in the left lung. These patients had: a pulmonary and hepatic cystectomies, a resection of the mediastinal tumor, an Akyama oesophagectomy and a resection of four left pulmonary metastases. Chylothorax became apparent post operatively between the 1st and the 4th day. All patients were treated with a medium-chain triglyceride diet. Two patients were re-explored with ligation of lymphatic vessels. One woman who did not have further surgery was treated with etilefrine. In the patient who had had an oesophagectomy, chylothorax persisted after re-operation. He was successfully treated by talc pleurodesis via a chest drain, which prevented further recurrence. In the management of postoperative chylothorax, medical treatment must be started early but surgery should not be delayed as operative risk is increased by the development of malnutrition and immune deficiency.

  19. Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors.

    Science.gov (United States)

    Wei, Naili; Jia, Yanfei; Wang, Xiu; Zhang, Yinian; Yuan, Guoqiang; Zhao, Baotian; Wang, Yao; Zhang, Kai; Zhang, Xinding; Pan, Yawen; Zhang, Jianguo

    2015-01-01

    bleeding and poor outcomes and merits careful attention. Practitioners should monitor plasma fibrinogen levels in patients with risk factors for postoperative fibrinogen deficiency. In addition, postoperative fibrinogen deficiency should be remediated as soon as possible to reduce postoperative bleeding, especially when postoperative bleeding is confirmed.

  20. The Hague Judgments Convention

    DEFF Research Database (Denmark)

    Nielsen, Peter Arnt

    2011-01-01

    The Hague Judgments Convention of 2005 is the first global convention on international jurisdiction and recognition and enforcement of judgments in civil and commercial matters. The author explains the political and legal background of the Convention, its content and certain crucial issues during...

  1. Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function and body composition

    DEFF Research Database (Denmark)

    Basse, L; Raskov, H H; Hjort Jakobsen, D

    2002-01-01

    exercise, pulmonary function and nocturnal oxygen saturation. RESULTS: Defaecation occurred earlier (median day 1 versus day 4) and hospital stay was shorter (median 2 versus 12 days) in patients who had multimodal treatment. Lean body and fat mass decreased in group 1 but not in group 2. Exercise......-supply (HR/oxygen saturation ratio) increased in group 1 but not in group 2. CONCLUSION: Multimodal rehabilitation prevents reduction in lean body mass, pulmonary function, oxygenation and cardiovascular response to exercise after colonic surgery....... receiving conventional care (group 1) and 14 patients who had multimodal rehabilitation (group 2) were studied before and 8 days after colonic resection. Outcome measures included postoperative mobilization, body composition by whole-body dual X-ray absorptiometry, cardiovascular response to treadmill...

  2. Vitreous loss during conversion from conventional extracapsular cataract extraction to phacoemulsification.

    Science.gov (United States)

    Ah-Fat, F G; Sharma, M K; Majid, M A; Yang, Y C

    1998-06-01

    To study the outcome of vitreous loss among senior surgeons converting from conventional extracapsular cataract extraction (ECCE) to phacoemulsification. A university teaching hospital in the United Kingdom. A retrospective analysis of 87 planned cataract extractions performed from January 1992 to December 1996 and complicated by vitreous loss was done. Outcome measures included postoperative complication rates and visual acuity. During the study, vitreous loss occurred in 39 patients having ECCE and in 48 having phacoemulsification; the latter group included 8 patients with dropped nucleus. Postoperative complications included cystoid macular edema (18.7% of phaco patients, 30.8% of ECCE patients), retinal detachment (2.1% of phaco patients, 5.1% of ECCE patients), and expulsive hemorrhage (5.1% of ECCE patients). Phaco patients had higher rates of postoperative corneal edema (27.1%) than ECCE patients (12.8%) and transient intraocular pressure elevation (33.3%) versus 20.5%) but were more likely to receive posterior chamber intraocular lenses (70.8% versus 35.9%; P = .0024, chi-square test). After excluding pre-existing diseases, 83.3% of phaco patients and 67.6% of ECCE patients achieved a visual acuity of 6/12 or better. With careful patient selection, experienced extracapsular surgeons converting to phacoemulsification can achieve favorable results even in the presence of complications such as vitreous loss or dropped nucleus.

  3. 前列腺增生术后患者谵妄的影响因素及预见性护理%Analysis of influencing factors and nursing care of postoperative delirium in patients with benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    陶菊; 马胜珺; 徐青青

    2013-01-01

    Objective To investigate the influence factors of postoperative delirium in benign prostatic hyperplasia patients,so as to provide the basis for developing predictive assessment and establishing corresponding nursing intervention measures.Methods In this retrospective study,the clinical data of 210 patients with prostate surgery,of which 19 cases complicated with postoperative delirium during January 2010 and June 2012 were analyzed statistically.Results Postoperative delirium in patients with benign prostatic hyperplasia was a common result of multiple factors,the reason mainly were age,operation stress response,hyoxemia and pain,etc.Conclusions Providing predictive and corresponding nursing intervention after prostate operation can significantly reduce the incidence of postoperative delirium and promote the patients' recovery.%目的 探讨前列腺增生手术后患者并发谵妄的影响因素,为护士进行预见性评估、制定相应护理干预措施提供依据.方法 2010年1月至2012年6月行前列腺增生手术患者210例,术后并发谵妄19例,对其临床资料进行回顾性分析.结果 前列腺增生术后并发谵妄是多因素共同作用的结果,高龄、手术应激反应、低氧血症、疼痛等都可引起谵妄的发生.结论 护士正确评估病情,早期给予预见性护理,能减少前列腺增生术后谵妄的发生,促进患者康复.

  4. Postoperative Ileus in the Elderly

    Directory of Open Access Journals (Sweden)

    Chih-Peng Tu

    2014-03-01

    Full Text Available Postoperative ileus is among the most common complications after surgery. Aging is associated with an increased colonic transit time, and anesthetic disturbance to colonic motility is often aggravated in the elderly. Postoperative ileus increases morbidity, prolongs the length of hospital stay, and constitutes a significant economic burden on the healthcare system. Multimodal enhanced recovery protocols, or fast-track surgeries, have been developed to improve postoperative recovery. Patient education, avoidance of perioperative fluid overload, selective use of nasogastric decompression, early ambulation, adopting a minimally invasive approach, early initiation of clear fluids, and gum chewing are all possible measures to reduce postoperative ileus. Thoracic epidural anesthesia is a well-established technique to hasten recovery, whereas insufficient data are available to ascertain the safety and efficacy of opioid-sparing analgesia in the elderly. The evidence is clear that traditional prokinetic medications are not helpful in the treatment or prevention of postoperative ileus. Early results suggest that alvimopan is a promising agent to reverse opioid-induced ileus. Since postoperative ileus is a multifactorial condition, a concerted effort is therefore necessary to prevent or decrease the duration of postoperative ileus using multimodal strategies.

  5. Deep brain stimulation: postoperative issues.

    Science.gov (United States)

    Deuschl, Günther; Herzog, Jan; Kleiner-Fisman, Galit; Kubu, Cynthia; Lozano, Andres M; Lyons, Kelly E; Rodriguez-Oroz, Maria C; Tamma, Filippo; Tröster, Alexander I; Vitek, Jerrold L; Volkmann, Jens; Voon, Valerie

    2006-06-01

    Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.

  6. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    Science.gov (United States)

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  7. Patient-controlled modalities for acute postoperative pain management.

    Science.gov (United States)

    Miaskowski, Christine

    2005-08-01

    Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Several patient-controlled analgesia (PCA) modalities are currently available for the treatment of acute postoperative pain, including intravenous (IV) PCA, epidural (PCEA), and oral PCA. Although PCEA and IV PCA are both commonly used modalities, IV PCA is considered the standard of care for postoperative pain management. Limitations of this modality do exist, however. Consequently, noninvasive PCA systems are under development to circumvent many of these limitations, including the fentanyl hydrochloride patient-controlled transdermal system (PCTS); (IONSYS Ortho-McNeil Pharmaceutical, Raritan, NJ) and a number of patient-controlled intranasal analgesia (PCINA) delivery systems. The objective of this article is to review the PCA modalities currently in use and to discuss those in development for the treatment of acute postoperative pain.

  8. Postoperative radiotherapy for endometrial cancer

    National Research Council Canada - National Science Library

    Choi, Eun Cheol; Kim, Jin Hee; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon

    2012-01-01

    .... Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study...

  9. Alcohol abuse and postoperative morbidity

    DEFF Research Database (Denmark)

    Tønnesen, Hanne

    2003-01-01

    precise identification of alcohol abuse. However, the inability of the questionnaires to detect short-term changes in intake and abuse without dependence, the inconsistent predictive values of the biological markers, and the lack of evidence of an association to postoperative morbidity reduces......Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could...... be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re...

  10. Dilemas bioéticos del postoperatorio en cirugía cardiovascular pediátrica: futilidad y limitación del esfuerzo terapéutico Bioethical dilemma of postoperative care of pediatric cardiovascular surgery: futility and limitation of life-sustaining treatments

    Directory of Open Access Journals (Sweden)

    Luis Enrique Marcano Sanz

    2011-08-01

    Full Text Available Los avances en la medicina, en especial en el área de los cuidados intensivos postoperatorios, han determinado un aumento importante en la supervivencia de niños que hasta hace poco tiempo morían de forma irremediable. Las decisiones de limitación del esfuerzo terapéutico y cuando considerar la futilidad de un tratamiento son polémicas pues generan gran estrés intelectual y emocional en las personas que tienen la responsabilidad de decidir, sobre todo en Pediatría. El trabajo tiene como objetivo reflexionar sobre los dilemas bioéticos que se presentan en el postoperatorio de la cirugía cardiovascular pediátrica, para fomentar discusiones y elaborar recomendaciones concretas que faciliten la toma de decisiones clínicas.Medical advances, especially in postoperative intensive care, have significantly increased the survival of children, who inevitably used to die in recent years. The decisions on life-sustaining treatments and acceptance of their futility are controversial and cause intellectual and emotional stress in those involve in decision making, particularly in Pediatrics. This paper reflects on bioethical dilemmas present in postoperative care of pediatric cardiovascular surgery, so as to incite discussions and produce concrete recommendations that facilitate clinical decision making.

  11. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study) : study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Valkenet, Karin; Trappenburg, Jaap Ca; Gosselink, Rik; Sosef, Meindert N; Willms, Jerome; Rosman, Camiel; Pieters, Heleen; Scheepers, Joris Jg; de Heus, Saskia C; Reynolds, John V; Guinan, Emer; Ruurda, Jelle P; Rodrigo, Els He; Nafteux, Philippe; Fontaine, Marianne; Kouwenhoven, Ewout A; Kerkemeyer, Margot; van der Peet, Donald L; Hania, Sylvia W; van Hillegersberg, Richard; Backx, Frank JG

    2014-01-01

    BACKGROUND: Esophageal resection is associated with a high incidence of postoperative pneumonia. Respiratory complications account for almost half of the readmissions to the critical care unit. Postoperative complications can result in prolonged hospital stay and consequently increase healthcare cos

  12. Radiological Features and Postoperative Histopathologic Diagnosis ...

    African Journals Online (AJOL)

    Radiological Features and Postoperative Histopathologic Diagnosis of Intracranial Masses at Tikur Anbessa ... East and Central African Journal of Surgery ... features and postoperative histopathology diagnosis of intracranial mass lesions.

  13. Varieties of conventional implicature

    Directory of Open Access Journals (Sweden)

    Eric Scott McCready

    2010-07-01

    Full Text Available This paper provides a system capable of analyzing the combinatorics of a wide range of conventionally implicated and expressive constructions in natural language via an extension of Potts's (2005 L_CI logic for supplementary conventional implicatures. In particular, the system is capable of analyzing objects of mixed conventionally implicated/expressive and at-issue type, and objects with conventionally implicated or expressive meanings which provide the main content of their utterances. The logic is applied to a range of constructions and lexical items in several languages. doi:10.3765/sp.3.8 BibTeX info

  14. [Postoperative patient. Treatment plan].

    Science.gov (United States)

    López Medina, I M; Sánchez Criado, V

    2001-03-01

    In order to prevent problems and complications which patients who have undergone surgery tend to suffer, it is fundamental to utilize a generic standardized treatment plan due to the preventive dimension which nursing care may then acquire. So that this treatment plan provide greater effectiveness, it should include standardized nursing interventions such as those listed in the Classification of Nursing Interventions since by this method, a common terminology is built up among professionals which provides continuity to treatment and facilitates the selection of adequate interventions for each situation. This report establishes the most frequent nursing diagnoses among post-surgical patients and adapts these to the nursing treatments in the Classification of Nursing Interventions.

  15. 下肢吊架在足踝部皮瓣术后护理中的应用%Study on Application of Lower Extremity Hanger in Postoperative Care of Foot and Ankle Flaps

    Institute of Scientific and Technical Information of China (English)

    姚楠; 孙士温; 王书岚

    2016-01-01

    目的:探讨自制下肢吊架在足踝部皮瓣术后护理中的实践应用和护理体会。方法:2012年9月—2016年2月共筛选了58例有不同程度足踝部皮肤软组织缺损的病人。行小腿外侧或内侧穿支皮瓣及游离皮瓣移植。术后应用下肢吊架辅助悬吊肢体体位。术前术后予有效的心理护理及密切的血运观察。结果:58例病人全部得到了随访,随访时间3~39个月,平均20个月。58例皮瓣均成活,其中有2例皮瓣远端部分坏死,经二次手术植皮修复。结论:下肢吊架可在足踝部皮瓣术后有效悬吊肢体,防止皮瓣压迫,有利于护理和血运观察。%Objective: to investigate the homemade lower limb hanger in the foot skin flap ’s postoperative nursing practice and nursing experience. Methods:screened 58 patients with different degree of skin and soft tissue defect of foot from September 2012 to February 2016. Line the inner or outer leg perforators flap and free flap transplantation. Postoperative lower limb hanger auxiliary suspension body postures. Preoperative to effective psychological nursing and postoperative close observation blood supply. Results: all 58 cases received follow-up, follow-up time 3~39 months, average of 20 months. 58 cases were transplanted tissues survived, one of the distal part of 2 cases of flap necrosis, skin graft to repair by the secondary surgery. Conclusion:the lower extremities suspension in the postoperative foot flap suspension body effectively, prevent skin flap, is advantageous to the nursing and observation blood supply.

  16. [Postoperative findings in the spinal column].

    Science.gov (United States)

    Lieb, J M; Ulmer, S; Kelm, J; Shariat, K; Stippich, C; Ahlhelm, F J

    2011-09-01

    Postoperative imaging after spinal surgery is usually performed to document the correct positioning of implants or to rule out complications if patients still suffer from pain after surgery. Depending on the question various imaging modalities can be used all of which have benefits and limitations. Conventional X-ray is used for the documentation of the correct positioning of spinal implants, stability (olisthesis) and during follow-up to rule out fractures or instability of the implants, whereas soft tissue changes cannot be completely assessed. Besides these indications, imaging is usually performed because of ongoing symptoms (pain for the most part) of the patients. Soft tissue changes including persistent or recurrent herniated disc tissue, hematoma or infection can best be depicted using magnetic resonance imaging (MRI) which should be performed within the immediate postoperative period to be able to distinguish physiological development of scar tissue from inflammatory changes in the area of the surgical approach. Often imaging alone cannot differentiate between these and imaging can therefore only be considered as an adjunct. Computed tomography is the modality of choice for the evaluation of bony structures and an adjunct of new therapies such as image-guided application of cement for kyphoplasty or vertebroplasty.

  17. Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study

    DEFF Research Database (Denmark)

    Ottesen, Marianne; Møller, Charlotte; Kehlet, H

    2001-01-01

    BACKGROUND: Postoperative care and convalescence recommendations following vaginal surgery are generally not evidence based. The aim of this study was to describe pre and postoperative treatment, and advice and restrictions for the convalescence period, given by Danish hospital-employed gynecolog...

  18. A qualitative report of patient problems and postoperative instructions.

    Science.gov (United States)

    Atchison, Kathryn A; Black, Edward E; Leathers, Richard; Belin, Thomas R; Abrego, Mirna; Gironda, Melanie W; Wong, Daniel; Shetty, Vivek; DerMartirosian, Claudia

    2005-04-01

    While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction. African American or Latino patients, 18 years of age or older, who had third molars removed under general anesthesia or received treatment for a mandibular fracture were recruited to participate in a focus group to discuss their treatment. Patients described their problem and any informed consent given about treatment risks and benefits and postoperative information they recalled. A total of 137 former patients were approached, 57 agreed to participate (42%) and 34 of those (60%) completed the interview. Subjects included 14 females and 20 males. Five categories of patient problems were reported: physical, eating, treatment-related, psychosocial, and other problems. People reported 5 categories of coping strategies: medication use, physical treatments, dietary solutions, rest, and clinical assistance. Twenty people recalled being given informed consent, and 5 participants recalled no elements of informed consent. Overall, 14 participants recalled elements of postoperative instruction. Gaps in patient understanding of postoperative care suggest room for improvement in postoperative instructions. Additional research is necessary to design and test high-quality postoperative instructions for surgical treatment and recovery in populations with limited health related literacy.

  19. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    Science.gov (United States)

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  20. A prospective study on postoperative discomfort after 20-gauge pars plana vitrectomy

    Directory of Open Access Journals (Sweden)

    Yu JG

    2015-07-01

    Full Text Available Ji-guo Yu,1,* Fang Ni,1,* Yi Xiang,1 Yi-fan Feng,2 Jue Wang,1 Xun-an Fu11Department of Ophthalmology, the Central Hospital of Wuhan, Wuhan, Hubei Province, 2Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workPurpose: To evaluate postoperative pain and other irritation symptoms after 20-gauge (20G pars plana vitrectomy.Materials and methods: A total of 110 consecutive patients were enrolled in our studies, and 87 patients who underwent the conventional 20G pars plana vitrectomy were included in the final analysis. All vitrectomies were performed using the same surgical technique by the same surgeon. Patients were examined before surgery and 1 day, 3 days, 7 days, 1 month, and 2 months postoperatively. The main outcome measures include patient age and sex, intraocular pressure (IOP, ocular pain, pain score, pain medication use, and other irritation symptoms comprising itching, foreign body sensation, burning, photophobia, and dryness. The pain was evaluated using the Numerical Rating Scale scored from 0 to 10.Results: Postoperative pain was relatively common during the first day after surgery, as it was reported by 43 (49.4% patients. Then, the prevalence gradually decreased to eleven (12.6% patients at 2 months. Most patients reported mild or moderate pain, with a pain score of 1–5, but only four patients were given analgesics for ocular pain. A postoperative rise of IOP was noted in 25 patients at day 1. Most of these patients with high IOP reported moderate pain. Other ocular irritation symptoms were varied after surgery. There was still one-quarter of patients that had foreign body sensation and dryness symptoms at month 2 after surgery.Conclusion: Mild and moderate ocular pain were relatively common after 20G vitrectomy, which is more often associated with elevated IOP. Other irritation symptoms were also presented after surgery and could

  1. Preventive analgesia for postoperative pain control: a broader concept

    Directory of Open Access Journals (Sweden)

    Vadivelu N

    2014-04-01

    Full Text Available Nalini Vadivelu,1 Sukanya Mitra,2 Erika Schermer,3 Vijay Kodumudi,4 Alan David Kaye,5 Richard D Urman61Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA; 2Department of Anesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India; 3Yale College, New Haven, 4School of Liberal Arts and Science, University of Connecticut, Storrs, CT, 5Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 6Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USAAbstract: Pain from surgical procedures occurs as a consequence of tissue trauma and may result in physical, cognitive, and emotional discomfort. Almost a century ago, researchers first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and long-term postoperative pain, now referred to as central sensitization. Nociceptor activation is mediated by chemicals that are released in response to cellular or tissue damage. Pre-emptive analgesia is an important concept in understanding treatment strategies for postoperative analgesia. Pre-emptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively but not after surgical incision. Additional research in pre-emptive analgesia is warranted to better determine good outcome measurements and a better appreciation with regard to treatment optimization. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics.Keywords: preventive analgesia, central

  2. Analysis of nursing care of postoperative gastric cancer of nasal jejunum nutrient canal%胃癌术后鼻空肠营养管的护理分析

    Institute of Scientific and Technical Information of China (English)

    王红梅

    2014-01-01

    目的:探讨胃癌术后利用鼻空肠营养管给予肠内营养支持的具体护理体会。方法选取我院2013年8月-2014年7月胃癌患者14例。所有患者完成手术后,均应用鼻空肠营养管给予肠内营养。通过随机数表法将所有胃癌患者分为B1组(观察组7例)与B2组(对照组7例)。 B2组:胃癌术后实施常规护理;B1组:胃癌术后实施鼻空肠营养管护理;对比B1组与B2组胃癌患者在术后并发症出现概率以及住院时间等方面表现出的差异性。结果 B1组患者中,术后出现胃肠不适症状患者1例。在B2组患者中,出现胃肠不适症状患者4例,出现吻合口瘘症状患者3例。在术后并发症方面,B1组优于B2组胃癌患者明显(P<0.05);B1组患者住院时间为(10.2±1.2)d,B2组患者为(13.9±1.9)d,在患者住院时间方面,B1组短于B2组患者明显(P<0.05)。结论针对胃癌术后患者,选择鼻空肠营养管给予肠内营养支持,并配合给予护理干预,能够显著促进患者胃肠功能的恢复,降低术后并发症出现概率,将住院时间有效缩短,有效凸显鼻空肠营养管护理的应用价值。%Objective To study the postoperative gastric cancer using nasal jejunum nutrition tube enteral nutrition support for specific nursing experience. Methods To choose our 5, 2013-08, 2014-07, 14 patients with gastric cancer.All patients completed after surgery, nasal jejunum nutrition tube enteral nutrition. All patients with gastric cancer by random indicator method divided into B1 group (observation group of 7 cases) and B2 group of 7 cases (control group). B2: gastric cancer postoperative routine nursing; B1: gastric cancer postoperative nasal jejunum nutrition tube nursing;Compare the B1 and B2 group of postoperative com-plications in patients with gastric cancer probability as well as the length of hospital stay, etc, to show the difference. Results In terms of

  3. A Case of Incus Vibroplasty: Postoperative Changes in Residual Hearing

    Science.gov (United States)

    Roh, Kyung Jin; Lee, Eun Jung; Choi, Byung Il

    2015-01-01

    In patients with mild to severe hearing loss, conventional hearing aids offer limited benefits and several problems with feedback and cosmesis. Middle ear implants are a feasible option for patients with moderate to severe hearing loss who are unable to achieve adequate benefit from or cannot tolerate hearing aids for various reasons. Here we present a case of middle ear implant surgery using Vibrant Soundbridge with incus vibroplasty technique, and describe the hearing changes during postoperative follow-up. PMID:26185793

  4. The Geometry of Conventionality

    CERN Document Server

    Weatherall, James Owen

    2013-01-01

    Hans Reichenbach famously argued that the geometry of spacetime is conventional in relativity theory, in the sense that one can freely choose the spacetime metric so long as one is willing to postulate a "universal force field". Here we make precise a sense in which the field Reichenbach defines fails to be a "force". We then argue that there is an interesting and perhaps tenable sense in which geometry is conventional in classical spacetimes. We conclude with a no-go result showing that the variety of conventionalism available in classical spacetimes does not extend to relativistic spacetimes.

  5. Alcohol abuse and postoperative morbidity

    DEFF Research Database (Denmark)

    Tønnesen, Hanne

    2003-01-01

    Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could...... be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re......-operation. The personal and economic consequences are tremendous. The incidence of alcohol abusers undergoing surgery was 7% to 49%, according to gender and diagnosis. They have been identified by a self-reported alcohol intake, which implies the possibility of underestimation. Alcohol markers could be used for a more...

  6. Observation and Nursing Care with Postoperative Acute Delirium%脑外科患者发生术后急性谵妄的临床观察及护理

    Institute of Scientific and Technical Information of China (English)

    王芬

    2013-01-01

    目的:分析脑外科患者发生术后急性谵妄的情况及临床表现,以便采取相应的护理对策,改善病情,促进术后恢复。方法收集2012年1月至2013年1月期间手术后入住我院脑外科的患者112例,对其中并发急性谵妄的27例患者的临床资料进行分析。结果随着年龄的增长,术后发生急性谵妄的比例也增高。80岁以上的高龄患者术后急性谵妄的发生率明显高于其他年龄组,患有器质性脑病的患者发生术后急性谵妄的比例远远高于患有其他基础疾病的患者。结论护理人员加强对住院老年患者的观察与护理,正确认识老年谵妄的临床特征,早期发现谵妄的先兆症状,分析其原因并采取相应的治疗及护理干预,是促使患者早日恢复健康的重要举措。%Objective To investigate the situation and clinical manifestations of postoperative acute delirium of elderly patients in deparment of cerebral surgery and take corresponding nursing countermeasures to improve their recovery.Methods Clinical data of 27 cases with postoperative acute delirium among 1 1 2 eld-erly patients hopitalized in our hospital from January 201 2 to January 201 3 were collected and analyzed.Results The occurrence rate of postoperative acute delirium increases with the age growing.The occurrence rate of postopera-tive acute delirium in patients over the age of 80 was significantly higher than those in groups of other age,patients with organic encephalopa-thy higher than those complicated with other underlying diseases.Conclusion The nurses should enhance the observation of hospitalized eld-erly pat ients,improve understanding of the clinical features of elderly delirium and get to know early detection of delirium symptoms.The causes should be analyzed and appropriate treatment and nursing intervention should be conducted.All these are important initiatives to pro-mote the health of patients.

  7. Conventional Spinal Anaesthesia

    African Journals Online (AJOL)

    patients scheduled for clcctive unilateral lower limb surgery. ... the conventional group were turned supine immediately after injection. Blood pressure, heart rate, respiratory rate and oxygen .... Characteristic Type of spinal anaesthcsia P-value.

  8. 个性化护理干预对直肠癌造口术后患者自护能力及自尊水平的影响%Efficacy of individualized nursing intervention on postoperative self-care ability and self-esteem of rectal cancer stoma patients

    Institute of Scientific and Technical Information of China (English)

    朱开梅; 丁瑜

    2016-01-01

    目的 探讨个体化护理干预在直肠癌造口术术后患者护理中的应用效果.方法 选取2013年12月至2014年12月间收治的70例直肠癌造口术患者,采用随机数字表法分为观察组和对照组,每组35例.观察组患者在常规护理的基础上给予个性化护理,对照组患者术后仅给予常规护理,比较两组患者术后的自护能力及自尊水平.结果 护理后,观察组患者在自我概念、自我责任、自我护理技能等方面的评分均高于对照组,差异有统计学意义(P<0.05).护理后,观察组患者的外表自尊、行为自尊和社会自尊评分均高于对照组,差异有统计学意义(P<0.05).结论 个体化护理干预能够提高直肠癌造口术患者的自护能力及自尊水平,利于身心康复.%Objective To investigate the efficacy of individualized nursing intervention in postoperative nursing of rectal cancer stoma patients.Methods From December 2013 to Decenber 2014 in Wuhan University People's Hospital,70 rectal cancer stoma patients were enrolled in the study and randomly divided into the observation group and the control group,with 35 cases in each group.The observation group accepted postoperative individualized nursing intervention based on postoperative routine nursing and the control group accepted postoperative routine nursing.The self-care postoperative ability and self-esteem of the two groups were compared.Results The scores of self-concept,self-responsibility and self-care skill after nursing in the observation group were significantly higher than those in the control group,with significant differences (P < 0.05).The scores of self-esteem,behavior self-esteem and social self-esteem in the observation group were significantly higher than those in the control group,with significant differences (P < 0.05).Conclusion Individualized nursing intervention can improve self-care ability and self-esteem level of rectal cancer stoma patients.It is conducive to

  9. The Evaluation of Standardized Nursing Model in Congenital Esophageal Atresia Postoperative Care%标准化护理模式在先天性食道闭锁患儿术后护理的效果评价

    Institute of Scientific and Technical Information of China (English)

    殷茵

    2015-01-01

    目的:总结标准化护理模式在32例新生儿先天性食道闭锁术后的护理经验。具体包括综合情况,管道护理,呼吸道护理和并发症观察。方法分析自2007年2月~2014年6月我科收治的先天性食道闭锁患儿,对是否使用标准化护理模式分组使用χ2检验和 FISH 确切改良法评估。结果标准化护理模式的不良事件发生率明显低于对照组。结论标准化护理模式可明显提高先天性食道闭锁术后患儿护理质量。%Objective To standardize models of care in 32 cases of congenital esophageal atresia of nursing experience. Including the consolidation of pipes care, respiratory care and complications encountered. Methods Since February 2007 to June 2014 congenital esophageal admitted to our department atresia, whether using a standardized model of care group using chi-square test and FISH exact assessment of the improved method. Results Standardized care model incidence of adverse events was significantly lower than the control group. Conclusion The standardized model of care can significantly improve the care quality of children with congenital esophageal atresia.

  10. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.

    Science.gov (United States)

    Haase-Fielitz, Anja; Bellomo, Rinaldo; Devarajan, Prasad; Story, David; Matalanis, George; Dragun, Duska; Haase, Michael

    2009-02-01

    To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function. Single-center, prospective observational study. Tertiary hospital. One hundred adult cardiac surgical patients. We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate fair value in such patients. At 24 hours postoperatively, all renal biomarkers were of good predictive value. On arrival in ICU, novel biomarkers were superior to conventional biomarkers (p value in the prediction of the composite end point. Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.

  11. Multimodal approach to postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2009-01-01

    PURPOSE OF REVIEW: To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). RECENT FINDINGS: The value of the fast-track methodology to improve recovery and decrease hospital stay...

  12. Postoperative ileus: a preventable event

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2000-01-01

    BACKGROUND: Postoperative ileus has traditionally been accepted as a normal response to tissue injury. No data support any beneficial effect of ileus and indeed it may contribute to delayed recovery and prolonged hospital stay. Efforts should, therefore, be made to reduce such ileus. METHODS: Mat...

  13. Postoperative Complications of Beger Procedure

    Directory of Open Access Journals (Sweden)

    Nayana Samejima Peternelli

    2015-01-01

    Full Text Available Introduction. Chronic pancreatitis (CP is considered an inflammatory disease that may cause varying degrees of pancreatic dysfunction. Conservative and surgical treatment options are available depending on dysfunction severity. Presentation of Case. A 36-year-old male with history of heavy alcohol consumption and diagnosed CP underwent a duodenal-preserving pancreatic head resection (DPPHR or Beger procedure after conservative treatment failure. Refractory pain was reported on follow-up three months after surgery and postoperative imaging uncovered stones within the main pancreatic duct and intestinal dilation. The patient was subsequently subjected to another surgical procedure and intraoperative findings included protein plugs within the main pancreatic duct and pancreaticojejunal anastomosis stricture. A V-shaped enlargement and main pancreatic duct dilation in addition to the reconstruction of the previous pancreaticojejunal anastomosis were performed. The patient recovered with no further postoperative complications in the follow-up at an outpatient clinic. Discussion. Main duct and pancreaticojejunal strictures are an unusual complication of the Beger procedure but were identified intraoperatively as the cause of patient’s refractory pain and explained intraductal protein plugs accumulation. Conclusion. Patients that undergo Beger procedures should receive close outpatient clinical follow-up in order to guarantee postoperative conservative treatment success and therefore guarantee an early detection of postoperative complications.

  14. Cumulative incidence of postoperative severe pain at Hospital Universitario San Jose, Popayan. Preliminar report

    Directory of Open Access Journals (Sweden)

    Ingrid Muñoz

    2013-12-01

    Full Text Available Introduction: Postoperative pain remains as a problem. National studies report incidences of 31% for moderate and 22% for severe pain. Inadequate analgesia is related to dissatisfaction and adverse outcomes. The aim of this study was to describe the incidence and characteristics of the postoperative pain in the post-anesthesia care unit (PACU at Hospital Universitario San José of Popayán (HUSJ in patients undergoing general anesthesia during the first postoperative hour. Methods: Cohort study. We recruited patients attending PACU and undergoing procedures using general anesthesia, between 18 and 70 years. Using a standardized collection form medical history, demographic data, medical history, anesthetic management, intraoperative analgesia and postoperative pain assessment by verbal and numerical pain scale (1-10 were recorded. Postoperative outcome data were also collected in the PACU. Results: The incidence of severe postoperative pain at 10 minutes was 12.3% 95%CI [7.1-18.2] (19 patients. Within 30 minutes of assessment 4.5% 95%CI [1.3-8.4] (7 patients and 1.9% 60 minutes 95%CI [0-4.5] (3 patients. 48.7% required rescue analgesic at PACU. Incidence of postoperative nausea and vomiting (PONV was significantly different in patients requiring rescue analgesic. Conclusion: The incidence of severe postoperative pain in the first postoperative hour at HUSJ is close to 12% and it decreases as time goes by. Patients requiring rescue analgesic have a higher incidence of postoperative complications such as PONV.

  15. Cuidados pré e pós-operatórios em cirurgia cardiotorácica: uma abordagem fisioterapêutica Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach

    Directory of Open Access Journals (Sweden)

    Lívia Arcêncio

    2008-09-01

    Full Text Available Sabe-se que a anestesia e determinadas cirurgias predispõem a alterações na mecânica respiratória, volumes pulmonares e trocas gasosas. A cirurgia cardíaca, considerada de grande porte, pode desencadear alterações respiratórias no pós-operatório, sendo estas relacionadas a causas diversas, como funções pulmonar e cardíaca no pré-operatório, utilização de circulação extracorpórea (CEC e grau de sedação. Nestes procedimentos torácicos extensos, a disfunção respiratória pode ser importante, persistindo no período pós-operatório. A Fisioterapia faz parte do atendimento multidisciplinar oferecido aos pacientes em Unidade de Terapia Intensiva, sendo sua atuação extensa, presente em várias etapas do tratamento intensivo, principalmente na recuperação pós-cirúrgica, com o objetivo de evitar complicações respiratórias e motoras. Sendo assim, realizou-se uma revisão bibliográfica com o objetivo de reunir informações atuais e relevantes sobre recursos disponíveis para a monitorização respiratória, bem como a sua importância para avaliação e atuação diante de alterações na função pulmonar, uma vez que tal complicação é causa freqüente de óbito em pacientes operados.It is well known that anesthesia and certain surgeries predispose patients to changes in respiratory function, pulmonary volumes, and gas exchange. Cardiac surgery, which is considered a major surgery, may trigger respiratory complications in the postoperative period. These complications have various causes, such as heart and lung functions in the pre-operative, the use of cardiopulmonary bypass (CPB, and the level of sedation. In these extensive thoracic procedures, respiratory dysfunction may be significant, persisting in the postoperative period. Physiotherapy is offered to patients in the ICU as part of a multidisciplinary treatment plan. It is a time-consuming treatment, and is possible at various times during the patient's stay

  16. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    Science.gov (United States)

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  17. Postoperative imaging of paranasal sinuses; Postoperative Bildgebung der Nasennebenhoehlen

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, S.; Czerny, C. [Abt. fuer Osteologie, Klinik fuer Radiodiagnostik, AKH/Medizinische Univ. Wien (Austria); Formanek, M. [Klinik fuer Hals-, Nasen- und Ohrenheilkunde, AKH/Medizinische Univ. Wien (Austria)

    2007-07-15

    The radiological interpretation of postoperative changes of the paranasal sinuses requires knowledge of why and how the surgical intervention was performed and what the basic clinical findings were. It is important to know whether there was an inflammation, a reconstructive procedure, or a tumorous process. Multidetector computed tomography (MDCT) evaluated in a high-resolution bone window level setting represents the method of choice for imaging after nonfunctional and functional procedures after inflammatory changes as well as for imaging after reconstructive surgery because of facial trauma or before dental implantation. In the postoperative follow-up of tumor patients contrast-enhanced MDCT evaluated in a soft tissue window and bone window and especially magnetic resonance imaging (MRI) represent the standard. In many cases it is possible to differentiate tumor recurrence from inflammation with the help of contrast-enhanced multiplanar MRI and to detect bone marrow changes prior to CT. (orig.)

  18. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty

    DEFF Research Database (Denmark)

    Fischer, H.B.; Simanski, C.J.; Sharp, C.

    2008-01-01

    The PROSPECT Working Group, a collaboration of anaesthetists and surgeons, conducts systematic reviews of postoperative pain management for different surgical procedures (http://www.postoppain.org). Evidence-based consensus recommendations for the effective management of postoperative pain are th...... techniques, should be supplemented with paracetamol and conventional non-steroidal anti-inflammatory drugs or COX-2-selective inhibitors, plus intravenous strong opioids (high-intensity pain) or weak opioids (moderate- to low-intensity pain) Udgivelsesdato: 2008/10...

  19. Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Lebron Cooper

    2011-01-01

    Full Text Available Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications.

  20. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

    Directory of Open Access Journals (Sweden)

    Spinelli Allison

    2011-07-01

    Full Text Available Abstract Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight and to the

  1. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

    OpenAIRE

    Mans Christina M; Reeve Julie C; Gasparini Catherine A; Elkins Mark R

    2012-01-01

    Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in...

  2. Minimal Invasive Urologic Surgery and Postoperative Ileus

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-07-01

    Full Text Available Postoperative ileus (POI is the most common cause of prolonged length of hospital stays (LOS and associated healthcare costs. The advent of minimal invasive technique was a major breakthrough in the urologic landscape with great potential to progress in the future. In the field of gastrointestinal surgery, several studies had reported lower incidence rates for POI following minimal invasive surgery compared to conventional open procedures. In contrast, little is known about the effect of minimal invasive approach on the recovery of bowel motility after urologic surgery. We performed an overview of the potential benefit of minimal invasive approach on POI for urologic procedures. The mechanisms and risk factors responsible for the onset of POI are discussed with emphasis on the advantages of minimal invasive approach. In the urologic field, POI is the main complication following radical cystectomy but it is rarely of clinical significance for other minimal invasive interventions. Laparoscopy or robotic assisted laparoscopic techniques when studied individually may reduce to their own the duration and prevent the onset of POI in a subset of procedures. The potential influence of age and urinary diversion type on postoperative ileus is contradictory in the literature. There is some evidence suggesting that BMI, blood loss, urinary extravasation, existence of a major complication, bowel resection, operative time and transperitoneal approach are independent risk factors for POI. Treatment of POI remains elusive. One of the most important and effective management strategies for patients undergoing radical cystectomy has been the development and use of enhanced recovery programs. An optimal rational strategy to shorten the duration of POI should incorporate minimal invasive approach when appropriate into multimodal fast track programs designed to reduce POI and shorten LOS.

  3. Persistent postoperative hiccups: a review

    DEFF Research Database (Denmark)

    Hansen, B J; Rosenberg, J

    1993-01-01

    The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess of gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined....... Numerous treatment modalities have been tried but with questionable success. Valproate has proven effective in two trials investigating persistent non-surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity...... in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided....

  4. [The importance of communication during the postoperative recovery period].

    Science.gov (United States)

    Razera, Ana Paula Ribeiro; Braga, Eliana Mara

    2011-06-01

    The objective of this study was to learn about the importance of communication when the nursing team gives postoperative orientations to patients and/or relatives at a private institution, and learn their perception about those orientations. This cross-sectional, descriptive study was performed using a qualitative approach, having Interpersonal Communication and Content Analysis as the theoretical and methodological frameworks, respectively. Participants were 16 patients interviewed in the postoperative period. Results showed that the nursing team focused the orientations on the instrumental techniques of the professions and did not approach the individuals in a holistic manner. It was also observed that when the nurse stands away from the patient and/or does not provide appropriate information, it generates feelings of anxiety, fear, insecurity and a sensation of lack of care in the patients. On the other hand, when the nursing team is present and provides coherent information, patients reported high satisfaction and a feeling of being well cared for.

  5. [Postoperative handling in biliodigestive derivation by iatrogenic bile duct injury].

    Science.gov (United States)

    Domínguez, I; Mercado, M A

    2008-01-01

    Bile duct injury is a severe complication related to cholecystectomy, impacting in the long-term quality of life and functional status. Bile duct repair is the first-line treatment for complex injuries. During short-term and long-term postoperative care, it is important to bear in mind the diagnostic tools, both laboratory and imaging, that will be useful to evaluate a possible surgical complication and to plan an adequate therapeutic strategy. In addition, post-surgical classification describes patients according to their complications and clinical course. In this review we describe the principal issues of postoperative care after bile duct repair, highlighting the diagnosis, severity classification and therapeutic approach of acute cholangitis.

  6. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery

  7. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery beca

  8. Prevention of postoperative recurrence of Crohn's disease

    NARCIS (Netherlands)

    van Loo, E. S.; Dijkstra, G.; Ploeg, R. J.; Nieuwenhuijs, V. B.

    2012-01-01

    Background: Up to 75% of patients with Crohn's disease (CD) will have intestinal resection during their life. Most patients will, however, develop postoperative recurrence (endoscopic, clinical or surgical). Several medical and surgical strategies have been attempted to prevent postoperative recurre

  9. 食管癌术后管道护理风险因素分析及防范对策%An analysis of the risk factors in the post-operative nursing care of the esophagus cancer for esophagus as well as precautions and countermeasures

    Institute of Scientific and Technical Information of China (English)

    赵红凤; 陈东桂; 谢秀萍

    2011-01-01

    Objective To summarize the risk factors in the post - operative nursing care of the esophagus cancer for the esophagus as well as the precautions and countermeasures. Methods A retrospective analysis of 35 cases of the post - operative nursing care for the esophagus was carried out. Results It turns out that the factors in the patients themselves, the esophagus and the nursing staff were the main factors which contributed to the risks of post - operative nursing care for the esophagus. Conclusion In conclusion, good management of post- operative patients, esophagus and the staff are key factors to prevent the risks of the esophagus cancer caused by post- operative nursing care for the esophagus and reduce the fatality rates and postoperative complications.%目的 总结食管癌术后管道护理风险因素及防范对策.方法 对35例食管癌术后管道护理进行回顾性总结分析.结果 患者本身因素、管道因素、护理人员因素是导致食管癌术后管道护理风险发生的主要因素.结论 加强术后患者、管道和护理人员管理,能有效预防食管癌术后管道护理风险发生,降低术后并发症和病死率发生.

  10. Postoperative activity restrictions: any evidence?

    Science.gov (United States)

    Weir, Larissa F; Nygaard, Ingrid E; Wilken, Jason; Brandt, Debra; Janz, Kathleen F

    2006-02-01

    Because of a widespread but untested belief that increased intra-abdominal pressure contributes to pelvic floor disorders, physicians commonly restrict various activities postoperatively. Our aim was to describe intra-abdominal pressures during common physical activities. Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters. We calculated median peak and net pressures (centimeters of H(2)O). We assessed correlations between abdominal pressures and body mass index, abdominal circumference, and grip strength (a proxy for overall strength). P climbing stairs, walking briskly, or doing abdominal crunches. Body mass index and abdominal circumference each correlated positively with peak, but not net, pressures. Age and grip strength were not associated with abdominal pressure. Some activities commonly restricted postoperatively have no greater effect on intra-abdominal pressures than unavoidable activities like rising from a chair. How lifting is done impacts intra-abdominal pressure. Many current postoperative guidelines are needlessly restrictive. Further research is needed to determine whether increased intra-abdominal pressure truly promotes pelvic floor disorders. III.

  11. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial.

    Science.gov (United States)

    Nilsson, U; Unosson, M; Rawal, N

    2005-02-01

    This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively. Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients' postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers. There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L(-1) decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups. This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption.

  12. CLINICAL STUDY OF POSTOPERATIVE WOUND INFECTION

    OpenAIRE

    Sudheer Darbha; Giddaluru Srihari

    2016-01-01

    BACKGROUND The aim of the study is to study the most common organisms encountered and their sensitivity and resistance to antibiotics in postoperative wound infection and to study relation of emergency and elective surgery to postoperative wound infection and to study efficacy of different modes of preoperative preparation on postoperative wound infection and to study distribution of postoperative wound infection among different surgeries based on bacterial contamination such a...

  13. Current Concepts in the Management of Postoperative Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    S. Chatterjee

    2011-01-01

    Full Text Available Postoperative nausea and vomiting (PONV are still common following surgery. This is not only distressing to the patient, but increases costs. The thorough understanding of the mechanism of nausea and vomiting and a careful assessment of risk factors provide a rationale for appropriate management of PONV. Strategy to reduce baseline risk and the adoption of a multimodal approach will most likely ensure success in the management of PONV.

  14. The significance of post-operative fever following airway reconstruction.

    Science.gov (United States)

    Schraff, Scott A; Brumbaugh, Cheryl; Meinzen-Derr, Jareen; Willging, J Paul

    2010-05-01

    Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction. Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs) from May 1, 2006 - April 30, 2007 at a tertiary care pediatric hospital. Fever was defined as temperature >or=38.5. A fever was "significant" if accompanied by a positive sputum, blood or urine culture, or an elevated WBC. Chest radiograph (CXR) results and co-morbidities were examined. Forty-five percent of cases (35/78) had fever. Of those febrile, 46% (n=16) had significant fever. Overall, 20.5% had significant fevers. Fifty-two cases were single-stage LTP (SSLTP) with 31 febrile and 26 cases were double-stage LTP (DSLTP) with 4 febrile. SSLTP cases were at a significantly greater risk for post-operative fever compared with DSLTP, 59% vs 15% respectively (p=0.0002). 42% of febrile SSLTPs (n=13) had significant fevers compared to 50% (n=2) of febrile DSLTPs (Fisher's Exact p=1.0). 81.5% of cases with CXR findings had fevers, but only 50% of these fevers were significant. Subjects with post-operative atelectasis were more likely to have a fever compared to subjects with no post-operative atelactasis (93% vs. 33% respectively, pfever, compared to 52% of those without atelectasis (p=0.2) and 25 of SSLTPs vs. 3.9% of DSLTPs had atelactasis (p=0.027). No comorbidities were shown to be significant risk factors for post-operative fever. Based on our review, most children undergoing LTPs will have insignificant fevers. Those children undergoing SSTLP and/or having post-operative atelectasis are at higher risk for post-operative fever. Fevers in children with double-stage procedures or all reconstruction cases with CXR findings other than atelectasis should have a thorough fever work-up. Copyright (c) 2010

  15. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  16. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  17. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  18. Conventional cerebrospinal fluid scanning

    Energy Technology Data Exchange (ETDEWEB)

    Schicha, H.

    1985-06-01

    Conventional cerebrospinal fluid scanning (CSF scanning) today is mainly carried out in addition to computerized tomography to obtain information about liquor flow kinetics. Especially in patients with communicating obstructive hydrocephalus, CSF scanning is clinically useful for the decision for shunt surgery. In patients with intracranial cysts, CSF scanning can provide information about liquor circulation. Further indications for CSF scanning include the assessment of shunt patency especially in children, as well as the detection and localization of cerebrospinal fluid leaks.

  19. National audit of post-operative management in spinal surgery

    Directory of Open Access Journals (Sweden)

    Dicken Ben

    2006-05-01

    Full Text Available Abstract Background There is some evidence from a Cochrane review that rehabilitation following spinal surgery may be beneficial. Methods We conducted a survey of current post-operative practice amongst spinal surgeons in the United Kingdom in 2002 to determine whether such interventions are being included routinely in the post-operative management of spinal patients. The survey included all surgeons who were members of either the British Association of Spinal Surgeons (BASS or the Society for Back Pain Research. Data on the characteristics of each surgeon and his or her current pattern of practice and post-operative care were collected via a reply-paid postal questionnaire. Results Usable responses were provided by 57% of the 89 surgeons included in the survey. Most surgeons (79% had a routine post-operative management regime, but only 35% had a written set of instructions that they gave to their patients concerning this. Over half (55% of surgeons do not send their patients for any physiotherapy after discharge, with an average of less than two sessions of treatment organised by those that refer for physiotherapy at all. Restrictions on lifting, sitting and driving showed considerable inconsistency both between surgeons and also within the recommendations given by individual surgeons. Conclusion Demonstrable inconsistencies within and between spinal surgeons in their approaches to post-operative management can be interpreted as evidence of continuing and significant uncertainty across the sub-speciality as to what does constitute best care in these areas of practice. Conducting further large, rigorous, randomised controlled trials would be the best method for obtaining definitive answers to these questions.

  20. Insulin-like growth factor I preserves renal function postoperatively.

    Science.gov (United States)

    Franklin, S C; Moulton, M; Sicard, G A; Hammerman, M R; Miller, S B

    1997-02-01

    Deterioration of renal function, which can lead to postoperative renal failure, is a complication of surgery involving the suprarenal aorta and surgery involving the renal arteries. Fifty-four patients who were at risk for developing this complication were enrolled in a double-blind, randomized, placebo-controlled trial of insulin-like growth factor (IGF-I) as a therapeutic agent to prevent the decline in renal function. The primary end point was the incidence of renal dysfunction, defined as a reduction of the glomerular filtration rate (creatinine clearance) at each of three measurements over 72 h. IGF-I (100 microg/kg subcutaneously every 12 h for 6 doses) or placebo was administered on admission to the intensive care unit immediately postoperatively. IGF-I- and placebo-treated groups were well matched for sex, age, type of surgery, renal ischemic time during surgery (ischemic index), baseline creatinine clearance, and baseline serum creatinine. No patient in the study developed acute renal failure postoperatively. IGF-I was well tolerated. A smaller proportion of patients in the IGF-I group had a postoperative decline in renal function (22%) than in the placebo-treated group (33%). There were no significant differences in levels of serum creatinine at time of discharge, length of hospital stay, length of intensive care unit stay, length of intubation, or incidence of dialysis or death. Our findings establish the feasibility and potential utility for the use of IGF-I to reduce the incidence of postoperative renal dysfunction in high-risk patients.

  1. Compliance of postoperative instructions following the surgical extraction of impacted lower third molars: A randomized clinical trial

    OpenAIRE

    Alvira González, Joaquín; Gay Escoda, Cosme

    2014-01-01

    Objectives: The understanding and adherence to postoperative care instructions are factors that influence the recuperation process after any surgical procedure. The aim of this study was to determine the percentage of patients who strictly follow the postoperative instructions after the extraction of an impacted lower third molar in relation to sociocultural level, preoperative anxiety scores and how postoperative information is provided to the patient. Study Design: Patients were randomly as...

  2. Features of postoperative treatment of patients with genital prolapse

    Directory of Open Access Journals (Sweden)

    Vdovin S.V.

    2012-03-01

    Full Text Available The aim of the study was to improve management of the postoperative period in patients with genital prolapse after surgery. Methods. Survey of 57 patients, which, depending on the characteristics of the postoperative period were divided into 2 groups: 22 patients received conventional treatment methods vagina seams, in complex treatment of 35 patients was included depantol. The effectiveness of inclusion depantol was control by clinical and laboratory (analysis of blood, vaginal discharge evidence. Results. Clinical and laboratory evidence of the effectiveness of inclusion depantol, which has antiseptic and stimulating regenerative processes, in the complex of therapeutic measures, reflected in the absence of infectious complications in patients of the main group and reducing lengths of stay in hospital. Conclusions. A higher efficiency of the new method is proved

  3. Postoperative jaundice after cardiac surger y

    Institute of Scientific and Technical Information of China (English)

    Aikaterini Mastoraki; Emmanouil Karatzis; Sotiria Mastoraki; Ioannis Kriaras; Petros Sifrakis; Stefanos Geroulanos

    2007-01-01

    BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clariifed. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation, to analyze the determinants, and to identify the clinical signiifcance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center, Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting (CABG), group B 31 patients who were subjected to aortic valve replacement (AVR)+CABG and group C 47 patients who underwent mitral valve replacement (MVR)+CABG. Aminotransferases, alkaline phosphatase, gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission, 24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS: Hyperbilirubinemia developed in 34 patients (26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-pass time (P CONCLUSIONS: Although hyperbilirubinemia seems to be multifactorial, the type of operation, the preoperative hepatic dysfunction due to advanced heart failure (NYHAⅡ-Ⅲ) and the decreased hepatic lfow during the operation seem to determine the incidence of jaundice.

  4. Prediction of postoperative pain after percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Pedersen, Katja Venborg; Olesen, Anne Estrup; Osther, Palle Jørn Sloth;

    2013-01-01

    Postoperative pain remains a significant problem and the individual variance in postoperative pain is not fully understood. In recent years, there has been focus on identifying risk factors predicting patients with high postoperative pain intensity or consumption of analgesics, which may facilitate...... thresholds were measured using electrical (single and 5 repeated) and pressure pain stimulation over the flank bilaterally (stone-side = operation side and control-side = non-operation side). Postoperative pain scores were recorded on a numerical rating scale and analgesic consumption was registered...... patients at high risk of postoperative pain....

  5. Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy.

    Science.gov (United States)

    Lee, Jandee; Nah, Kuk Young; Kim, Ra Mi; Ahn, Yeun Hee; Soh, Euy-Young; Chung, Woong Youn

    2010-12-01

    Robotic thyroidectomy using a gasless transaxillary approach, first described in 2008, has become popular. This study compared outcomes, including postoperative distress and patient satisfaction, for patients undergoing robotic thyroidectomy with those for patients treated by conventional open thyroidectomy. Of 84 prospectively enrolled patients, 41 underwent robotic thyroidectomy (the robot group), and 43 received conventional open thyroidectomy (the open group). All the patients were followed up for at least 3 months after surgery. Videolaryngostroboscopic examinations were performed preoperatively and after 1 week and after 3 months postoperatively. Postoperative pain and discomfort were evaluated using a symptom scale. Subjective voice and swallowing changes were assessed by questionnaires; and satisfaction with cosmetic outcome was measured by verbal response at 3 months. The two groups were similar in age, gender, type of operation, and final pathologic diagnosis. Although the mean operating time was significantly longer with the robotic technique than with open surgery, there were no between-group differences in postoperative pain or duration of hospital stay. No patient in either group experienced any major postoperative complication. Postoperative discomfort in the neck and swallowing disturbances were significantly more frequent in the open group than in the robot group, both at 1 week and at 3 months after surgery. However, there was no significant between-group difference in subjective voice parameters. At 3 months, the mean cosmetic satisfaction score was significantly higher in the robotic than in the open group. Although postoperative pain levels and complications were comparable in the two groups, conventional open thyroidectomy requires a shorter operative time. The robotic technique, however, offers several distinct advantages including very good to excellent cosmetic results, reduced postoperative neck discomfort, and fewer adverse swallowing

  6. Effect of team intervention model of multidisciplinary cooperation on postoperative self - care ability of patients with laryngeal cancer%多学科合作团队干预模式对喉癌患者术后自我护理能力的影响

    Institute of Scientific and Technical Information of China (English)

    高莲英; 李娜

    2015-01-01

    目的:探讨多学科合作团队干预模式对喉癌患者术后自我护理能力的影响。方法:将84例喉癌喉部分切除术患者随机分为观察组和对照组各42例,两组患者住院期间均给予呼吸内科常规护理,对照组出院后定期进行门诊随访,随访过程中对患者进行健康宣教;观察组在对照组基础上应用多学科合作团队干预模式实施干预。干预前后应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、自我护理能力测定量表(ESCA)、WHO 生存质量测定量表(WHO QOL - BREF)对两组患者负性情绪、自我护理能力及生存质量进行评价。结果:观察组干预后 HAMA、HAMD 评分显著高于对照组(P <0.05),观察组干预后健康知识水平、自护责任感、自我护理技能、自我概念评分均显著高于对照组(P <0.05),观察组出院时生理、心理、社会、环境维度评分均显著高于对照组(P <0.05)。结论:多学科合作团队干预模式能有效提高喉癌患者自我护理能力,改善患者负性情绪及生存质量。%Objective:To explore the effect of team intervention model of multidisciplinary cooperation on postoperative self - care ability of patients with laryngeal cancer. Methods:84 laryngeal cancer patients who underwent partial resection were randomly divided into the ob-servation group and the control group(42 cases in each group). The patients in both groups were given routine nursing care of respiratory department of internal medicine during hospitalization. The patients in the control group were given regular outpatient follow - up after dis-charge;the team intervention model of multidisciplinary cooperation was implemented in the observation group. HAMA,HAMD,ESCA and WHO QOL - BREF were used to evaluate the negative emotion,self - care ability and quality of life of the patients in the two groups before and after the intervention. Results

  7. 胃、十二指肠溃疡急性穿孔手术治疗的术前、术后护理%Preoperative and postoperative nursing care for patients with acute perforation of gastric and duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    王瑞梅

    2016-01-01

    Objective:Acute perforation of gastric and duodenal ulcer is a common clinical emergency, and the nursing care of patients before and after surgery plays an important role in the rehabilitation of patients.The nursing of acute perforation of stomach and duodenum will be briefly introduced in this paper.%胃、十二指肠溃疡急性穿孔是临床常见的急症,手术前后的护理对患者的康复起着至关重要的作用.本文简要介绍胃、十二指肠急性穿孔手术前后的护理.

  8. Effects of posture on postoperative pulmonary function

    DEFF Research Database (Denmark)

    Nielsen, K G; Holte, Kathrine; Kehlet, H

    2003-01-01

    effect on postoperative pulmonary function in the sitting or standing position compared with the supine. Thus, avoidance of the supine position may improve postoperative pulmonary function. Three of six studies showed a positive effect on postoperative pulmonary function of the lateral side compared......BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed...... with the supine. Thus, the lateral position has limited effects on pulmonary function. CONCLUSION: Changes of postoperative position from supine to sitting or standing are of major importance in the interpretation of postoperative pulmonary outcome studies and in future strategies to improve pulmonary outcome....

  9. Postoperative radiotherapy for endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Eun Cheol; Kim, Jin Hee; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2012-09-15

    To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Sixty four patients with stage I?III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended fi eld. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

  10. POSTOPERATIVE MUSCLE SPASM IN A CHILD WITH CEREBRAL PALSY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sanmuga Piriya

    2014-10-01

    Full Text Available Cerebral palsy is a non-progressive motor disorder which occurs due to hypoxic insult to fetus during perinatal period. These children often present for elective surgical procedures to correct various deformities. Peri-operative care of a child with cerebral palsy is a real challenge to the anaesthetics because of associated comorbidities. Yet another problem in these patients is behavior abnormality and difficulty in communication. Therefore regional anaesthesia is usually combined with general anaesthesia and not used alone. The two most important anaesthetics concerns in these patients are hypothermia and post-operative muscle spasm. Epidural analgesia is the most effective method of post-operative pain relief. Even though opioids can be used for post-operative analgesia, clonidine is more effective in relieving post-operative muscle spasm. In this case report we have discussed about the anesthetic management and postoperative muscle spasm in a child with cerebral palsy.

  11. Time course of postoperative hypoxaemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Ullstad, T; Rasmussen, J;

    1994-01-01

    OBJECTIVE: To study the time course of nocturnal episodic and constant hypoxaemia during the first five nights after a major abdominal operation in patients not given supplementary oxygen. DESIGN: Open study. SUBJECTS: 17 patients undergoing major elective operations and with no recognised risk...... factors. MAIN OUTCOME MEASURES: Arterial oxygen saturation measured by pulse oximetry. RESULTS: The level of constant hypoxaemia was lowest during night 2 (p time spent below 90% saturation (p ... during night 3 (p constant hypoxaemia on postoperative nights 1, 3, 4, and 5...

  12. Conventional and unconventional superconductivity

    Science.gov (United States)

    Fernandes, R. M.

    2012-02-01

    Superconductivity has been one of the most fruitful areas of research in condensed matter physics, bringing together researchers with distinct interests in a collaborative effort to understand from its microscopic basis to its potential for unprecedented technological applications. The concepts, techniques, and methods developed along its centennial history have gone beyond the realm of condensed matter physics and influenced the development of other fascinating areas, such as particle physics and atomic physics. These notes, based on a set of lectures given at the 2011 Advanced Summer School of Cinvestav, aim to motivate the young undergraduate student in getting involved in the exciting world of conventional and unconventional superconductors.

  13. Strategic interaction and conventions

    Directory of Open Access Journals (Sweden)

    Espinosa, María Paz

    2012-03-01

    Full Text Available The scope of the paper is to review the literature that employs coordination games to study social norms and conventions from the viewpoint of game theory and cognitive psychology. We claim that those two alternative approaches are in fact complementary, as they provide different insights to explain how people converge to a unique system of self-fulfilling expectations in presence of multiple, equally viable, conventions. While game theory explains the emergence of conventions relying on efficiency and risk considerations, the psychological view is more concerned with frame and labeling effects. The interaction between these alternative (and, sometimes, competing effects leads to the result that coordination failures may well occur and, even when coordination takes place, there is no guarantee that the convention eventually established will be the most efficient.

    El objetivo de este artículo es presentar la literatura que emplea los juegos de coordinación para el estudio de normas y convenciones sociales, que se han analizado tanto desde el punto de vista de la teoría de juegos como de la psicología cognitiva. Argumentamos en este trabajo que estos dos enfoques alternativos son en realidad complementarios, dado que ambos contribuyen al entendimiento de los procesos mediante los cuales las personas llegan a coordinarse en un único sistema de expectativas autorrealizadas, en presencia de múltiples convenciones todas ellas igualmente viables. Mientras que la teoría de juegos explica la aparición de convenciones basándose en argumentos de eficiencia y comportamientos frente al riesgo, el enfoque de la psicología cognitiva utiliza en mayor medida consideraciones referidas al entorno y naturaleza de las decisiones. La interacción entre estos efectos diferentes (y en ocasiones, rivales desemboca con frecuencia en fallos de coordinación y, aun cuando la coordinación se produce, no hay garantía de que la convención en vigor sea la m

  14. Is robotic mitral valve surgery more expensive than its conventional counterpart?

    Science.gov (United States)

    Canale, Leonardo Secchin; Colafranceschi, Alexandre Siciliano

    2015-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If

  15. [Nutritional status and postoperative complications in patients with digestive cancer].

    Science.gov (United States)

    Pañella, Loreto; Jara, Marlene; Cornejo, Morelia; Lastra, Ximena; Contreras, María Gladys; Alfaro, Kattia; De La Maza, María Pía

    2014-11-01

    Risk of malnutrition is elevated among oncologic patients, and this increases postoperative morbidity and mortality. To study the association between nutritional status and postoperative outcomes in a group of patients with gastrointestinal cancers. We studied 129 patients with diagnosis of digestive cancer, previous to potentially curative surgery. Nutritional status was evaluated through anthropometric measures, Subjective Global Assessment (SGA), dietary intake recalls and routine biochemical parameters. Functional performance was assessed by the Karnofsky index (KI). Cancer stage was classified according to TNM4. During the postoperative period, complications, length of stay at the critical care ward and duration of hospitalization were registered. Thirty days after discharge, patients were contacted, and the appearance of new complications was listed. According to SGA 14.7% of patients were classified as well nourished (A), 57.3% as moderately undernourished or at risk of malnutrition (B) and 27.9% as severely malnourished (C). The incidence of total complications was 25.5%. Nutritional status was not associated with cancer stage. The frequency of complications among patients classified as A, B and C were 5.5, 25.3 and 37.1% respectively (p = 0.03). We detected a high frequency of malnutrition in this group of patients. Overall the frequency of postoperative complications was low, however malnourished patients exhibited a higher rate of surgical complications.

  16. European Society of Anaesthesiology evidence-based and consensus-based guidelines on postoperative delirium

    DEFF Research Database (Denmark)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoper......The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care......, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline...

  17. Postoperative complications and mortality after major gastrointestinal surgery.

    Science.gov (United States)

    Jakobson, Triin; Karjagin, Juri; Vipp, Liisa; Padar, Martin; Parik, Ants-Hendrik; Starkopf, Liis; Kern, Hartmut; Tammik, Olavi; Starkopf, Joel

    2014-01-01

    The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence of postoperative complications, length of stay, and mortality after major abdominal surgery for gastrointestinal, hepatobiliary and pancreatic malignancies and to identify the risk factors for impaired outcome. Data of patients, operated on for gastro-intestinal malignancies during 2009-2010 were retrieved from the clinical database of Tartu University Hospital. Major outcome data included incidence of postoperative complications, hospital-, 30-day, 90-day and 1-year mortality, and length of ICU and hospital stay. High-risk patients were defined as patients with American Society of Anesthesiologists (ASA) physical status ≥3 and revised cardiac risk index (RCRI) ≥3. Multivariate analysis was used to determine the risk factors for postoperative mortality and morbidity. A total of 507 (259 men and 248 women, mean age 68.3±11.3 years) were operated on for gastrointestinal, hepatobiliary, or pancreatic malignancies during 2009 and 2010 in Tartu University Hospital, Department of Surgical Oncology. 25% of the patients were classified as high risk patients. The lengths of intensive care and hospital stay were 4.4±7 and 14.5±10 days, respectively. The rate of postoperative complications was 33.5% in the total cohort, and 44% in high-risk patients. The most common complication was delirium, which occurred in 12.8% of patients. For patients without high risk (ASA130min, and positive fluid balance >1300mL after the 1st postoperative day, were identified as independent risk factors for the development of complications. The complication rate after major gastro-intestinal surgery is high. ASA physical status and revised cardiac risk index adequately reflect increased risk for postoperative complications and

  18. 胃癌手术后患者肠内营养的舒适护理%Comfortable Nursing Care of Postoperative Enteral Nutrition in Patients with Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    吴惠琼

    2012-01-01

    目的:探究积极指导饮食、提高营养支持舒适护理对胃癌患者的影响情况.方法:对在我院2009年9月至2011年9月住院120例胃癌患者随机分组,观察组60例,对照组60例.对照组予胃癌住院常规护理,观察组在对照组护理治疗措施上积极指导饮食、提高营养支持舒适护理.观察两组在一般情况及营养指标中的恢复情况.结果:观察组在精神、躯体活动能力、对手术及放化疗治疗耐受方面较对照组均好转,好转率分别为:23.33%、21.67%、18.34%.在体重、血红蛋白、白蛋白、肝功能(ALT)、淋巴细胞检查下降值中均小于对照组,经统计学分析,差异有统计学意义.结论:经积极饮食指导、营养支持等舒适护理可使胃癌患者病情恢复.%Objective: To explore the effect of active guidance, improve diet nutrition support of comfortable nursing in patients with gastric cancer. Method: In my hospital in 2009 .9 - 2011.9, 120 cases of gastric cancer patients were diveided into the observation group ( 60 cases ), and the control group ( 60 cases ). The control group received routine nursing care of gastric cancer hospital, observation group in nursingtreatment measures to actively guide the diet, improve the nutritional support of comfortable nursing. Observation of the two groups in general and nutritional index of recovery. Result: The observation group in the spirit, body, the activities of operation and radiotherapy and chemotherapy for the treatment of tolerance are better than the control group, the improvement rate respectively: 23. 33% , 21. 67% , 18. 34% . In weight, hemoglobin, albumin, liver function ( ALT ), lymphocyte check drop values were less than that of the control group, the statistical analysis, the difference was statistically significant. Conclusion: The positive guidance of diet, nutritional support and comfort nursing care can improve gastric cancer patients.

  19. Post-operative negative pressure pulmonary oedema in an athletic male.

    Science.gov (United States)

    Stewart, Sarah K; Johnston, A McD

    2013-03-01

    A case of post-operative negative pressure pulmonary oedema in a young, athletic male is reported. We discuss this rare but life-threatening condition and its aetiology, and review the published literature. Military health care providers need to be aware of this condition as young fit personnel may be at increased risk of developing negative pressure pulmonary oedema in the post-operative period.

  20. Risk of postoperative recurrence and postoperative management of Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Matteo Sacchi; Gionata Fiorino; Silvio Danese; Marco Montorsi

    2011-01-01

    Crohn's disease (CD) is a chronic inflammatory disease of the digestive tract with systemic manifestations. Etiology is unknown, even if immunological, genetic and environmental factors are involved. The majority of CD patients require surgery during their lifetime due to progressive bowel damage, but, even when all macroscopic lesions have been removed by surgery, the disease recurs in most cases. Postoperative management represents therefore a crucial mean for preventing recurrence. Several drugs and approaches have been proposed to achieve this aim. Endoscopic inspection of the ileocolic anastomosis within 1 year from surgery is widely encouraged, given that endoscopic recurrence is one of the greatest predictors for clinical recurrence. A strategy should be planned only after stratifying patients according to their individual risk of recurrence, avoiding unnecessary therapies when possible benefits are reduced, and selecting high-risk patients for more aggressive intervention.

  1. In patients with post-sternotomy mediastinitis is vacuum-assisted closure superior to conventional therapy?

    Science.gov (United States)

    Yu, Angela W; Rippel, Radoslaw A; Smock, Elliott; Jarral, Omar A

    2013-11-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether vacuum-assisted closure therapy (VAC) is superior to conventional therapy for treating post-sternotomy mediastinitis. Altogether >261 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Several studies indicate that VAC therapy is associated with shorter lengths of intensive care and in-hospital stay as well as faster rates of wound healing and fewer dressing changes. It has also been shown that VAC therapy is correlated with a statistically significant reduction in reinfection rates, particularly those that occur in the early postoperative period (at the 1-week follow-up). Patients can be discharged with the dressing in situ and managed in the community with a view to delayed closure or reconstruction. However, the studies comparing VAC with conventional therapy are all retrospective in nature and reinforce the need for randomized controlled trials in order to more accurately establish differences in outcomes between VAC and conventional therapy. Additionally, owing tło the variability of treatment protocols within the non-VAC arm, it is more challenging to draw definitive conclusions regarding the superiority of VAC therapy to every modality that is considered conventional treatment. We conclude that VAC therapy is a portable and an increasingly economical option for the treatment of post sternotomy mediastinitis. Although reductions in mortality rates were not reproduced in all studies, evidence suggests that VAC should still be considered as a first-line therapy for post-sternotomy mediastinitis and as a bridge therapy to musculocutaneous reconstruction or primary closure.

  2. Lidocaine for preventing postoperative sore throat.

    Science.gov (United States)

    Tanaka, Yuu; Nakayama, Takeo; Nishimori, Mina; Tsujimura, Yuka; Kawaguchi, Masahiko; Sato, Yuki

    2015-07-14

    Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat varies with the type, diameter, and cuff pressure of the endotracheal tube used. If intubation is essential, it may be helpful to give drugs prophylactically to alleviate postoperative sore throat. Local anaesthetics and steroids have been used for this purpose. This review was originally published in 2009 and was updated in 2015. The objective of this review was to evaluate the efficacy and any harm caused by topical and systemic lidocaine used prophylactically to prevent postoperative sore throat in adults undergoing general anaesthesia with endotracheal intubation. We searched CENTRAL (The Cochrane Library 2013, Issue 9), MEDLINE (January 1966 to October 2013), and EMBASE (1980 to October 2013). We also contacted manufacturers and researchers in the field. The original search was undertaken in June 2007. We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review. We included randomized controlled trials (RCTs) of topical and systemic prophylactic lidocaine therapy versus control (using air or saline) that reported on the risk and severity of postoperative sore throat as an outcome. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information, such as the risk of any adverse effects. We included 19 studies involving 1940 participants in this updated review. Of those 1940 participants, 952 received topical or systemic lidocaine therapy and 795 were allocated to the control groups. Topical and systemic lidocaine therapy appeared to reduce the risk of postoperative sore throat (16 studies, 1774 participants, risk ratio (RR) was 0.64 (95% confidence interval (CI) 0.48 to 0.85), the quality of the evidence was low), although when only high-quality trials were

  3. 1例颅内胶质瘤术后化疗患者的药学监护%Pharmaceutical Care for a Postoperative Patient with Intracranial Glioma Treated by Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    王宏盛; 岳峰; 陈正楼; 胥敏; 季宏建

    2014-01-01

    Objective:To investigate the role of clinical pharmacists in the process of chemotherapy for a patient with intracranial glioma. Methods:Usage and dosage of antitumor drugs, drug interactions, adverse drug reactions and medication education after dis-charged as the breakthrough points, clinical pharmacists and clinicians explored options for the patient treatment and adjusted the medi-cation timely according to the condition. Results:There were no serious adverse drug reactions in the adjusted therapeutic regimen and the treatment results of the patient were satisfactory. Conclusion:Clinical pharmacists provide pharmaceutical care can play an impor-tant role in improving the safety and effectiveness of drug use.%目的::临床药师通过对1例颅内胶质瘤术后化疗患者的药学服务,探讨临床药师如何对肿瘤患者进行药学监护。方法:临床药师以抗肿瘤药物的用法、药物相互作用、药物不良反应、出院用药指导等作为切入点,根据患者病情提出用药方案调整,给临床医师提出合理化治疗建议。结果:该患者在调整后的治疗方案中无严重不良反应发生,治疗效果满意。结论:临床药师的药学监护发挥了较重要的作用,保证患者用药安全有效。

  4. [Acute myocardial infarction in the postoperative period following pneumonectomy].

    Science.gov (United States)

    López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilariño, M J; Etxainz Alvarez, A; Alvarez Refojo, F

    2002-11-01

    A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided.

  5. Biodiesel from conventional feedstocks.

    Science.gov (United States)

    Du, Wei; Liu, De-Hua

    2012-01-01

    At present, traditional fossil fuels are used predominantly in China, presenting the country with challenges that include sustainable energy supply, energy efficiency improvement, and reduction of greenhouse gas emissions. In 2007, China issued The Strategic Plan of the Mid-and-Long Term Development of Renewable Energy, which aims to increase the share of clean energy in the country's energy consumption to 15% by 2020 from only 7.5% in 2005. Biodiesel, an important renewable fuel with significant advantages over fossil diesel, has attracted great attention in the USA and European countries. However, biodiesel is still in its infancy in China, although its future is promising. This chapter reviews biodiesel production from conventional feedstocks in the country, including feedstock supply and state of the art technologies for the transesterification reaction through which biodiesel is made, particularly the enzymatic catalytic process developed by Chinese scientists. Finally, the constraints and perspectives for China's biodiesel development are highlighted.

  6. Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation

    NARCIS (Netherlands)

    Vos, J. J.; Scheeren, T. W. L.; Lukes, D. J.; de Boer, M. T.; Hendriks, H. G. D.; Wietasch, J. K. G.

    2013-01-01

    Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDRICG) may have an additional diagnostic and

  7. Effects of disease symptoms and the degree of care of patients′ spouses on postoperative depression in female with breast cancer%疾病症状与配偶在意程度对女性乳腺癌患者术后抑郁的影响

    Institute of Scientific and Technical Information of China (English)

    周立芝; 陈长香; 马杰; 崔志超; 李建君; 张凤萍; 刘新华

    2016-01-01

    目的:探讨女性乳腺癌患者术后抑郁的发生状况及主要影响因素,为采取应对措施提供依据。方法选取2014年6月-2015年5月在唐山某三级甲等医院住院治疗的307例女性乳腺癌术后患者为研究对象,使用汉密顿抑郁量表( HAMD)对其进行抑郁及疾病症状等评测。结果307例女性乳腺癌患者术后HAMD总分平均为(7.46±6.44)分;存在抑郁情绪者130例,占42.3%。单因素分析显示,配偶在意形象、有无转移、患肢活动、恶心、呕吐、气促、食欲丧失、失眠、关节疼痛、失眠、脱发与女性乳腺癌患者术后抑郁评分有关,差异有统计学意义(t/F值分别为3.707,3.522,3.005,5.690,4.978,10.805,18.836,28.478,7.586,28.478,8.540;P<0.05)。多元回归分析显示,有无转移、配偶在意形象及气促、失眠、食欲丧失、脱发症状是乳腺癌患者术后抑郁发生的影响因素( P<0.05)。结论乳腺癌术后抑郁的患病率较高,应关注疾病症状及配偶的支持度,降低乳腺癌术后抑郁的发生。%Objective To investigate the prevalence situation and the main influencing factors of postoperative depression in female patients with breast cancer, and provide basis for response measures. Methods Totally 307 cases of patients with breast cancer from June 2014 to May 2015 in a tertiary hospital in Tangshan were selected as the research object, and Hamilton Depression Scale ( HAMD) was used to measure the depressive and symptoms of the disease.Results The total HAMD score of 307 patients with breast cancer after surgery was (7.46±6.44);130 patients had depression mood, which accounted 42.3%. Univariate analysis showed that spouses care about image, metastasis, ill-limb activity, nausea, vomiting, shortness of breath, loss of appetite, insomnia, joint pain, insomnia and hair loss were related to total depression score of female patients with breast cancer after operation ( t/F=3. 707, 3. 522, 3. 005, 5. 690, 4. 978

  8. Fused 99m-Tc-GSA SPECT/CT imaging for the preoperative evaluation of postoperative liver function: can the liver uptake index predict postoperative hepatic functional reserve?

    Science.gov (United States)

    Yoshida, Morikatsu; Shiraishi, Shinya; Sakaguchi, Fumi; Utsunomiya, Daisuke; Tashiro, Kuniyuki; Tomiguchi, Seiji; Okabe, Hirohisa; Beppu, Toru; Baba, Hideo; Yamashita, Yasuyuki

    2012-04-01

    To evaluate the role of hepatic asialoglycoprotein receptor analysis in the preoperative estimation of postoperative hepatic functional reserve. We obtained technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-GSA) SPECT/CT fusion images in 256 patients with liver disease scheduled for hepatic resection. The liver uptake value corrected for body surface area [LUV(BSA)] and liver uptake ratio (LUR) of the remnant were preoperatively estimated based on the fused images. These values were compared with the postoperative hepatic functional reserve. Significant correlations were observed between LUV(BSA), LUR, and most conventional indicators of hepatic functional reserve. Postoperatively, nonpreserved liver functional reserve was observed in 15 of the 256 patients (5.8%). Remnant LUV(BSA) showed better correlation than remnant LUR or the other indicators. No patients with remnant LUV(BSA) above 28.0 manifested poor nonpreserved functional reserve. Using a LUV(BSA) of 27.0, it was possible to predict postoperative poor hepatic functional reserve at a sensitivity of 91%, specificity of 81%, and accuracy of 81% postoperatively. According to multivariate analysis, a low remnant LUV(BSA) was the only significant independent predictor of poor hepatic functional reserve. Our 99mTc-GSA SPECT/CT fusion imaging method was clinically useful for evaluating regional hepatic function and for predicting postoperative hepatic functional reserve.

  9. Conventional Posterior Approach without Far Lateral Approach for Ventral Foramen Magnum Meningiomas

    Science.gov (United States)

    Sohn, Seil

    2013-01-01

    Objective We present our experience of conventional posterior approach without fat lateral approach for ventral foramen magnum (FM) meningioma (FM meningioma) and tried to evaluate the approach is applicable to ventral FM meningioma. Methods From January 1999 to March 2011, 11 patients with a ventral FM meningioma underwent a conventional posterior approach without further extension of lateral bony window. The tumor was removed through a working space between the dura and arachnoid membrane at the cervicomedullary junction with minimal retraction of medulla, spinal cord or cerebellum. Care should be taken not to violate arachnoid membrane. Results Preoperatively, six patients were of Nurick grade 1, three were of grade 2, and two were of grade 3. Median follow-up period was 55 months (range, 20-163 months). The extent of resection was Simpson grade I in one case and Simpson grade II in remaining 10 cases. Clinical symptoms improved in eight patients and stable in three patients. There were no recurrences during the follow-up period. Postoperative morbidities included one pseudomeningocele and one transient dysphagia with dysarthria. Conclusion Ventral FM meningiomas can be removed gross totally using a posterior approach without fat lateral approach. The arachnoid membrane can then be exploited as an anatomical barrier. However, this approach should be taken with a thorough understanding of its anatomical limitation. PMID:24379942

  10. Post-operative sleep disturbance: causes, factors and effects on outcome

    DEFF Research Database (Denmark)

    Rosenberg, J; Rosenberg-Adamsen, S; Kehlet, H

    1995-01-01

    Post-operative sleep disturbance, with suppression of rapid eye movement sleep and slow wave sleep followed by a subsequent rebound, seems to be related to the magnitude of trauma and thereby to the surgical stress response. In this context, cortisol, autonomic stimulation, and certain cytokines...... may lead to abnormal sleep. Furthermore, the environment, pain and the administration of analgesics seem to be important factors in the precipitation of sleep abnormalities. Post-operative sleep disturbance may contribute to the development of episodic hypoxaemia, haemodynamic instability and altered...... mental status, all of which have an influence on post-operative morbidity and mortality. Prevention or reduction of the post-operative sleep disturbance may be achieved by minimizing surgical trauma, changing the conventional nursing procedures, avoiding opioids and treating pain with non...

  11. Impact of early postoperative enteral nutrition on clinical outcomes in patients with gastric cancer.

    Science.gov (United States)

    Li, B; Liu, H Y; Guo, S H; Sun, P; Gong, F M; Jia, B Q

    2015-06-29

    The impact of early enteral nutrition (EEN) on clinical outcomes of gastric cancer patients was investigated. Three hundred pa-tients undergoing gastric cancer surgery from July 2010 to May 2014 were randomly divided into experimental and control groups (n = 150/group). Experimental group patients received enteral nutrition in water during the early postoperative period. Control group patients received conventional perioperative treatment. Patients' clinical outcomes, post-operative immune function, and nutritional statuses were compared, which revealed that the postoperative fever duration (80.2 ± 6.0 vs 88.1 ± 8.1 h, P 0.05]. At postoperative days 3 and 7, the CD3(+), CD4(+), natural killer cell, albumin, and prealbumin levels and CD4(+)/CD8(+) ra-tio were significantly higher in the experimental group than the control group (all P nutritional status and immune function and promote early recovery of intestinal function in patients with gastric cancer.

  12. What constitutes a convention? : implications for the coexistence of conventions

    OpenAIRE

    Kolstad, Ivar

    2002-01-01

    A model of repeated play of a coordination game, where stage games have a location in social space, and players receive noisy signals of the true location of their games, is reviewed. Sugden (1995) suggests that in such a model, there can be a stationary state of convention coexistence only if interaction is non-uniform across social space. This paper shows that an alternative definition of conventions, which links conventions to actions rather than expectations, permits convention coexistenc...

  13. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial.

    Science.gov (United States)

    Mozaffarian, Dariush; Marchioli, Roberto; Macchia, Alejandro; Silletta, Maria G; Ferrazzi, Paolo; Gardner, Timothy J; Latini, Roberto; Libby, Peter; Lombardi, Federico; O'Gara, Patrick T; Page, Richard L; Tavazzi, Luigi; Tognoni, Gianni

    2012-11-21

    Postoperative atrial fibrillation or flutter (AF) is one of the most common complications of cardiac surgery and significantly increases morbidity and health care utilization. A few small trials have evaluated whether long-chain n-3-polyunsaturated fatty acids (PUFAs) reduce postoperative AF, with mixed results. To determine whether perioperative n-3-PUFA supplementation reduces postoperative AF. The Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) double-blind, placebo-controlled, randomized clinical trial. A total of 1516 patients scheduled for cardiac surgery in 28 centers in the United States, Italy, and Argentina were enrolled between August 2010 and June 2012. Inclusion criteria were broad; the main exclusions were regular use of fish oil or absence of sinus rhythm at enrollment. Patients were randomized to receive fish oil (1-g capsules containing ≥840 mg n-3-PUFAs as ethyl esters) or placebo, with preoperative loading of 10 g over 3 to 5 days (or 8 g over 2 days) followed postoperatively by 2 g/d until hospital discharge or postoperative day 10, whichever came first. Occurrence of postoperative AF lasting longer than 30 seconds. Secondary end points were postoperative AF lasting longer than 1 hour, resulting in symptoms, or treated with cardioversion; postoperative AF excluding atrial flutter; time to first postoperative AF; number of AF episodes per patient; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events. At enrollment, mean age was 64 (SD, 13) years; 72.2% of patients were men, and 51.8% had planned valvular surgery. The primary end point occurred in 233 (30.7%) patients assigned to placebo and 227 (30.0%) assigned to n-3-PUFAs (odds ratio, 0.96 [95% CI, 0.77-1.20]; P = .74). None of the secondary end points were significantly different between the placebo and fish oil groups, including postoperative AF that was sustained, symptomatic, or treated (231

  14. [Postoperative recurrence of Crohn's disease, and its prevention].

    Science.gov (United States)

    Lakatos, László; Lakatos, Péter László

    2010-05-23

    Crohn's disease is a chronic, progressive disabling condition ultimately leading to stricturing and/or penetrating complications. The need for surgery may be as high as 70% in patients with severe active disease or complications. However, relapse may develop in a significant proportion of the patients after surgery leading to frequent re-operations. Despite emerging data, postoperative prevention is still controversial. After careful evaluation of the individual risk a tailored therapy should be considered. In patients with small risk for relapse mesalazine or in selected cases no-treatment may be an option. In patients with a moderate-to-high risk azathioprine should be considered together with metronidazole in the three months. Follow-up ileocolonoscopy 6-12 months after the surgery is helpful in the determination of endoscopic severity and may assist in the optimization of the therapy. In most severe cases anti-TNF agents may be appropriate for postoperative prevention and therapy.

  15. Postoperative wound infections after a proctectomy—Patient experiences

    Directory of Open Access Journals (Sweden)

    Karin Hassel

    2016-02-01

    Full Text Available Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery.

  16. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  17. Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Nobuaki Fujikuni; Kazuaki Tanabe; Noriaki Tokumoto; Takahisa Suzuki; Minoru Hattori; Toshihiro Misumi; Hideki Ohdan

    2016-01-01

    AIM: To assess the safety of enhanced recovery after surgery(ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance. METHODS: Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group(CG) or ERAS group(EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life(HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin(TTR), retinal-binding protein(RBP), and transferrin(Tf)], the homeostasis model assessment-insulin resistance(HOMA-R) index, postoperative urine volume,postoperative weight change, and postoperative oral intake.RESULTS: The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d(95.0% vs 92.5% respectively; 95%CI:-10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients(P = 0.014). There were no significant differences with respect to rapid turnover proteins(TTR, RBP and Tf) or HRQOL scores using the SF8 method.CONCLUSION: Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

  18. Trauma and postoperative follow-up; Traumata und postoperative Folgezustaende

    Energy Technology Data Exchange (ETDEWEB)

    Voth, E. [Univ. Koeln (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    1997-10-01

    Indications for the use of nuclear medicine techniques, mostly bone scintigraphy, occur in case of diagnostic problems, especially if there are discrepancies between the clinical symptoms and X-ray findings. This may happen in case of stress fractures, fractures in bones difficult to judge by X-ray imaging, and in the differentation of recent versus old fracture. A further indication for bone scanning is to assess the extent of skeletal lesions in polytrauma and in the battered child syndrome. In postoperative patients bone scanning is most frequently performed in order to assess loosening or infection of endoprosthesis. Due to bone remodelling uptake of Tc-diphosphonates varies between cemented and cementfree implants. This fact should be taken into consideration when interpreting bone scans in areas with endoprostheses. In both trauma and postoperative patients, indications for nuclear medicine imaging exist if healing is complicated. Bone scanning can be used to assess pseudoartrosis or non-union, infection, viability of grafts and bone fragments and reflex sympathetic dystrophy. In suspicious infection with positive bone scan, white blood cell or microcollid scintigraphy can be used for further differentiation. (orig./MG) [Deutsch] Indikationen zum Einsatz nuklearmedizinischer Verfahren, in der Regel der Skelettszintigraphie, ergeben sich bei diagnostischen Problemen, speziell bei Diskrepanzen zwischen der klinischen Symptomatik und dem roentgenologischen Befund. In der Traumatologie kann dies Stressfrakturen, Frakturen in roentgenologisch schwer beurteilbaren Skelettabschnitten, das Ausmass der knoechernen Verletzungen bei Polytraumata oder Kindermisshandlungen sowie die Differenzierung alte versus frische Fraktur betreffen. In der postoperativen Verlaufs- bzw. Therapiekontrolle ist die haeufigste Indikation zur Skelettszintigraphie die Frage nach Lockerung einer Endoprothese. Wegen des aus pathophysiologischen Gruenden unterschiedlichen Anreicherungsmusters

  19. A review of recent advances in data analytics for post-operative patient deterioration detection.

    Science.gov (United States)

    Petit, Clemence; Bezemer, Rick; Atallah, Louis

    2017-08-21

    Most deaths occurring due to a surgical intervention happen postoperatively rather than during surgery. The current standard of care in many hospitals cannot fully cope with detecting and addressing post-surgical deterioration in time. For millions of patients, this deterioration is left unnoticed, leading to increased mortality and morbidity. Postoperative deterioration detection currently relies on general scores that are not fully able to cater for the complex post-operative physiology of surgical patients. In the last decade however, advanced risk and warning scoring techniques have started to show encouraging results in terms of using the large amount of data available peri-operatively to improve postoperative deterioration detection. Relevant literature has been carefully surveyed to provide a summary of the most promising approaches as well as how they have been deployed in the perioperative domain. This work also aims to highlight the opportunities that lie in personalizing the models developed for patient deterioration for these particular post-surgical patients and make the output more actionable. The integration of pre- and intra-operative data, e.g. comorbidities, vitals, lab data, and information about the procedure performed, in post-operative early warning algorithms would lead to more contextualized, personalized, and adaptive patient modelling. This, combined with careful integration in the clinical workflow, would result in improved clinical decision support and better post-surgical care outcomes.

  20. How effective is postoperative packing in FESS patients? A critical analysis of published interventional studies.

    Science.gov (United States)

    Vlastarakos, Petros V; Iacovou, Emily; Fetta, Melina; Tapis, Marios; Nikolopoulos, Thomas P

    2016-12-01

    The present study aimed to assess the clinical effectiveness of absorbable packing alone, non-absorbable packing alone, and absorbable versus non-absorbable packing in the postoperative care of FESS patients, regarding bleeding control, adhesion formation, wound healing, and overall patient comfort. Systematic literature review in Medline and other database sources until July 2013, and critical analysis of pooled data were conducted. Blinded prospective randomized control trials, prospective, and retrospective comparative studies were included in study selection. The total number of analyzed studies was 19. Placing packs in the middle meatus after endoscopic procedures does not seem to be harmful for postoperative patient care. Regarding the postoperative bleeding rate, absorbable packing is not superior to no postoperative packing (strength of recommendation A). Comparing absorbable to non-absorbable packing, the former one seems slightly more effective than the latter in the aforementioned domain (strength of recommendation C). Absorbable packing was also found more effective than non-absorbable packing as a means of reducing the postoperative adhesion rate (strength of recommendation B), and more effective in comparison with not placing any packing material at all (strength of recommendation C). Non-absorbable packing also proves more effective than no postoperative packing in preventing the appearance of such adhesions (strength of recommendation A). Absorbable packing is also more comfortable compared to non-absorbable materials (strength of recommendation A), or no postoperative packing in FESS patients (strength of recommendation B). The comparative analysis between the different packing modalities performed in the present study may help surgeons design a more individualized postoperative patient care.

  1. ESD and the Rio Conventions

    Science.gov (United States)

    Sarabhai, Kartikeya V.; Ravindranath, Shailaja; Schwarz, Rixa; Vyas, Purvi

    2012-01-01

    Chapter 36 of Agenda 21, a key document of the 1992 Earth Summit, emphasised reorienting education towards sustainable development. While two of the Rio conventions, the Convention on Biological Diversity (CBD) and the United Nations Framework Convention on Climate Change (UNFCCC), developed communication, education and public awareness (CEPA)…

  2. A rare cause of pulmonary edema in the postoperative period

    Directory of Open Access Journals (Sweden)

    Kshitij Chatterjee

    2017-01-01

    Full Text Available With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.

  3. A Rare Cause of Pulmonary Edema in the Postoperative Period.

    Science.gov (United States)

    Chatterjee, Kshitij; Mittadodla, Penchala S; Colaco, Clinton; Jagana, Rajani

    2017-02-01

    With the increasing longevity of the population, the annual rates of hip arthroplasties performed have been steadily increasing over the past decade. Given the presence of medical comorbidities in the older patients, the peri-operative care of these individuals requires multi-specialty care, now more than ever. Hip arthroplasty is generally well tolerated, with early mortality after the procedure being <1%. Bone cement implantation syndrome (BCIS) is an entity that is occasionally encountered during or after the surgery. It is characterized by hypoxemia, hypotension, cardiac arrhythmias, and cardiac arrest leading to death, in severe cases. We report a case of a middle-aged female who developed refractory hypotension and pulmonary edema while undergoing hemiarthroplasty for a pathological femoral neck fracture and experienced cardiac arrest in the immediate postoperative period. Critical care physicians must familiarize themselves with promptly diagnosing and managing BCIS.

  4. Pre- and postoperative MR imaging of craniopharyngiomas

    Energy Technology Data Exchange (ETDEWEB)

    Hald, J.K. [Rijkshospitalet, Oslo (Norway). Dept. of Radiology; Eldevik, O.P. [Rijkshospitalet, Oslo (Norway). Dept. of Neurosurgery; Quint, D.J. [Rijkshospitalet, Oslo (Norway). Dept. of Neurosurgery; Chandler, W.F. [Univ. of Michigan Hospital, Ann Arbor, MI (United States). Dept. of Radiology; Kollevold, T. [Univ. of Michigan Hospital, Ann Arbor, MI (United States). Dept. of Neurosurgery

    1996-09-01

    Purpose: To compare the pre- and postoperative MR appearance of craniopharyngiomas with respect to lesion size, tumour morphology and identification of surrounding normal structures. Material and Methods: MR images obtained prior to and following craniopharyngioma resection were evaluated retrospectively in 10 patients. Tumour signal charcteristics, size and extension with particular reference to the optic chiasm, the pituitary gland, the pituitary stalk and the third ventricle were evaluated. Results: Following surgery, tumour volume was reduced in all patients. In 6 patients there was further tumour volume reduction between the first and second postoperative images. Two of these patients received radiation therapy between the 2 postoperative studies, while 4 had no adjuvant treatment to the surgical intervention. There was improved visualization of the optic chiasm, in 3, the pituitary stalk in one, and the third ventricle in 9 of the 10 patients. The pituitary gland was identified preoperatively only in one patient, postoperatively only in another, pre- and postoperatively in 5, and neither pre- nor postoperatively in 3 patients. In 3 patients MR imaging 0-7 days postoperatively identified tumour remnants not seen at the end of the surgical procedure. The signal intensities of solid and cystic tumour components were stable from pre- to the first postoperative MR images. Optic tract increased signal prior to surgery was gone 28 days postoperatively in one patient, but persisted on the left side for 197 days after surgery in another. Conclusion: Postoperative MR imaging of craniopharyngiomas demonstrated tumour volume reduction and tumour remnants not seen at surgery. Early postoperative MR imaging of craniopharyngiomas may overestimate the size of residual tumour. Improved visualization of peritumoral structures may be achieved. (orig.).

  5. Preoperative Smoking Status and Postoperative Complications

    DEFF Research Database (Denmark)

    Grønkjær, Marie; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang;

    2014-01-01

    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  6. Risk, diagnosis and treatment to postoperative delirium in elderly patients with gastrointestinal cancers.

    Science.gov (United States)

    Ma, Li-Na; Zhang, Rui-Li

    2015-01-01

    In recent years, more elderly patients with gastrointestinal cancers have been undergoing surgery. As one of main postoperative complications, postoperative delirium (POD) is harmful and difficult to prevent and treat. Prevention, diagnosis and treatment to POD properly and ptomptly can promote the patient's overall recovery. However, health care providers still have many problems for POD to face in elderly,with gastrointestinal cancers during the clinical care. In this paper, Etiology, damages, prevention, diagnosis and treatment of POD in elderly with gastrointestinal cancer were reviewed, and the prospect of POD was also discussed.

  7. [Effect of capnoperitoneum on postoperative carbon dioxide homeostasis].

    Science.gov (United States)

    Blobner, M; Felber, A R; Hösl, P; Gögler, S; Schneck, H J; Jelen-Esselborn, S

    1994-11-01

    release of the KP for 60 min. Simultaneously, a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency (RF) were obtained by the Capnomac Ultima (Datex) and registered every minute as well. Values were averaged over four periods of 15 min each. An arterial blood gas sample was drawn at the end of every 15-min period. Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being. All data were analysed by the Friedman or Wilcoxon test; P < 0.05 was considered significant. RESULTS. The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy (Tables 2 and 3, Fig. 1). Arterial CO2 as well as PeCO2 were elevated postoperatively (45 mm Hg vs. 36 mm Hg intraoperatively), while VCO2 and VO2 were unchanged when compared to the preoperative measuring period. The postoperative RF was comparable to preoperative values. Calculated delta CO2 was lower than 10 ml/min and within accuracy of measurements. The post-operative pain index ranged between 3 and 4, and 3.75-15 mg piritramid was administered. All patients felt tired immediately after the operation, but scores improved slightly at the end of the 60-min period of metabolic monitoring. CONCLUSIONS. There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.

  8. Postoperative delirium in elderly citizens and current practice

    Directory of Open Access Journals (Sweden)

    Siddareddygari Velayudha Reddy

    2017-01-01

    Full Text Available Postoperative delirium (POD represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD. On literature search in EMBASE, CINAHL, and PUBMED between January 2000 and September 2015 using search words delirium, POD, acute postoperative confusion, and brain dysfunction resulted in 9710 articles. Among them, 73 articles were chosen for review, in addition, National Institute for Health and Clinical Excellence guidelines, American Geriatric Society guidelines, hospital elderly life program-confusion assessment method training manual, New York geriatric nursing protocols, World Health Organization's International Classification of Diseases, 10th Revision classification of mental disorders, Food and Drug Administration requests boxed warnings on older class of antipsychotic drugs 2008 and delirium in Miller's text book of anesthesia were reviewed and relevant information presented in this article.

  9. Automated postoperative blood pressure control

    Institute of Scientific and Technical Information of China (English)

    Hang ZHENG; Kuanyi ZHU

    2005-01-01

    It is very important to maintain the level of mean arterial pressure (MAP).The MAP control is applied in many clinical situations,including limiting bleeding during cardiac surgery and promoting healing for patient's post-surgery.This paper presents a fuzzy controller-based multiple-model adaptive control system for postoperative blood pressure management.Multiple-model adaptive control (MMAC) algorithm is used to identify the patient model,and it is a feasible system identification method even in the presence of large noise.Fuzzy control (FC) method is used to design controller bank.Each fuzzy controller in the controller bank is in fact a nonlinear proportional-integral (PI) controller,whose proportional gain and integral gain are adjusted continuously according to error and rate of change of error of the plant output,resulting in better dynamic and stable control performance than the regular PI controller,especially when a nonlinear process is involved.For demonstration,a nonlinear,pulsatile-flow patient model is used for simulation,and the results show that the adaptive control system can effectively handle the changes in patient's dynamics and provide satisfactory performance in regulation of blood pressure of hypertension patients.

  10. Postoperative radicular neuroma. Case report.

    Science.gov (United States)

    Erman, T; Tuna, M; Göçer, A I; Idan, F; Akgül, E; Zorludemir, S

    2001-11-15

    Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the "failed back surgery syndrome." The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

  11. Recovery from post-operative anaemia.

    Science.gov (United States)

    Wallis, J P; Wells, A W; Whitehead, S; Brewster, N

    2005-10-01

    Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.

  12. Serial MRI in the early postoperative period after lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Annertz, M. [Dept. of Radiology, University Hospital, Lund (Sweden); Joensson, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Stroemqvist, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Holtaas, S. [Dept. of Radiology, University Hospital, Lund (Sweden)

    1995-04-01

    The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation. (orig.)

  13. [Surgery for children and adolescents. Post-operative phase].

    Science.gov (United States)

    Ruzafa Martínez, María; Ruiz García, María Jesús; Gómez García, Carmen I

    2004-05-01

    The authors explain the third and last phase in the surgical process, the post-operative phase. The authors propose a standardized model of nursing care for children and adolescents. The third and last phase in the surgical process commences at the moment the child arrives in the recovery room and lasts until he/she is released from the hospital. This phase includes the treatment applied in the recovery room and later in a hospital ward or in the child's home. The authors use the Gordon Functional Health Patterns. Special emphasis is given to the perception-management health pattern, the nutritional-metabolic pattern, the elimination pattern, the exercise-activity pattern, and the cognitive-perception pattern. Of special importance is the vigilance during the first post-operative hours, as well as the child's parenteral nutrition or total parenteral nutrition, TPN, and the evaluation of pain according to the age of the child. The authors select the NANDA (North American Nursing Diagnosis Association) Nursing Diagnoses which appear most frequently in this post-operative phase.

  14. Epidemiology and outcome of patients with postoperative abdominal fistula

    Directory of Open Access Journals (Sweden)

    Janaina Wercka

    2016-04-01

    Full Text Available ABSTRACT Objective: to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. Methods: This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. Results: The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%, followed by colonic fistulas (22% and stomach (15%. The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit Conclusion: abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality.

  15. Initial real world experience with a novel insertable (Reveal LinQ(@Medtronic)) compared to the conventional (Reveal XT(@Medtronic)) implantable loop recorder at a tertiary care center - Points to ponder!

    Science.gov (United States)

    Gunda, Sampath; Reddy, Yeruva Madhu; Pillarisetti, Jayasree; Koripalli, Sandeep; Jeffery, Courtney; Swope, Jeanine; Atkins, Donita; Bommana, Sudharani; Emert, Martin P; Pimentel, Rhea; Dendi, Raghuveer; Berenbom, Loren D; DiBiase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya

    2015-07-15

    Limited data is available regarding the novel Reveal LinQ (LinQ) which is a new generation implantable loop recorders (ILRs). We performed a prospective, observational study of all consecutive patients undergoing conventional (Reveal XT; XT) and LinQ devices at our institution between January 2012 and December 2014. A total of 217 patients underwent ILR implantation. XT was implanted in 105 and LinQ in 112 patients. There were no significant differences in baseline characteristics between the two groups. LinQ implantation using the manufacturer's technique termed, "manufacturer's method" group had significantly higher incidence of pocket infection compared to XT (6/50, 12% vs 3/105, 3%, p=0.032). With modifications to the LinQ implantation technique (using a conventional scalpel and placing a suture when needed to the incision) termed "modified method" group, the rate of infection has decreased significantly compared to "manufacturer's method group" (0/62, 0% vs 6/50, 12%, p=0.004) (Table 3). In multivariate regression analysis, the only independent predictors of infection were younger age (OR 0.95; p=0.04), insertion of LinQ device (OR 30.02; p=0.006) and procedure time (OR 1.07; p=0.03). In our single-center, prospective, observational study we found that with the current implantable techniques, the novel insertable LinQ device is associated with increased risk of complications. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Editorial: Improving cataract outcomes through good postoperative care

    Directory of Open Access Journals (Sweden)

    Nick Astbury

    2016-10-01

    Full Text Available Cataract surgery is one of the most successful and frequently performed operations worldwide, and yet cataract remains the commonest cause of global blindness. This is in part due to the shortage and uneven distribution of trained personnel in some countries. More worryingly, a high rate of cataract blindness also reflects poor visual outcomes after surgery, as has been documented in many RAAB (rapid assessment of avoidable blindness studies.

  17. The pitfalls of postoperative theatre to intensive care unit handovers ...

    African Journals Online (AJOL)

    Johan van der Walt

    2016-04-11

    Apr 11, 2016 ... multi-organ involvement.2,3 Cardiac patients often present with complex medical and .... on the newly developed handover protocol, Catchpole et al demonstrated a .... in medicine is based on verbal communication subjected to ... skills of many healthcare workers.20 It prompts verbal communication and ...

  18. POSTOPERATIVE MANAGEMENT OF SCOLIOSIS SURGERY: A PAEDIATRIC INTENSIVE CARE EXPERIENCE

    OpenAIRE

    Aires de Sousa, L.; Silvestre, C.; A. Carvalho; Oom, P; Santos, E.; Correia, M.

    2006-01-01

    RESUMO Objectivo: Analisar os casos de escoliose submetidos a intervenção cirúrgica, que fi zeram o pós-operatório na Unidade de Cuidados Intensivos Pediátricos, para identifi car problemas ou defi ciências e propor soluções. Métodos: Análise retrospectiva dos casos referidos, no período de 2000 a 2004. Resultados: Em 39 doentes identifi cados foram analisados 30, dos quais 21 eram do sexo feminino e as idades encontravam-se compreendidas entre 17 mes...

  19. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Chung-Sik Oh

    2016-01-01

    Full Text Available Background. Residual neuromuscular block (NMB after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD. We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P=0.750. Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P<0.001 and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P=0.010 in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

  20. Cardiac surgery patients' evaluation of the quality of theatre nurse postoperative follow-up visit.

    Science.gov (United States)

    Falk-Brynhildsen, Karin; Nilsson, Ulrica

    2009-06-01

    Theatre nurses at the Department of Cardiothoracic Surgery in Orebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission. The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient's perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study. The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items. In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.

  1. Postoperative chemoradiotherapy for gallbladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Chie, E.K.; Ha, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Seoul National Univ. (Korea, Republic of). Inst. of Radiation Medicine; Jang, J.Y.; Kim, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Surgery; Han, S.W.; Oh, D.Y.; Im, S.A.; Kim, T.Y.; Bang, Y.J. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Internal Medicine

    2012-05-15

    The goal of this work was to analyze the outcome of adjuvant chemoradiotherapy for patients with gallbladder cancer who underwent surgical resection and to identify the prognostic factors for these patients. Between August 1989 and November 2006, 47 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 26 females, and median age was 60 years (range 44-75 years). Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40-50 Gy at 2 Gy/fraction; 41 patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 48 months for survivors. There were 2 isolated locoregional recurrences, 14 isolated distant metastases, and 7 combined locoregional and distant relapses. The 5-year overall survival rate was 43.7%. According to the extent of resection, the 5-year overall survival rates were 52.8%, 20.0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p = 0.0038). On multivariate analysis incorporating extent of resection, T stage, N stage, performance of lymph node dissection, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p = 0.0075). Among the 37 patients with R0 resection, there was no difference of 5-year overall survival rates in patients with N0, N1, and Nx diseases (46.2%, 60.0%, and 44.4%, respectively, p = 0.6246). As for significant treatment-related morbidity, there was only 1 patient with grade 4 gastric ulcer. Adjuvant chemoradiotherapy after R0 resection can achieve a good long-term survival rate in gallbladder cancer patients, even in those with lymph node metastases, and may play a role for patients who underwent R0 resection of primary tumor without lymph node dissection. (orig.)

  2. Role of buprenorphine in acute postoperative pain

    Directory of Open Access Journals (Sweden)

    J. Alcázar-Castro

    2016-07-01

    Full Text Available Nowadays acute postoperative pain persists as a high prevalence symptom. The incidence, intensity and duration of postoperative pain vary considerably from one patient to another, from one surgery to another, from one hospital to another, and even from one country to another. It is important to learn about recent developments in central sensitisation, as it plays an important role in postoperative pain. Postoperative pain is mainly nociceptive somatic, in response to surgical damage. The surgical trauma and pain cause an endocrine response that increases the secretion of cortisol, catecholamines, and other stress hormones. Tachycardia, hypertension, decreased regional blood flow, impaired immune response, hyperglycaemia, lipolysis, and negative nitrogen balance also occur. All this plays an important role in morbidity and mortality in the postoperative period. Buprenorphine is a semi-synthetic opioid derived from thebaine. It has a binding affinity for the mu, kappa and delta receptors, and has a slow dissociation from these receptors. Because of its action on the mu and kappa receptors it can be used as an analgesic, as well as for maintenance therapy in patients with a history of drug abuse. This article will describe the characteristics of acute postoperative pain, the pharmacology of buprenorphine, and its interference in the management of postoperative pain.

  3. Control of postoperative pain after awake craniotomy with local intradermal analgesia and metamizol.

    Science.gov (United States)

    Grossman, Rachel; Ram, Zvi; Perel, Azriel; Yusim, Yakov; Zaslansky, Ruth; Berkenstadt, Haim

    2007-05-01

    Pain following brain surgery is a significant problem. Infiltration of the scalp with local intradermal anesthetics was suggested for postoperative pain control but was assessed only in the first hour postoperatively. To evaluate wound infiltration with a single dose of metamizol (dipyrone) for postoperative pain control in patients undergoing awake craniotomy. This open, prospective, non-randomized observational study, conducted in anesthesiology and neurosurgical departments of a teaching hospital, included 40 patients undergoing awake craniotomy for the removal of brain tumor. Intraoperative anesthesia included wound infiltration with lidocaine and bupivacaine, conscious sedation using remifentanil and propofol, and a single dose of metamizol (dipyrone) for postoperative pain control. Outcome was assessed by the Numerical Pain Scale on arrival at the postoperative care unit, and 2, 4 and 12 hours after the end of surgery. On arrival at the postoperative care unit, patients reported NPS scores of 1.2 +/- 1.1 in a scale of 0-10 (mean +/- SD) (median = 1, range 0-4). The scores were 0.8 +/-0.9, 0.9 +/- 0.9 and 1 +/- 0.9 at 2 hours, 4 hours and 12 hours after the end of surgery, respectively. Based on patients' complaints and NPS lower than 3, 27 patients did not require any supplementary analgesia during the first 12 postoperative hours, 11 patients required a single dose of oral metamizol or intramuscular diclofenac, one patient was given 2 mg of intravenous morphine, and one patient required two separate doses of metamizol. Although the clinical setup prevents the use of placebo local analgesia as a control group, the results suggest the possible role of local intradermal infiltration of the scalp combined with a single dose of metamizol to control postoperative pain in patients undergoing craniotomy.

  4. Effects of posture on postoperative pulmonary function

    DEFF Research Database (Denmark)

    Nielsen, K G; Holte, Kathrine; Kehlet, H

    2003-01-01

    BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed....... METHODS: Review of controlled, clinical trials evaluating postoperative pulmonary function in patients positioned in the supine vs. the sitting or standing position and patients positioned in the supine vs. the lateral position. Data were obtained from a search in the Medline and Cochrane databases (1966...

  5. Imaging of the postoperative middle ear

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Marc T. [Department of Medical Imaging, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75940, Paris (France); Ayache, Denis [Department of Otorhinolaryngology, Fondation Ophtalmologique Adolphe de Rothschild, Paris (France)

    2004-03-01

    The aim of this article is twofold: (a) to present the principles and the indications of surgical treatment of middle ear pathologies; and (b) to review the imaging findings after middle ear surgery, including the normal postoperative aspects and imaging findings in patients presenting with unsatisfactory surgical results or with suspicion of postoperative complications. This review is intentionally restricted to the most common diseases involving the middle ear: chronic otitis media and otosclerosis. In these specific fields of interest, CT and MR imaging play a very important role in the postoperative follow-up and in the work-up of surgical failures and complications. (orig.)

  6. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis

    Science.gov (United States)

    Arumugam, Sudha; Lau, Christine SM; Chamberlain, Ronald S

    2016-01-01

    Objectives Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin’s use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. Materials and methods A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. Results A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference −1.35, 95% confidence interval [CI]: −1.96 to −0.73; Pfentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10–1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. Conclusion The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment plans among patients undergoing elective surgery. PMID

  7. Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study.

    Science.gov (United States)

    Goyal, Manoj; Marya, Karan; Jhamb, Aakarsh; Chawla, Sonia; Sonoo, Priyanshu Ranjan; Singh, Veenita; Aggarwal, Anuj

    2012-09-01

    Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.

  8. Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery

    DEFF Research Database (Denmark)

    Rubinsky, Anna D; Bishop, Michael J; Maynard, Charles

    2013-01-01

    Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery ("documented drinking >2d/d") are associated with increased postoperative complications and health care utilization. The purpose of this stud...... was to evaluate whether documented drinking >2d/d contributed additional information about postoperative risk beyond past-year AUDIT-C screening results.......Both AUDIT-C alcohol screening scores up to a year before surgery and clinical documentation of drinking over 2 drinks per day immediately prior to surgery ("documented drinking >2d/d") are associated with increased postoperative complications and health care utilization. The purpose of this study...

  9. The Effect of Mobile App Follow-up Care on the Number of In-person Visits Following Ambulatory Surgery: A Randomized Control Trial.

    Science.gov (United States)

    Armstrong, Kathleen; Coyte, Peter; Semple, John

    2015-01-01

    Women's College Hospital (WCH) in Toronto offers specialized ambulatory surgical procedures. A feasibility study using a mobile appliciation (app) to supplement in-person follow-up care after surgery suggests that the mobile app adequately detects postoperative complications, eliminates the need for in-person follow-up care and is cost-effective. This is concordant with other postoperative telemedicine studies. The purpose of this study is to determine if we can avert in-person follow-up care through the use of mobile app compared to conventional, in-person follow-up care in the first month following surgery amongst breast reconstruction patients at WCH. This will be a pragmatic, single-centre, open, controlled, 2-arm parallel-group superiority randomized trial. Mobile app follow-up care is a novel approach to managing patients postoperatively with the potential to avert in-person follow-up and generate cost-savings for the healthcare system and patient.

  10. Management of acute pain in the postoperative setting

    DEFF Research Database (Denmark)

    Meissner, Winfried; Huygen, Frank Jpm; Neugebauer, Edmund A M

    2017-01-01

    /unsuccessful. In the hospital sector the development and implementation of QIs is complex. The nature of POPM requires a highly-trained, multidisciplinary team and it is at this level where major improvements can be made. Greater involvement of patients regarding pain management is also seen as a priority area for improving......Despite the introduction of evidence-based recommendations for postoperative pain management (POPM), the consensus is that pain control remains suboptimal. Barriers to achieving patient-satisfactory analgesia include deficient knowledge regarding POPM among staff, lack of instructions, insufficient...... pain assessments and sub-optimal treatment. Effective monitoring of POPM is essential to enable policy makers and healthcare providers to improve the quality of care. Quality indicators (QIs) are quantitative measures of clinical practice that can monitor, evaluate and guide the quality of care...

  11. Thyroid Storm in Postoperative Delirium Etiology: Case Report

    Directory of Open Access Journals (Sweden)

    Nermin Kelebek Girgin

    2016-08-01

    Full Text Available Delirium is an acute organic brain syndrome of different physical and pathophysiological etiologies characterized by a disturbance in consciousness with accompanying change in cognition. Delirium causes prolonged length of stay in hospital and intensive care unit, also increased morbidity and mortality. Thyroid storm is a severe, life-threatening type of thyrotoxicosis and is one of a few endocrine disorders that cause delirium. It is mostly occured suddenly after acute infection, surgical stress or trauma. This condition occurs due to excess production of thyroid hormone and 20-50% mortality rate depends on early diagnosis and treatment. In this study it was aimed to present the diagnosis and treatment of a previously unknown hyperthyroid patient who underwent suspension laryngoscopy under general anesthesia and was post-operatively admitted to the intensive care unit because of pulmonary edema and proceeded to develop severe delirium caused by hyrotoxicosis.

  12. EVALUATION OF POST-OPERATIVE SENSITIVITY AND ...

    African Journals Online (AJOL)

    Prof

    composites in wear resistance and achievement of good proximal contour ... change in result was recorded for post-operative sensitivity at the end of the evaluation period. 100% was recorded ..... Overcoming challenges with resin in class II ...

  13. [Postoperative inconveniences after breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Callesen, T.; Kroman, N.

    2008-01-01

    The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure...

  14. Prevention of postoperative infections in ophthalmic surgery

    Directory of Open Access Journals (Sweden)

    Ram Jagat

    2001-01-01

    Full Text Available Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.

  15. Abdominal CT findings of delayed postoperative complications

    Energy Technology Data Exchange (ETDEWEB)

    Zissin, R.; Osadchy, A. [Sapir Medical Center, Dept. of Diagnostic Imaging, Kfar Saba (Israel)]. E-mail: zisinrivka@clalit.org.il; Gayer, G. [Assaf Harofe Medical Center, Dept. of Diagnostic Imaging, Zrifin (Israel)

    2007-10-15

    Despite progress in surgical techniques and modern medical treatment, postoperative complications occur not infrequently and vary according to type of surgery, clinical setting, and time elapsed since surgery. In general, they can be divided into early and delayed complications. Delayed postoperative complications can be classified as specific and nonspecific. The common nonspecific delayed complications are incisional hernia and postoperative bowel obstruction. Bowel obstruction can be further categorized as obstruction related to benign or neoplastic etiology, the latter occurring in oncology patients in whom the primary surgery was related to an underlying abdominal neoplasm. Gossypiboma is another, fortunately rare, postoperative complication. Specific complications appear after specific operations and include the following: Splenosis - following splenectomy. Retained gallstones and spilled gallstones - following cholecystectomy, mainly laparoscopic. Dropped appendicolith and stump appendicitis - following appendectomy, mainly laparoscopic. Obturation obstruction by a bezoar - following gastric surgery. Afferent loop syndrome (ALS) - following Bilroth II gastrectomy. (author)

  16. Methodological issues of postoperative cognitive dysfunction research

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    to reveal postoperative cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects...

  17. Postoperative Pain Management: Clinicians' Knowledge and ...

    African Journals Online (AJOL)

    Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and ... It, therefore, commands a central position in health seeking behavior. ... it causes, but also because of its negative effects on the process of recovery.

  18. Multimodality imaging of the postoperative shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

    2007-12-15

    Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

  19. The surgical team and outcomes management: focus on postoperative ileus.

    Science.gov (United States)

    Carter, Susan

    2006-04-01

    Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). The fact that POI is generally transient and therefore self-limited should not deter the surgical team from seeking improved ways to mitigate its associated adverse effects, which can be substantial and immensely uncomfortable for the patient, and can have far-reaching implications regarding overall hospitalization costs for many types of surgeries. Optimization of POI management and prevention efforts is a responsibility of all members of the surgical team and can drastically affect the overall clinical outcome of major abdominal surgery. Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.

  20. Role of intercostal nerve block in reducing postoperative pain following video-assisted thoracoscopy: A randomized controlled trial.

    Science.gov (United States)

    Ahmed, Zulfiqar; Samad, Khalid; Ullah, Hameed

    2017-01-01

    The main advantages of video assisted thoracoscopic surgery (VATS) include less post-operative pain, rapid recovery, less postoperative complications, shorter hospital stay and early discharge. Although pain intensity is less as compared to conventional thoracotomy but still patients experience upto moderate pain postoperatively. The objective of this study was to assess the efficacy and morphine sparing effect of intercostal nerve block in alleviating immediate post-operative pain in patients undergoing VATS. Sixty ASA I-III patients, aged between 16 to 60 years, undergoing mediastinal lymph node biopsy through VATS under general anaesthesia were randomly divided into two groups. The intercostal nerve block (ICNB group) received the block along with patient control intravenous analgesia (PCIA) with morphine, while control group received only PCIA with morphine for post-operative analgesia. Patients were followed for twenty four hours post operatively for intervention of post-operative pain in the recovery room and ward. The pain was assessed using visual analogue scale (VAS) at 1, 6, 12 and 24 hours. There was a significant decrease in pain score and morphine consumption in ICNB group as compared to control group in first 6 hours postoperatively. There was no significant difference in pain scores and morphine consumption between the two groups after 6 hours. Patients receiving intercostal nerve block have better pain control and less morphine consumption as compared to those patients who did not receive intercostal nerve block in early (6 hours) post-operative period.

  1. Colonic resection with early discharge after combined subarachnoid-epidural analgesia, preoperative glucocorticoids, and early postoperative mobilization and feeding in a pulmonary high-risk patient

    DEFF Research Database (Denmark)

    Møiniche, S; Dahl, J B; Rosenberg, J

    1994-01-01

    BACKGROUND AND OBJECTIVES. A pulmonary high-risk patient undergoing right hemicolectomy for cancer was treated with a combination of intense afferent neural block with subarachnoid-epidural local anesthetics followed by continuous epidural analgesia, preoperative high-dose glucocorticoids......) with unchanged pulmonary function. Nocturnal episodic oxygen desaturation, hyperthermia, and postoperative fatigue were prevented. Defecation occurred on the first postoperative day and oral caloric intake was normal after 24 hours with no postoperative weight loss. Self care was normalized on the third...

  2. [Postoperative fever in orthopedic and urologic surgery].

    Science.gov (United States)

    Saavedra, Federico; Myburg, Cristina; Lanfranconi, Marisa B; Urtasun, Martin; De Oca, Luis Montes; Silberman, Andres; Lambierto, Alberto; Gnocchi, Cesar A

    2008-01-01

    Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n = 19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.

  3. Postoperative pyrexia after arthroplasty - when to panic ?

    OpenAIRE

    Agarwala Sanjay; Jain Deepak; Bhagwat Abhijit

    2005-01-01

    Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperat...

  4. Need for improved treatment of postoperative pain

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Thomsen, Berit Ahlmann; Kitter, Birgitte;

    2012-01-01

    A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential.......A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential....

  5. Methodological issues of postoperative cognitive dysfunction research

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    Postoperative cognitive dysfunction (POCD) is a subtle impairment of memory, concentration, and speed of information processing. It is a frequent complication following surgery and can have a debilitating effect on patients' recovery and future prognosis. Neuropsychological testing is needed...... to reveal postoperative cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects...

  6. Benzodiazepines and postoperative cognitive dysfunction in the elderly

    DEFF Research Database (Denmark)

    Rasmussen, L.S.; Steentoft, Anni; Rasmussen, H.

    1999-01-01

    hypnotics benzodiazepine,diazepam,age factor,anaesthesia,geriatric,psychological responses,postoperative......hypnotics benzodiazepine,diazepam,age factor,anaesthesia,geriatric,psychological responses,postoperative...

  7. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

    NARCIS (Netherlands)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D.; Audisio, Riccardo; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; Maclullich, Alasdair; Radtke, Finn; Riese, Florian; Slooter, Arjen J C|info:eu-repo/dai/nl/173059740; Veyckemans, Francis; Kramer, Sylvia; Neuner, Bruno; Weiss, Bjoern; Spies, Claudia D.

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperati

  8. Effect of Pre-Designed Instructions for Mothers of Children with Hypospadias on Reducing Postoperative Complications

    Science.gov (United States)

    Mohamed, Sanaa A.

    2015-01-01

    Hypospadias is a common congenital anomaly with a prevalence estimated to be as high as 1 in 125 live male births. Complications after surgical procedures are possible. The incidence of complications can be reduced by meticulous preoperative planning, and judicious postoperative care. So the aim of the study was to investigate the effect of…

  9. Is duration of postoperative fasting associated with infection and prolonged length of stay in surgical patients?

    OpenAIRE

    Assis, Michelli Cristina Silva de; Carla Rosane de Moraes SILVEIRA; Beghetto, Mariur Gomes; Mello, Elza Daniel de

    2014-01-01

    Objective: Verify whether the postoperative fasting period increases the risk for infection and prolonged length of stay. Methods: Prospective cohort study. Elective surgery patients were included. Excluded: those with no conditions for nutritional assessment, admitted in minimal care units, as well as with

  10. Hyperfractionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: Results from the randomized multicenter HIT-SIOP PNET 4 trial

    NARCIS (Netherlands)

    B. Lannering (Birgitta); P. Rutkowski (Piotr); F.F. Doz (François); B. Pizer (Barry); G. Gustafsson (Göran); A. Navajas (Aurora); M. Massimino (Maura); R.E. Reddingius (Roel); M. Benesch (Martin); C. Carrie (Christian); R. Taylor; L. Gandola (Lorenza); T. Bjor̈k-Eriksson (Thomas); S. Giralt; F. Oldenburger (Foppe); T. Pietsch (Torsten); D. Figarella-Branger (Dominique); K. Robson (Kathryn); G. Forni (Gianluca); S.C. Clifford (Steven); M. Warmuth-Metz (Monica); D.D. Von Hoff; A. Faldum (Andreas); V. Mosseri (Véronique); B. Kortmann

    2012-01-01

    textabstractPurpose: To compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy. Patients

  11. Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

    Directory of Open Access Journals (Sweden)

    Guo-Xi Zhang

    2017-01-01

    Full Text Available We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II-III according to the Dubin grading system were randomly assigned to TTLVL (n = 45 and conventional laparoscopic varicocele ligation (CLVL (n = 45. The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05. However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively. The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001. There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes.

  12. Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

    Science.gov (United States)

    Zhang, Guo-Xi; Yang, Jun; Long, Da-Zhi; Liu, Min; Zou, Xiao-Feng; Yuan, Yuan-Hu; Xiao, Ri-Hai; Xue, Yi-Jun; Zhong, Xin; Liu, Quan-Liang; Liu, Fo-Lin; Jiang, Bo; Xu, Rui-Quan; Xie, Kun-Lin

    2017-01-01

    We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II–III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes. PMID:26732104

  13. Equally increased hypercoagulability irrespective of using minimized or conventional ECC systems

    DEFF Research Database (Denmark)

    Steinbrüchel, Ann S; Johansson, Pär I; Rafiq, Sulman;

    2012-01-01

    Minimized extracorporeal circulation systems in coronary artery bypass may have less impairing effect on hematological parameters and bleeding compared to conventional systems. The aim of this study was to investigate whether the use of mini systems does result in an increased postoperative hyper...

  14. CONVENTIONAL DEVELOPMENT OF ENVIRONMENTAL PREOCCUPATIONS

    OpenAIRE

    2011-01-01

    A great number of the conventions referring to nature, even if they do not refer ton particular species, were limited from the point of view of geography and territories: we may give as example here a convention for the protection of flora, fauna and panoramic beauties of America, the African convention for nature and natural resources… By the Stockholm conferences, from the 5th of June 1972, we entered in a “dynamic of globalization”. Article 1 of the Declaration that followed the conference...

  15. Conventional Armaments for coming decades .

    Directory of Open Access Journals (Sweden)

    S.K. Salwan

    1997-10-01

    Full Text Available Conventional arnaments have continued to play a decisive role even in the present scenario of nuclear weapons and electronic warfare. As a war-fighting technology, they are low cost, reliable, highly effective and proven in several battlefield situations. With the application of advancements in electronics, materials and manufacturing technologies, computers and propulsion technologies to conventional weapon systems, they are capable of having greater flexibility, lethality , accuracy and effectiveness. This communication gives an overview on advancements in conventional armament systems, emerging trends in weapon technologies and modern enabling technologies for advanced weapon systems.

  16. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

    Science.gov (United States)

    Carlson, Russell M; Smith, Nicholas C; Dux, Katherine; Stuck, Rodney M

    2014-04-01

    Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.

  17. Caudal analgesia and cardiothoracic surgery: a look at postoperative pain scores in a pediatric population.

    Science.gov (United States)

    Nguyen, Khoa N; Byrd, Heather S; Tan, Jonathan M

    2016-11-01

    Caudal epidural anesthesia has been shown to reduce stress response and shorten the time to extubation in children after cardiac surgery. Combined with general anesthesia, regional anesthesia has been proven to be safe and efficacious in the pediatric population. It is not known, however, whether the use of caudal anesthesia actually reduces postoperative pain scores and decreases postoperative opioid use. We retrospectively analyzed the charts of 199 children who underwent repair for atrial septal defect (ASD), ventricular septal defect (VSD), and Tetralogy of Fallot (TOF) at a major academic children's hospital between 2010 and 2013. Eighty-six patients underwent preoperative placement of caudal anesthesia (bupivacaine 0.25% 1 ml·kg(-1) up to 20 ml + clonidine 2mcg·kg(-1) + Duramorph 40 mcg·kg(-1) up to 2.5 mg) and 113 patients did not have a caudal block. Postoperative cardiac intensive care pain scores were analyzed according to standard nurse-recorded patient-appropriate pain scales ranging from 0 to 10 (CRIES for neonates and FLACC for 2 months-7 years). There was no statistical difference between caudal and noncaudal groups with respect to postoperative pain scores or with postoperative opioid requirements. There was a statistical significance with regard to intraoperative opioid use as noncaudal patients invariably received more opioid during the procedure. Although regional anesthesia reduced intraoperative opioid usage, there was no difference in postoperative opioid usage or pain scores. © 2016 John Wiley & Sons Ltd.

  18. Orem自护模式对全膝关节置换术后康复期患者自护能力和日常生活活动能力的影响%Effect of self nursing mode on ability of self-care and daily activities of postoperative TKA patients during rehabilitation

    Institute of Scientific and Technical Information of China (English)

    李辉

    2012-01-01

    目的 探讨自护健康教育对全膝关节置换术后(TKA)康复期患者自护能力和日常生活活动能力(ADL)的影响.方法 选取哈尔滨某三甲医院骨科2010年3月至2011年3月TKA术后康复期患者61例,采用抽签方法随机分为观察组(31例)和对照组(30例),对照组进行常规健康教育,观察组患者在此基础上进行自护健康教育.采用自护能力测定量表和日常生活活动能力量表评价患者的自护能力和ADL.结果 干预前两组患者在自护能力和日常生活活动能力两方面得分比较差异无统计学意义(P>0.05);干预后观察组患者在自护责任感(13.48±4.66)、自护概念(25.25±3.65)、自护技能(38.98±5.73)、健康知识水平(48.00±8.26)、自护能力(125.81±17.59)及ADL方面评分(76.25±14.80)明显高于对照组的(10.87±4.73),(20.97±4.45),(33.57±6.06),(42.84±6.60),(108.23±16.30),(62.30±15.55),两组比较,差异均有统计学意义(t分别为2.287,4.139,3.610,2.730,4.073,3.606;P<0.01).结论 自护健康教育与常规健康教育相比能更有效地提高TKA术后康复期患者的自护能力和ADL.%Objective To investigate the effect of health education about self nursing on the ability of self-care and daily activities of postoperative total knee arthroplasty (TKA) patients during rehabilitation.Methods Sixty-one patients after TKA between March 2010 and March 2011 were randomly divided into self nursing group (n =31) and control group (n =30).In self nursing group,the patients were educated about self nursing knowledge.while in control groups,the paticnts wcre educated about general health knowledge.Questionnaire of self nursing capacity determination and questionnaire of activities of daily living were used to assess the patients.Results Before the intervention,the scores of self-care abilities and activities of daily living of two groups has no significant different (P > 0.05).After the intervention,the scores of self-care

  19. Postoperative Pulmonary Dysfunction and Mechanical Ventilation in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Rafael Badenes

    2015-01-01

    Full Text Available Postoperative pulmonary dysfunction (PPD is a frequent and significant complication after cardiac surgery. It contributes to morbidity and mortality and increases hospitalization stay and its associated costs. Its pathogenesis is not clear but it seems to be related to the development of a systemic inflammatory response with a subsequent pulmonary inflammation. Many factors have been described to contribute to this inflammatory response, including surgical procedure with sternotomy incision, effects of general anesthesia, topical cooling, and extracorporeal circulation (ECC and mechanical ventilation (VM. Protective ventilation strategies can reduce the incidence of atelectasis (which still remains one of the principal causes of PDD and pulmonary infections in surgical patients. In this way, the open lung approach (OLA, a protective ventilation strategy, has demonstrated attenuating the inflammatory response and improving gas exchange parameters and postoperative pulmonary functions with a better residual functional capacity (FRC when compared with a conventional ventilatory strategy. Additionally, maintaining low frequency ventilation during ECC was shown to decrease the incidence of PDD after cardiac surgery, preserving lung function.

  20. Pre-, intra- and post-operative imaging of cochlear implants

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J.; Naguib, N.N.N.; Burck, I. [University Hospital Frankfurt (Germany). Inst. of Diagnostic and Interventional Radiology; Tawfik, A. [Mansoura Univ. (Egypt). Dept. of Diagnostic and Interventional Radiology; Emam, A. [University Hospital Alexandria (Egypt). Dept. of Diagnostic and Interventional Radiology; Nour-Eldin, A. [University Hospital Cairo (Egypt). Dept. of Radiology; Stoever, T. [University Hospital of Frankfurt (Germany). Dept. of Otolaryngology

    2015-11-15

    The purpose of this review is to present essential imaging aspects in patients who are candidates for a possible cochlear implant as well as in postsurgical follow-up. Imaging plays a major role in providing information on preinterventional topography, variations and possible infections. Preoperative imaging using DVT, CT, MRI or CT and MRI together is essential for candidate selection, planning of surgical approach and exclusion of contraindications like the complete absence of the cochlea or cochlear nerve, or infection. Relative contraindications are variations of the cochlea and vestibulum. Intraoperative imaging can be performed by fluoroscopy, mobile radiography or DVT. Postoperative imaging is regularly performed by conventional X-ray, DVT, or CT. In summary, radiological imaging has its essential role in the pre- and post-interventional period for patients who are candidates for cochlear implants.

  1. Impact of specific postoperative complications on the outcomes of emergency general surgery patients.

    Science.gov (United States)

    McCoy, Christopher Cameron; Englum, Brian R; Keenan, Jeffrey E; Vaslef, Steven N; Shapiro, Mark L; Scarborough, John E

    2015-05-01

    The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. Patients from the 2005 to 2011 American College of Surgeons' National Surgical Quality Improvement Program database who underwent emergency operation by a general surgeon for one of seven diagnoses (gallbladder disease, gastroduodenal ulcer disease, intestinal ischemia, intestinal obstruction, intestinal perforation, diverticulitis, and abdominal wall hernia) were analyzed. Postoperative complications (pneumonia, myocardial infarction, incisional surgical site infection, organ/space surgical site infection, thromboembolic process, urinary tract infection, stroke, or major bleeding) were chosen based on surgical outcome measures monitored by national quality improvement initiatives and regulatory bodies. Regression techniques were used to determine the independent association between these complications and 30-day mortality, after adjustment for an array of patient- and procedure-related variables. Emergency operations accounted for 14.6% of the approximately 1.2 million general surgery procedures that are included in American College of Surgeons' National Surgical Quality Improvement Program but for 53.5% of the 19,094 postoperative deaths. A total of 43,429 emergency general surgery patients were analyzed. Incisional surgical site infection had the highest incidence (6.7%). The second most common complication was pneumonia (5.7%). Stroke, major bleeding, myocardial infarction, and pneumonia exhibited the strongest associations with postoperative death. Given its disproportionate contribution to surgical mortality, emergency surgery represents an ideal focus for quality improvement. Of the potential postoperative targets for quality improvement, pneumonia, myocardial

  2. Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Almushayt Abdullah

    2009-02-01

    Full Text Available Abstract Background Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1 investigate post-operative complications associated with dental care under GA and (2 correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol. Methods Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation. Results Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%, sleepiness (71%, and pain (48% were the most common complaints in the first day, followed by bleeding (40%, drowsiness (39%, sore throat (34%, vomiting (26%, psychological changes (24%, fever (21%, cough (12%, and nausea (8%. A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints. Conclusion Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

  3. The Stabilization of Postoperative Exo-drift in Intermittent Exotropia after Surgical Treatment.

    Science.gov (United States)

    Park, Hoon; Kim, Won Jae; Kim, Myung Mi

    2016-02-01

    To investigate the long-term clinical course of intermittent exotropia after surgical treatment to determine whether and when postoperative exo-drift stabilizes, and the required postsurgery follow-up duration in cases of intermittent exotropia. We retrospectively reviewed the medical records of patients diagnosed with intermittent exotropia who underwent surgical treatment between January 1992 and January 2006 at Yeungnam University Hospital and postoperatively performed regular follow-up examinations for up to 7 years. We also analyzed the difference in exo-drift stabilization, according to surgical procedure. A total of 101 patients were enrolled in the study. Thirty-one patients underwent lateral rectus recession and medial rectus resection (R&R) and 70 patients underwent bilateral lateral rectus recession (BLR). The postoperative angles of deviation increased significantly during the initial 36 months, but no subsequent significant changes were observed for up to 84 months. Follow-ups for 7 years revealed that more than 50% of the total amount of exo-drift was observed within the first postoperative year. In addition, the angles of deviation at 1 year correlated with those at 7 years postoperatively (Pearson correlation coefficient r = 0.517, p exo-drift was observed after 36 months in patients who underwent BLR, whereas after 18 months in patients who underwent R&R. The minimum postoperative follow-up required after surgical treatment to ensure stable results is 36 months. In particular, careful follow-up is necessary during the first postoperative year to detect rapid exo-drift. Patients who underwent BLR required a longer follow-up than those who underwent R&R to ensure stable postoperative alignment.

  4. Moderate-degree acidosis is an independent determinant of postoperative bleeding in cardiac surgery.

    Science.gov (United States)

    Ranucci, M; Baryshnikova, E; Simeone, F; Ranucci, M; Scolletta, S

    2015-08-01

    Acidosis is a well-known factor leading to coagulopathy. It has been widely explored as a risk factor for severe bleeding in trauma patients. However, no information with respect to acidosis as a determinant of postoperative bleeding in cardiac surgery patients exists. The aim of this study was to investigate the role of acidosis and hyperlactatemia (HL) in determining postoperative bleeding and need for surgical revision in cardiac surgery patients. We carried out a retrospective analysis on 4521 patients receiving cardiac operations in two institutions. For each patient the preoperative data and operative profile was available. Arterial blood gas analysis data at the arrival in the intensive care unit were analyzed to investigate the association between acidosis (pH4.0 mMol/L) and postoperative bleeding and surgical revision rate. After correction for the potential confounders, both acidosis (P=0.001) and HL (P=0.001) were significantly associated with the amount of postoperative bleeding. HL was an independent risk factor for postoperative bleeding even in absence of acidosis. Overall, surgical revision rate was 5.6% in patients with HL and no acidosis; 7.7% in patients with acidosis and HL, and 7.2% in patients with acidosis and no HL. All these values are significantly (P=0.001) higher than the ones in patients without acidosis/HL (2%). Even a moderate degree of postoperative acidosis is associated with a greater postoperative bleeding and surgical revision rate in cardiac surgery patients. Correction of acidosis with bicarbonate does not lead to an improvement of the postoperative bleeding asset.

  5. Postoperative morbidity and histopathologic characteristics of tonsillar tissue following coblation tonsillectomy in children: a prospective randomized single-blind study.

    Science.gov (United States)

    Roje, Zeljka; Racić, Goran; Dogas, Zoran; Pisac, Valdi Pesutić; Timms, Michael

    2009-03-01

    The aim of this prospective randomized single blind study was to determine the depth of thermal damage to tonsillar tissue due to coblation, and to compare it with thermal damage to tonsillar tissue following conventional tonsillectomy; to correlate the depth of thermal damage to tonsillar tissue with the parameters of postoperative morbidity, to compare intraoperative blood loss, postoperative pain severity, time to resuming normal physical activity, and incidence of postoperative bleeding between two groups of tonsillectomized children aged up to 16 years. 72 children aged 3-16 years scheduled for tonsillectomy randomly assigned into two groups submitted either to conventional tonsillectomy with bipolar diathermy coagulation or to coblation tonsillectomy, with a 14-day follow up. Statistically significant differences were observed in the depth of thermal damage to tonsillar tissue (p < 0.001), intraoperative blood loss (p < 0.004), in postoperative pain severity (p < 0.05) and in time to resuming normal physical activity between the two groups (p < 0.001). There was no case of reactionary or secondary bleeding in either group. In this paper for the first time we have correlated postoperative morbidity and thermal tissue damage: less thermal damage is associated with less postoperative morbidity.

  6. NULL Convention Floating Point Multiplier

    OpenAIRE

    Anitha Juliette Albert; Seshasayanan Ramachandran

    2015-01-01

    Floating point multiplication is a critical part in high dynamic range and computational intensive digital signal processing applications which require high precision and low power. This paper presents the design of an IEEE 754 single precision floating point multiplier using asynchronous NULL convention logic paradigm. Rounding has not been implemented to suit high precision applications. The novelty of the research is that it is the first ever NULL convention logic multiplier, designed to p...

  7. Analysis of the electric heating conventional system replacement by the solar heating in day-care centers at Poco de Caldas - MG; Analise da substituicao de sistema convencional de aquecimento eletrico por aquecimento solar em creches em Pocos de Caldas -MG

    Energy Technology Data Exchange (ETDEWEB)

    Dantas, Carlos Tadeu [Escola Tecnica Limassis, Delfim Moreira, MG (Brazil); Mariotoni, Carlos Alberto [Universidade Estadual de Campinas, SP (Brazil)

    2006-07-01

    Located in the South of Minas Gerais, average altitude of 1186 m and population about 170.000 inhabitants Pocos de Caldas is one of the most developed tourist cities of Minas Gerais. Beyond this quality, that makes it one of the best cities in quality of life in Brazil, measured for the HDI, the city presents an enviable educational polar region comparing to cities of the south region. With 91 institutions of education, from children's education to superior education, Pocos de Caldas has more than 49,000 students today. From this scholar population, 1870 pupils represent the children's education in particular or municipal day-care centers, called CEI. Pocos de Caldas has its own generation of energy through the Municipal Department of Electricity, DME. The energy production today arrives the house of 58 MW reaching 100% of the population in 2005. The analysis of the substitution of conventional system of electric heating for solar heating in day-care centers has left of an unknown project, with the objective to minimize the consumption of energy unfastened during the children's baths who stay at CEI. In this context, this work presents a study carried through this project, after the implantation of the related system in four of the eleven day-care centers that the initial project composes. The data had been collected in the DME and the City department of Education. The pathological manifestations in the points of water consumption of the related day-care centers as well as the state of conservation of the systems of implanted solar heating had been investigated also. (author)

  8. 自我效能理论在全喉切除术后护理中的应用%Application of self-efficacy theory in postoperative nursing of patients with laryngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    田园; 张淑艳

    2014-01-01

    目的:观察自我效能理论在全喉切除术后护理中的应用效果。方法将60例喉癌患者随机分为两组,对照组给予常规护理,实验组运用自我效能理论指导喉癌患者的护理。结果实验组患者的自我效能及术后生命质量明显高于对照组(P<0.05)。结论将自我效能理论应用于喉癌患者的护理中,可提高患者的术后生命质量。%Objective To explore the effect of self-efficacy intervention on the quality of life of postoperative patients with laryngeal carcinoma .Methods Total of 60 patients were randomly divided into two groups, 30 cases were treated with conventional nursing (the control group) and other 30 cases with self-efficacy intervention on the basis of conventional nursing ( the experimental group ) .Results The quality of life of the experimental group was higher than that of the control group .Conclusions If the self-efficacy theory is applied to the care of laryngeal carcinoma patients , the quality of life of postoperative patients could be improved .

  9. [Comparative study of ambulatory laparoscopic cholecystectomy versus management of laparoscopic cholecystectomy with conventional hospital stay].

    Science.gov (United States)

    Lezana Pérez, María Ángeles; Carreño Villarreal, Guillermo; Lora Cumplido, Paola; Alvarez Obregón, Raúl

    2013-01-01

    To analyse the effectiveness and quality of ambulatory laparoscopic cholecystectomy (CLCMA) versus management of laparoscopic cholecystectomy with conventional hospital stay (CLEST). A retrospective study was conducted on all patients ASA I-II, who had a laparoscopic cholecystectomy (LC) over a period of 6 years. The patients were divided into 2 groups: group CLCMA (n = 141 patients) and group CLEST (n = 286 patients). The effectiveness was analysed by evaluating morbidity, further surgery, re-admission and hospital stay. The quality analysis was performed using CLCMA group satisfaction surveys and subsequent assessment by indicators of satisfaction. There was no significant differences between groups (CLEST vs. CLCMA) in morbidity (5.24 vs 4.26), further surgery (2.45 vs. 1.42) or re-admissions (1.40 vs. 3.55). There was no postoperative mortality. In the CLCMA group 82% of patients were discharged on the same day of surgery, with a mean stay of 1.16 days, while in the CLEST group the mean hospital stay was 2.94 days (P=.003).The overall satisfaction rate was 82%, and the level of satisfaction of care received was 81%, both above the previously set standard. CLCMA is just as effective and safe as hospital based CLEST, with a good level of perceived quality. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  10. A systematic review of cost-effective treatment of postoperative rotator cuff repairs.

    Science.gov (United States)

    Dickinson, Rebecca N; Kuhn, John E; Bergner, Jamie L; Rizzone, Katherine H

    2017-05-01

    The Bundled Payments for Care Improvement initiative combines payment of multiple services for episodes of care into 1 bundle. Rotator cuff repair is a likely candidate for future inclusion. The objective of this study was to determine cost-effective, high-quality postoperative rehabilitation dosing and cryotherapy for patients undergoing rotator cuff repair based on systematic review of the literature. Systematic review of level I and level II articles was performed in PubMed, Cochrane Databases, and PEDro. Conference references and bibliographies were also reviewed. For postoperative therapy, keywords included rotator cuff, rotator cuff repair, exercise therapy, exercise, unsupervised, self-care, postoperative period, physical therapy, and physiotherapy; for cryotherapy, keywords included rotator cuff repair, shoulder, cryotherapy, and ice. Five studies compared postoperative outcomes in participants assigned to supervised therapy vs. unsupervised therapy. Three found no difference between groups. One found improved outcomes in supervised therapy. Limitations included that therapies were not consistently defined and significant methodologic issues were present, decreasing the applicability and validity of the results. Five articles examined cryotherapy outcomes in the postoperative shoulder. Two studies showed improved patient outcomes with cryotherapy vs. no cryotherapy; 2 studies showed no decrease in joint space temperatures at 90 minutes but decrease in temperature at 4 to 23 hours postoperatively. One study indicated that an ice bag and Ace bandage might be as effective as continuous, compressive cryotherapy units using patient-reported outcomes. Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair. Cryotherapy is favorable and cost-effective using simple methods for delivery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. 右美托咪定用于重症监护病房正颌外科术后留置气管插管患者的镇静%Dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    方舒东; 朱也森; 徐辉; 姜虹

    2012-01-01

    AIM To study the effectiveness and safety of dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery admitted to intensive care unit (ICU). METHODS Forty post-operative patients undergoing orthognathic surgery with tracheal intubation in ICU were enrolled and randomized into 2 groups to receive either midazolam or dexmedetomidine. The dexmedetomidine group starting dose was 0.4μg·kg-1·h-1 without a loading dose and adjusted 0.2 to 0.7 μg ·kg·h-1. The midazolam group starting dose was 0.1 mg·kg-1·h-1 and adjusted 0.05 to 0.2 mg·kg·h-1, the dose of sedation was regulated by Ramsay Sedation Score (RSS) maintain 2 to 4 sedative score. During the course, RSS, heart rate (HR) , blood pressure, respiratory rate ( RR) and pulse oxygen saturation ( SpO2) were observed and registered continuously. The amount of the drug, and incidence of adverse reactions, such as hypotension, bradycardia, delirium, etc. were recorded in two groups. RESULTS The expected sedative scores were obtained in all patients in two groups. The HR and mean arterial blood pressures ( MAP) showed no significantly different between two groups before sedation (P > 0.05). The HR in the dexmedetomidine group at 1, 2, 3, 4, 6, 8, 12 and 16 h were lower compared with those in the midazolam group ( P < 0.05) . The MAP in the dexmedetomidine group at 1, 2, 3, and 4 h were lower than those in the midazolam group (P < 0.05) .The times of dose adjustment needed were significantly lower in the dexmedetomidine group ( 2 patients with 1 adjustment each) than those in the midazolam group ( 3 patients with 1 adjustment, 4 patients with 2 adjustments). Atropine was administered to 2 patients in the dexmedetomidine group because of bradycardia. No serious adverse reactions occurred in both groups. CONCLUSION Dexmedetomidine 0.4 μg · kg-1 · h-1 is effective sedatives for post-operative patients undergoing orthognathic surgery with tracheal intubation in

  12. Postoperative pyrexia after arthroplasty - when to panic ?

    Directory of Open Access Journals (Sweden)

    Agarwala Sanjay

    2005-01-01

    Full Text Available Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperature charts up to 6 th postoperative day and all investigations were reviewed to determine the cause of fever. Results: Post operative fever was recorded after 82 procedures (44.6%. The average maximum temperature occurred on post-operative day 1 (98.9 o F. Only 2 TKR got infected. Incidence of fever was higher in TKR as compared to THR. Conclusion: Post-operative fever is common and probably inflammatory. It is not an important predictive factor of joint infection. Work up for joint infection is not indicated unless other corroborative features are present. Aspiration of painful joint is a highly accurate for identifying an infection.

  13. Management of postoperative recurrence of Crohn's disease.

    Science.gov (United States)

    van Lent, Anja U; D'Haens, Geert R

    2013-01-01

    The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical therapy to reduce the rate of postoperative recurrence has been proven to be effective, yet the incidence of recurrence remains high. Patient profiling (risk stratification) is important in this postoperative setting. High-risk patients (associated with e.g. smoking, the need of repetitive surgery and penetrating disease) require strong immunosuppressive treatment, which should be commenced immediately after surgery, when recurrent disease activity begins. Additionally, early screening endoscopy should be performed to monitor treatment effect. The efficacy of thiopurines is shown to be higher than mesalazine or imidazole antibiotics alone for preventing and ameliorating endoscopic recurrence of CD postoperatively; however, anti-tumor necrosis factors (anti-TNFs) are increasingly considered the most potent agents. In patients with a risk factor for early postoperative recurrence, the first line of treatment is 6-mercaptopurine, in combination with imidazole antibiotics if tolerated, followed by anti-TNFs. When lesions are found at colonoscopy, therapy should be upscaled. We propose a treatment algorithm to direct therapeutic management of CD postoperatively. © 2013 S. Karger AG, Basel.

  14. Effects of Mini-Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low-Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support.

    Science.gov (United States)

    Kim, Sang Yoon; Cho, Sungkyu; Choi, Eunseok; Kim, Woong-Han

    2016-01-01

    Mixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low-bodyweight neonates. In an effort to reduce these effects, mini-volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low-bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low-bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS-1, priming volume, CPB time, and aortic cross-clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30-day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P priming volume and higher RACHS-1 were significant risk factors of postoperative ECMO support in univariate and multivariate analysis. The results of the present study suggest that MP may be beneficial in avoiding transfusion without having a significant effect on the hematocrit. Clinical outcomes did not differ between the two groups. However, larger priming volume was a significant risk factor for postoperative ECMO support with RACHS-1 category. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals Inc.

  15. Postoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?

    DEFF Research Database (Denmark)

    Krenk, L; Rasmussen, L S

    2011-01-01

    Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities of postoperat...

  16. Hippocampal internal architecture and postoperative seizure outcome in temporal lobe epilepsy due to hippocampal sclerosis.

    Science.gov (United States)

    Elkommos, Samia; Weber, Bernd; Niehusmann, Pitt; Volmering, Elisa; Richardson, Mark P; Goh, Yen Y; Marson, Anthony G; Elger, Christian; Keller, Simon S

    2016-02-01

    Semi-quantitative analysis of hippocampal internal architecture (HIA) on MRI has been shown to be a reliable predictor of the side of seizure onset in patients with temporal lobe epilepsy (TLE). In the present study, we investigated the relationship between postoperative seizure outcome and preoperative semi-quantitative measures of HIA. We determined HIA on high in-plane resolution preoperative T2 short tau inversion recovery MR images in 79 patients with presumed unilateral mesial TLE (mTLE) due to hippocampal sclerosis (HS) who underwent amygdalohippocampectomy and postoperative follow up. HIA was investigated with respect to postoperative seizure freedom, neuronal density determined from resected hippocampal specimens, and conventionally acquired hippocampal volume. HIA ratings were significantly related to some neuropathological features of the resected hippocampus (e.g. neuronal density of selective CA regions, Wyler grades), and bilaterally with preoperative hippocampal volume. However, there were no significant differences in HIA ratings of the to-be-resected or contralateral hippocampus between patients rendered seizure free (ILAE 1) compared to those continuing to experience seizures (ILAE 2-5). This work indicates that semi-quantitative assessment of HIA on high-resolution MRI provides a surrogate marker of underlying histopathology, but cannot prospectively distinguish between patients who will continue to experience postoperative seizures and those who will be rendered seizure free. The predictive power of HIA for postoperative seizure outcome in non-lesional patients with TLE should be explored. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Effectiveness of submucosal dexamethasone to control postoperative pain & swelling in apicectomy of maxillary anterior teeth.

    Science.gov (United States)

    Shah, Shahzad Ali; Khan, Irfanullah; Shah, Humera Shahzad

    2011-07-01

    The purpose of this study was to evaluate the effect of submucosal dexamethasone injection to control postoperative pain and swelling in apicectomy of maxillary anterior teeth. A randomized, controlled trial comprising 60 adult patients (68.3% male, 31.7% female) with no local or systemic problems was conducted. Patients were randomly divided into two groups: Group A was given 4mg dexamethasone injection perioperatively. Group B (control group) was treated conventionally without any steroid injection. Postoperative pain and swelling was evaluated using a visual analog scale (VAS). Objective measurements of facial pain and swelling were performed daily up to six days postoperatively. Dexamethasone group showed significant reduction in pain and swelling postoperatively compared with the control. Submucosal dexamethasone 4mg injection is an effective therapeutic strategy for swift and comfortable improvement after surgical procedure and has a significant effect on reducing postoperative pain and swelling. The treatment offers a simple, safe, painless, noninvasive and cost effective therapeutic option for moderate and severe cases.

  18. Voxel Based Analysis of Surgical Revascularization for Moyamoya Disease: Pre- and Postoperative SPECT Studies.

    Directory of Open Access Journals (Sweden)

    Yasutaka Fushimi

    Full Text Available Moyamoya disease (MMD is a chronic, progressive, cerebrovascular occlusive disease that causes abnormal enlargement of collateral pathways (moyamoya vessels in the region of the basal ganglia and thalamus. Cerebral revascularization procedures remain the preferred treatment for patients with MMD, improving the compromised cerebral blood flow (CBF. However, voxel based analysis (VBA of revascularization surgery for MMD based on data from pre- and postoperative data has not been established. The latest algorithm called as Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL has been introduced for VBA as the function of statistical parametric mapping (SPM8, and improved registration has been achieved by SPM8 with DARTEL. In this study, VBA was conducted to evaluate pre- and postoperative single photon emission computed tomography (SPECT images for MMD by SPM8 with DARTEL algorithm, and the results were compared with those from SPM8 without DARTEL (a conventional method. Thirty-two patients with MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA bypass surgery as the first surgery were included and all patients underwent pre- and postoperative 3D T1-weighted imaging and SPECT. Pre- and postoperative SPECT images were registered to 3D T1-weighted images, then VBA was conducted. Postoperative SPECT showed more statistically increased CBF areas in the bypassed side cerebral hemisphere by using SPM8 with DARTEL (58,989 voxels; P<0.001, and increased ratio of CBF after operation was less than 15%. Meanwhile, postoperative SPECT showed less CBF increased areas by SPM8 without DARTEL. In conclusion, VBA was conducted for patients with MMD, and SPM8 with DARTEL revealed that postoperative SPECT showed statistically significant CBF increases over a relatively large area and with at most 15% increase ratio.

  19. Electro-acupuncture to prevent prolonged postoperative ileus:A randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    M; Kay; Garcia; Joseph; S; Chiang; Bob; Thornton; J; Lynn; Palmer; Jennifer; McQuade; Lorenzo; Cohen

    2010-01-01

    AIM:To examine whether acupuncture can prevent prolonged postoperative ileus(PPOI)after intraperitoneal surgery for colon cancer. METHODS:Ninety patients were recruited from the Fudan University Cancer Hospital,Shanghai,China. After surgery,patients were randomized to receive acupuncture(once daily,starting on postoperative day 1, for up to six consecutive days)or usual care.PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery.The main outcomes were time to first fl...

  20. [Science and clinical practice. 1865 psychiatric convention in Hannover].

    Science.gov (United States)

    Tölle, R

    2006-11-01

    Psychiatric conventions in Germany have taken place since the 1840s. Concerning content and influence, outstanding was one in 1865 for scientists and physicians in Hannover, Germany. Practical and scientific problems of current psychiatric interest were discussed, particularly the question of monomania in the context of Unitarian theory, and further new, extramural ways of psychiatric care which already had received notice abroad (family care, agricultural colonies). The Hannover congress reveals the progressive influence of German institutional psychiatry.

  1. OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE IN THE TREATMENT OF POSTOPERATIVE HEMIPLEGIA

    Institute of Scientific and Technical Information of China (English)

    包飞; 张云祥

    2004-01-01

    Objective: To observe the therapeutic effect of acupuncture in the treatment of hemiplegia resulted from craniocerebral operation. Methods: A total of 40 cases of postoperative hemiplegia patients were randomly and evenly divided into treatment group and control group that were respectively treated with acupuncture plus conventional therapy (anti-inflammation, intracranial pressure-lowering and alimentotherapy) and conventional therapy. Results: After treatment, the therapeutic effect for raising myodynamia of the paralyzed limbs in treatment group was significantly superior to that of control group (upper limb P<0.01, and lower limb P<0.05). Conclusion: Acupuncture can effectively facilitate the recovery of the paralyzed limb in patients undergoing cerebral surgical operation.

  2. Delirium is associated with early postoperative cognitive dysfunction

    DEFF Research Database (Denmark)

    Rudolph, J.L.; Marcantonio, E.R.; Culley, D.J.

    2008-01-01

    The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects......). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative...... cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive...

  3. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    Science.gov (United States)

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

  4. Peripherally applied opioids for postoperative pain

    DEFF Research Database (Denmark)

    Nielsen, B N; Henneberg, S W; Schmiegelow, K;

    2015-01-01

    BACKGROUND: Opioids applied peripherally at the site of surgery may produce postoperative analgesia with few side effects. We performed this systematic review to evaluate the analgesic effect of peripherally applied opioids for acute postoperative pain. METHODS: We searched PubMed (1966 to June...... 2013), Embase (1980 to June 2013), and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 6). Randomized controlled trials investigating the postoperative analgesic effect of peripherally applied opioids vs. systemic opioids or placebo, measured by pain intensity...... difference -5 mm, 95% CI: -7 to -3) for peripherally applied opioids vs. placebo and statistically significant increased time to first analgesic (mean difference 153 min, 95% CI: 41-265). When preoperative inflammation was reported (five studies), peripherally applied opioids significantly improved...

  5. Evaluation for postoperative recurrence of Crohn disease.

    Science.gov (United States)

    Swoger, Jason M; Regueiro, Miguel

    2012-06-01

    Disease recurrence following resective surgery for Crohn disease remains a challenging clinical problem, and more studies are needed to better define risk stratification and treatment recommendations in the postoperative setting. Endoscopy remains the gold standard for the assessment of postoperative disease recurrence, and all Crohn disease patients who undergo surgery should undergo ileocolonoscopy within 6 to 12 months of surgery. The degree of endoscopic recurrence in the neoterminal ileum during this procedure provides prognostic information regarding the severity of the future disease course. WCE, MRE, and SICUS are all promising noninvasive modalities to assess for postoperative Crohn disease activity. However, further studies are needed to better define scoring systems, operating characteristics and variability, and prognostic data for each of these modalities. In patients at risk for early disease recurrence, more aggressive prophylactic therapy should be considered, in hopes of delivering true “top-down” therapy that may offer maximum impact in altering the natural history of Crohn disease.

  6. Biomarkers of postoperative delirium and cognitive dysfunction

    Directory of Open Access Journals (Sweden)

    Ganna eAndrosova

    2015-06-01

    Full Text Available Elderly surgical patients frequently experience postoperative delirium (POD and the subsequent development of postoperative cognitive dysfunction (POCD. Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers.

  7. Postoperative course of chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Toshiaki; Tsubone, Kyoji; Kyuma, Yoshikazu; Kuwabara, Takeo (Yokohama City Univ. (Japan). Faculty of Medicine)

    1983-10-01

    1) Fourty cases of chronic subdural hematoma were operated on by trephination, irrigation and external drainage. Postoperative neurological recovery and decrease of hematoma cavity on CT scan were followed. 2) Operations were effective for recovery of neurological grade in 28 cases, moderately effective in 7 cases and not effective in 5 cases. 3) Within the tenth postoperative day, more than half residual hematoma cavity existed in 53% of examined cases. After that, more than half residual cavity existed in only 17%. 4) Preoperative feature of neurologically unimproved cases were no definite history of head trauma and water like low density of hematoma cavity. Postoperative feature was persistence of more than three fourth of residual hematoma cavity on CT scan. 5) A group of unimproved cases described above are thought to have a feature of subdural hygroma rather than subdural hematoma. When possibility of subdural hygroma is high in preoperative differential diagnosis, indication of operation should be different from chronic subdural hematoma.

  8. [Postoperative respiratory insufficiency and its treatment].

    Science.gov (United States)

    Kösek, V; Wiebe, K

    2015-05-01

    The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.

  9. Postoperative recovery profile after elective abdominal hysterectomy: a prospective, observational study of a multimodal anaesthetic regime

    DEFF Research Database (Denmark)

    Jensen, Kenneth; Kehlet, Henrik; Lund, Claus M

    2009-01-01

    BACKGROUND AND OBJECTIVE: To evaluate the applicability, effectiveness, immediate postoperative complaints and requirements for a postanaesthesia care unit stay after elective abdominal hysterectomy under a well defined, multimodal anaesthetic regime. METHODS: Observational study of 145 consecutive...... patients scheduled for the procedure at a major university hospital in Denmark. Perioperative treatments and postoperative complaints were recorded continuously until discharge from the postanaesthesia care unit. Main outcome measures were treatment regimen adherence, pain, nausea and vomiting, respiratory...... epidural analgesia (bupivacaine, morphine) was feasible in more than 90% of all patients. In the postanaesthesia care unit, 64% did not require opioids, but 25% experienced severe pain. Mean length of stay was 2 h with a mean discharge readiness of 80 min. Half the patients required supplemental oxygen...

  10. Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Christensen, Dorte Stig; Krasheninnikoff, Michael;

    2006-01-01

    a multidisciplinary effort between anaesthesiologists and orthopaedic surgeons. METHODS: During the first 25 weeks of 2004, 98 consecutive community-residing patients admitted to a hip fracture unit received daily rounds by anaesthesiologists during the first four post-operative days, on weekdays only, focusing...... on all facets of peri-operative care. Two hours were allotted to rounds in the 14-bed unit. One hundred and twenty-six consecutive patients admitted to the unit in 2003, receiving the same well-defined care programme, were chosen as a control group. Outcome measures were morbidity and the need for visits...... in the intervention group (P = 0.02). There was no significant difference between post-operative morbidity and hospital stay in the control and intervention groups; in-hospital mortality was 12% in the control group and 7% in the intervention group (P = 0.24). The rounds by anaesthesiologists improved nursing care...

  11. Early postoperative oral feeding impacts positively in patients undergoing colonic resection: results of a pilot study La alimentación oral precoz posoperatoria tiene un impacto positivo en pacientes sometidos a resección colónica: resultados de un estudio piloto

    OpenAIRE

    M. Lobato Dias Consoli; L. Maciel Fonseca; R. Gomes da Silva; M.ª I. Toulson Davisson Correia

    2010-01-01

    Background and aims: Early oral feeding after colorectal resections is one of the many factors that contributes to enhance recovery after surgery, mainly impacting on postoperative ileus. The aim of this study was to evaluate the impact of early postoperative oral feeding in patients undergoing elective colorectal resection. Methods: Patients were randomly assigned to either a conventional postoperative dietary regimen or a free diet on the first postoperative day. Results: Altogether 29 pati...

  12. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    Science.gov (United States)

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  13. Pylorus-preserving whipple pancreaticoduodenectomy : CT findings of immediate postoperative complications

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keon Woo; Kim, Tae Hun [Kyungpook National Univ., Taegu (Korea, Republic of). School of Medicine

    1998-03-01

    The purpose of this paper is to determine the CT findings of immediately postoperative complications including anastomotic leakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications of pylorus preserving whipple pancreaticoduodenectomy (PPPD). During the early postoperative period, fluid accumulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, the time interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, we compared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oral water-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, the site of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram via percutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluid collections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case with six patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six, this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomotic leakage. In some cases of suspected complications arising after PPPD, and including anastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in such cases, CT scanning may help detect the complications and determine the site of anastomotic leakage. (author). 10 refs., 2 figs.

  14. Recognition of Delirium in Postoperative Elderly Patients: A Multicenter Study.

    Science.gov (United States)

    Numan, Tianne; van den Boogaard, Mark; Kamper, Adriaan M; Rood, Paul J T; Peelen, Linda M; Slooter, Arjen J C

    2017-09-01

    To evaluate to what extent delirium experts agree on the diagnosis of delirium when independently assessing exactly the same information and to evaluate the sensitivity of delirium screening tools in routine daily practice of clinical nurses. Prospective observational longitudinal study. Three medical centers in the Netherlands. Elderly postoperative adults (n = 167). A researcher examined participants daily (Postoperative Day 1-3) for delirium using a standardized cognitive assessment and interview including the Delirium Rating Scale Revised-98 as global impression without any cut-off values that was recorded on video. Two delirium experts independently evaluated the videos and clinical information from the last 24 hours in the participants' record and classified each assessment as delirious, possibly delirious, or not delirious. Interrater agreement between the delirium experts was determined using weighted Cohen's kappa. When there was no consensus, a third expert was consulted. Final classification was based on median score and compared with the results of the Confusion Assessment Method for Intensive Care Unit and Delirium Observation Scale that clinical nurses administered. Four hundred twenty-four postoperative assessments of 167 participants were included. The overall kappa was 0.61 (95% confidence interval = 0.53-0.68). There was no agreement between the experts for 89 (21.0%) assessments and a third delirium expert was needed for the final classification. Delirium screening that nurses performed detected 32% of the assessments that the experts diagnosed as (possibly) delirious. There was considerable disagreement in classification of delirium by experts who independently assessed exactly the same information, showing the difficulty of delirium diagnosis. Furthermore, the sensitivity of daily delirium screening by clinical nurses was poor. Future research should focus on development of objective instruments to diagnose delirium. © 2017, Copyright the

  15. Pathogenic Staphylococcus aureus Isolates from Postoperative Wounds of Hospitalized Patients

    Directory of Open Access Journals (Sweden)

    Smritikana Biswas

    2010-07-01

    Full Text Available Staphylococcus sp., gram positive pyogenic bacteria located on skin, nose etc, secretes toxin that causes toxic shock syndrome, abscess, food poisoning and other infectious diseases. This study was carried out to identify and characterize the type of Staphylococcus sp. bacteria especially Staphylococcus aureus in the pus from postoperative wounds of hospitalized patients. From pus samples collected from twenty-four patients from Kharagpur Hospital, Paschim Medinipur, West Bengal, twenty-eight bacterial isolates were obtained. Among them twenty-five (89.2% were appeared with golden yellow colonies which is usually formed by Staphylococcus aureus. Twenty-three (82.14% of the bacterial isolates were Gram positive. Among them twenty isolates (86.9% were further confirmed to be Staphylococcus aureus by their ability to produce Catalase enzyme (positive in Catalase test and Coagulase enzyme (positive in Coagulase Test. Eighteen (90.00% of these Staphylococcus aureus were found to liquefy gelatin (Gelatin hydrolysis test, were able to hydrolyze urea (Urea hydrolysis test and were also l positive in Mannitol Fermentation Test. But there was no growth found of these isolates on MacConkey Agar, while sixteen isolates (80.00% of Staphylococcus aureus were resistant to penicillin (50µg/ml. Moreover eighteen (90.00% Staphylococcus aureus isolates were able to elaborate Hemolysin (Hemolysis test on Blood Agar media. Hence the bacterial isolates obtained from pus of postoperative wounds were predominantly pathogenic Staphylococcus aureus. So it can be concluded that careful treatment and postoperative measures to be taken to avoid serious health problem that may often be life threatening.

  16. Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Nertila Kodra

    2016-05-01

    Full Text Available BACKGROUND: Incidence of postoperative pulmonary complications (PPC in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures. MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors. RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01. CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

  17. EFFICACY OF HYOSCINE BUTYL BROMIDE SUPPOSITORY FOR POSTOPERATIVE PAIN RELIEF

    Directory of Open Access Journals (Sweden)

    Soniya C. Alphonse

    2017-07-01

    Full Text Available BACKGROUND Caesarean Section is on the rise all over the world. Women undergoing Caesarean section often wish to be awake post operatively and to avoid excessive medications affecting interactions with the new born infant. Multimodal pain therapy has been advocated for postoperative pain management after caesarean section. MATERIALS AND METHODS The study is a prospective randomized controlled study conducted at a tertiary care hospital to study the effect of Hyoscine Butyl Bromide Suppositories for postoperative analgesia following elective repeat caesarean section. The study included sixty patients divided into two groups- Group1 (study group were given Hyoscine Butyl Bromide Suppository (10 mg along with Injection. Tramadol 50 mg IM and Group II (control group were given Injection Tramadol IM only at the end of surgery. Pain score of the patient assessed at 1 hr, 2 hrs, 6hrs and 24 hrs post operatively. The total no of doses of injection tramadol needed in 24 hrs and the interval between 1st and 2nd dose of tramadol was also noted. The adverse effects of the drug and additional advantages of the drug if any were also assessed. RESULTS There was no statistically significant difference in pain score during the assessment intervals between the two groups. There was no difference in the number of doses of tramadol needed in the first 24 hrs. The mean interval between the 1st and 2nd dose of tramadol was found to be 7.6538 hours for group 1 patients and 6.9130 for group patients which was found to be statistically significant. There was no statistically significant side effects/ additional advantages for the drugs. CONCLUSION Concurrent administration of Hyoscine Butyl Bromide Suppository (10 mg and injection Tramadol 50 mg IM offers a longer postoperative analgesia without any increased adverse effects.

  18. Post-operative delirium in elderly patients

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2014-01-01

    Full Text Available Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge about the disease, diagnosis, pathogenesis, preventive strategies, and treatment of post-operative delirium.

  19. Outsourced cataract surgery and postoperative endophthalmitis

    DEFF Research Database (Denmark)

    Solborg Bjerrum, Søren; Kiilgaard, Jens F; Mikkelsen, Kim Lyngby;

    2013-01-01

    To compare the risk of postoperative endophthalmitis (PE) after cataract surgery at eye departments in public hospitals and private hospitals/eye clinics and to evaluate if the Danish National Patient Registry (NPR) is a reliable database to monitor the PE risk.......To compare the risk of postoperative endophthalmitis (PE) after cataract surgery at eye departments in public hospitals and private hospitals/eye clinics and to evaluate if the Danish National Patient Registry (NPR) is a reliable database to monitor the PE risk....

  20. Imaging of postoperative knee extensor mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Motamedi, Kambiz [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-59, Los Angeles, CA 90095 (United States); Seeger, Leanne L. [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-57, Los Angeles, CA 90095 (United States); Hame, Sharon L. [David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Box 956902, 76-143 CHS, Los Angeles, CA 90095 (United States)

    2005-05-01

    Disorders of the anterior knee are common and include patellofemoral syndrome, patella instability, patella fracture, and patellar and quadriceps tendon ruptures. Depending on the operative procedure performed, the post-operative imaging appearance of these knees may be confusing. It is crucial for the radiologist to be familiar with the procedures performed in order to recognize the postoperative findings. Radiologists must be able to interpret hardware (anchors, screw and wires) and disruptions in soft tissue planes that may persist with these types of procedures.

  1. Comparison of a Vessel Sealing System with a Conventional Technique in Hemorrhoidectomy

    Directory of Open Access Journals (Sweden)

    Serkan Teksöz

    2011-06-01

    Full Text Available Objective: Milligan-Morgan, Park and Ferguson hemorrhoidectomy procedures are the ones most frequently used for the surgical treatment of hemorrhoidal disease. Attempts to modify these conventional approaches are made by using different techniques or tools to decrease blood loss, and reduce operating time and postoperative analgesic requirement. In this prospective randomized trial, the conventional Ferguson hemorrhoidectomy method is compared with the LigaSure® hemorrhoidectomy according to various criteria. Material and Methods: Forty patients who had grade 3-4 hemorrhoidal disease were randomly divided into two equal groups: the Ferguson Hemorrhoidectomy (n=20 and the LigaSure® hemorrhoidectomy (n=20. Operating time, demographic data, intraoperative and postoperative complications, postoperative pain, return of bowel movements and postoperative hospital stay were evaluated. The visual analogue score was used for the evaluation of pain on the first postoperative day. The patients have been followed up for at least 19 months. Results: The pain score, blood loss and operating time were significantly reduced in the LigaSure® hemorrhoidectomy group. Conclusion: LigaSure® hemorrhoidectomy is safe and feasible for the surgeon, and more comfortable than classical surgery for the patient.

  2. NULL Convention Floating Point Multiplier

    Directory of Open Access Journals (Sweden)

    Anitha Juliette Albert

    2015-01-01

    Full Text Available Floating point multiplication is a critical part in high dynamic range and computational intensive digital signal processing applications which require high precision and low power. This paper presents the design of an IEEE 754 single precision floating point multiplier using asynchronous NULL convention logic paradigm. Rounding has not been implemented to suit high precision applications. The novelty of the research is that it is the first ever NULL convention logic multiplier, designed to perform floating point multiplication. The proposed multiplier offers substantial decrease in power consumption when compared with its synchronous version. Performance attributes of the NULL convention logic floating point multiplier, obtained from Xilinx simulation and Cadence, are compared with its equivalent synchronous implementation.

  3. NULL convention floating point multiplier.

    Science.gov (United States)

    Albert, Anitha Juliette; Ramachandran, Seshasayanan

    2015-01-01

    Floating point multiplication is a critical part in high dynamic range and computational intensive digital signal processing applications which require high precision and low power. This paper presents the design of an IEEE 754 single precision floating point multiplier using asynchronous NULL convention logic paradigm. Rounding has not been implemented to suit high precision applications. The novelty of the research is that it is the first ever NULL convention logic multiplier, designed to perform floating point multiplication. The proposed multiplier offers substantial decrease in power consumption when compared with its synchronous version. Performance attributes of the NULL convention logic floating point multiplier, obtained from Xilinx simulation and Cadence, are compared with its equivalent synchronous implementation.

  4. Towards a Theory of Convention

    DEFF Research Database (Denmark)

    Hansen, Pelle Guldborg

    2006-01-01

    theory. Like for the study of common knowledge much has happened in this latter field since then. The theory of convention has been developed and extended so as to include multiple types as well as a basis for the study of social norms. However, classical game theory is currently undergoing severe crisis...... as a tool for understanding and explaining social phenomena; a crisis emerging from the problem of equilibrium selection around which any theory of convention must revolve. The so-called evolutionary turn in game theory marks a transition from the classical assumptions of rationality and common knowledge...... of such to evolutionary game theoretical frameworks inspired by the models of (Maynard Smith & Price 1973), (Taylor & Jonker 1978) and (Maynard Smith 1982). By providing an account of equilibrium selection these are thought to work as well-defined metaphors of learning processes upon which a revised theory of convention...

  5. Patella Eversion Reduces Early Knee Range of Motion and Muscle Torque Recovery after Total Knee Arthroplasty: Comparison between Minimally Invasive Total Knee Arthroplasty and Conventional Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Tokifumi Majima

    2011-01-01

    Full Text Available We hypothesized that patella eversion during total knee arthroplasty (TKA reduces early return of active knee extension and flexion, quadriceps muscle strength, and postoperative pain. In 100 conventional TKA knees and 100 minimally invasive TKA (MIS TKA knees, we compared knee range of motion (ROM, postoperative pain, and quadriceps muscle strength at 1 day, 4 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 12 weeks, 1 year, and 5 years after surgery. The differences of surgical approach between MIS TKA and conventional TKA of this study are length of skin incision with subcutaneal flap and patella eversion. In MIS TKA, skin incision is shorter than conventional TKA. Furthermore, patella is not everted in MIS TKA procedure. There were no significant differences in preoperative factors. Postoperative improvement of ROM, postoperative muscle strength recovery, and postoperative improvement of visual analog scale were faster in patients with MIS TKA when compared to that in patients with conventional TKA. On the other hand, no significant difference was observed in complication, 5-year clinical results of subjective knee function score, and the postoperative component angle and lower leg alignment. These results indicate that patella eversion may affect muscle strength recovery and postoperative pain.

  6. Postoperative Adiponectin Levels in Pediatric Patients Undergoing Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    A. Thaler

    2013-01-01

    Full Text Available Background. Adipose tissue is an important endocrine organ that secretes cytokines, including adiponectin, levels of which are negatively correlated with the severity of the inflammatory process. Aim. To assess the time course of adiponectin levels following open heart surgery with cardiopulmonary bypass and its correlation with early postoperative outcomes. Materials and Methods. Blood samples were obtained from 24 children undergoing cardiac surgery and analyzed for adiponectin, C-reactive protein, and other inflammatory markers. Results. Baseline adiponectin levels were negatively correlated with patients’ preoperative weight and age. Postoperative adiponectin levels decreased compared to baseline ( and correlated negatively with duration of cardiopulmonary bypass (, , length of stay in the pediatric intensive care unit (, , and the inotropic score (, . Adiponectin levels were positively correlated with sVCAM 1 levels; however, there was no correlation between adiponectin levels and sP selectin, tPA, MCP1, and sCD40. Conclusions. The inflammatory response after open heart surgery with cardiopulmonary bypass is associated with a reduction in adiponectin levels. Prolonged or more complicated surgery induced a more substantial inflammatory process characterized by a significant reduction in adiponectin levels over time and a delayed return to baseline levels.

  7. Towards a Theory of Convention

    DEFF Research Database (Denmark)

    Hansen, Pelle Guldborg

    2006-01-01

    theory. Like for the study of common knowledge much has happened in this latter field since then. The theory of convention has been developed and extended so as to include multiple types as well as a basis for the study of social norms. However, classical game theory is currently undergoing severe crisis...... as a tool for understanding and explaining social phenomena; a crisis emerging from the problem of equilibrium selection around which any theory of convention must revolve. The so-called evolutionary turn in game theory marks a transition from the classical assumptions of rationality and common knowledge...

  8. Annual report of Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2013.

    Science.gov (United States)

    Douchi, Tsutomu; Wakatsuki, Akihiko

    2014-02-01

    The activity of the Women's Health Care Committee for 1 year up to June 2013 includes: (i) guides for the management of health care in middle-aged women; (ii) postoperative women's health care; (iii) survey on the treatment of pelvic organ prolapse; and (iv) survey of postoperative infection in gynecologic surgery. The detailed activity of the four subcommittees is described in the text.

  9. Postoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?

    DEFF Research Database (Denmark)

    Krenk, L; Rasmussen, L S

    2011-01-01

    Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities of postoperat......Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities...... of postoperative cognitive decline, delirium and postoperative cognitive dysfunction, which are often reported as being part of the same continuum. Although there are similarities in the predisposing factors, it seems unlikely that they share the same pathophysiology. Both have multifactorial pathogenesis...... but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological...

  10. Prospective Randomized Trial Comparing Hepatic Venous Outflow and Renal Function after Conventional versus Piggyback Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Marília D'Elboux Guimarães Brescia

    Full Text Available This randomized prospective clinical trial compared the hepatic venous outflow drainage and renal function after conventional with venovenous bypass (n = 15 or piggyback (n = 17 liver transplantation.Free hepatic vein pressure (FHVP and central venous pressure (CVP measurements were performed after graft reperfusion. Postoperative serum creatinine (Cr was measured daily on the first week and on the 14th, 21st and 28th postoperative days (PO. The prevalence of acute renal failure (ARF up to the 28th PO was analyzed by RIFLE-AKIN criteria. A Generalized Estimating Equation (GEE approach was used for comparison of longitudinal measurements of renal function.FHVP-CVP gradient > 3 mm Hg was observed in 26.7% (4/15 of the patients in the conventional group and in 17.6% (3/17 in the piggyback group (p = 0.68. Median FHVP-CVP gradient was 2 mm Hg (0-8 mmHg vs. 3 mm Hg (0-7 mm Hg in conventional and piggyback groups, respectively (p = 0.73. There is no statistically significant difference between the conventional (1/15 and the piggyback (2/17 groups regarding massive ascites development (p = 1.00. GEE estimated marginal mean for Cr was significantly higher in conventional than in piggyback group (2.14 ± 0.26 vs. 1.47 ± 0.15 mg/dL; p = 0.02. The conventional method presented a higher prevalence of severe ARF during the first 28 PO days (OR = 3.207; 95% CI, 1.010 to 10.179; p = 0.048.Patients submitted to liver transplantation using conventional or piggyback methods present similar results regarding venous outflow drainage of the graft. Conventional with venovenous bypass technique significantly increases the harm of postoperative renal dysfunction.ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT01707810.

  11. The effect of aromatherapy on postoperative nausea in women undergoing surgical procedures.

    Science.gov (United States)

    Ferruggiari, Luisa; Ragione, Barbara; Rich, Ellen R; Lock, Kathleen

    2012-08-01

    Postoperative nausea and vomiting (PONV) is a common source of patient discomfort and decreased satisfaction. Aromatherapy has been identified as a complementary modality for the prevention and management of PONV. The purpose of this study was to assess the effect of aromatherapy on the severity of postoperative nausea (PON) in women undergoing surgical procedures in the postanesthesia care unit. Women complaining of PON received traditional antiemetics, inhalation of peppermint oil, or saline vapor. A visual analog scale was used to rate nausea at the first complaint; at 5 minutes after intervention; and, if nausea persisted, at 10 minutes after intervention. At both 5 and 10 minutes, statistical analysis showed no significant differences between intervention and nausea rating. Obtaining eligible subjects was challenging. Although many women consented, most received intraoperative antiemetics and did not report nausea postoperatively.

  12. Evidence based postoperative treatment of distal radius fractures following internal locking plate fixation.

    Science.gov (United States)

    Klein, S M; Prantl, L; Koller, M; Vykoukal, J; Dolderer, J H; Graf, S; Nerlich, M; Loibl, M; Geis, S

    2015-01-01

    Originally, the treatment method of choice for distal radial fractures (DRF) has been a non-operative approach with six to eight weeks of plaster casting. The introduction of volar locking plate systems at the beginning of the 21 st century has pushed trends towards open reduction and internal fixation (ORIF). While the introduction of fixed angle locking plates together with the increasing knowledge on wrist function and related variable outcomes has led to consensus that operative fixation in instable DRF is the treatment method of choice, there is no agreement on a postoperative care of these injuries. The authors will discuss the available evidence for current concepts of postoperative treatment of DRFs following fixed angle fixation under socioeconomical, biomechanical and burden of disease aspects. Further, relevant randomized controlled trials are evaluated with regard to applied postoperative treatment regimes and related risks for complications.

  13. Tourniquet use during ankle surgery leads to increased postoperative opioid use

    DEFF Research Database (Denmark)

    Kruse, Heidi; Christensen, Kristian P; Møller, Ann M

    2015-01-01

    STUDY OBJECTIVE: Ankle surgery is often done using a tourniquet. Ischemia/reperfusion injury caused by the tourniquet may increase postoperative pain. The study objective was to investigate the amount of opioids given to patients after ankle surgery with and without tourniquet. DESIGN: We did......: Main outcome was opioid use during first 24 hours postoperatively (in equipotent intravenous morphine doses). Secondary outcomes were the peak pain on a verbal rating scale, time in postanesthetic care unit, and additional antiemetic medicine. We performed multiple regression to analyze the primary...... outcome. MAIN RESULTS: Three hundred fifty-eight patients underwent surgery with tourniquet. There was a correlation between tourniquet time and postoperative opioid use (P value = .001) after controlling for confounders. The slope of the correlation was 0.04 mg/min (95% confidence interval, 0...

  14. Pyothorax in a cat managed by intrathoracic debridement and postoperative ventilatory support

    Directory of Open Access Journals (Sweden)

    Doyle Ronan S

    2005-04-01

    Full Text Available A domestic-longhair cat presented due to lethargy, dyspnoea and hypersalivation. Radiographic examination revealed a bilateral pleural effusion, which was diagnosed as pyothorax based on cytological examination. Ultrasonographic examination revealed extensive loculations within the thoracic cavity. Exploratory sternotomy, under general anaesthesia, allowed the removal of approximately 100 ml of purulent fluid and debridement of a partially walled-off abscess and necrotic material from the pleural cavity. Postoperative positive-pressure ventilation was required due to severe respiratory depression. Intensive postoperative care, including intensive continuous monitoring, thoracostomy tube drainage and lavage of the pleural cavity and oesophagostomy tube feeding, was performed. Complete resolution of clinical signs had occurred by 15 days postoperatively. Clinical or radiographic abnormalities were not detected at a follow-up examination one year after surgery.

  15. Toddlers' Social Interactions Regarding Moral and Conventional Trangressions.

    Science.gov (United States)

    Smetana, Judith G.

    1984-01-01

    Social interactions regarding moral and conventional transgressions were observed among two toddler groups. Each of 16 day care center classrooms, eight serving 13- to 27-month-olds and eight serving 18- to 40-month-olds, was observed for three 45-minute sessions. Implications of results concerned the developmental origins of distinctions between…

  16. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing majo

  17. Postoperative pain treatment for ambulatory surgery.

    Science.gov (United States)

    Rawal, Narinder

    2007-03-01

    One of the most significant changes in surgical practice during the last two decades has been the growth of ambulatory surgery. Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery. Recent studies have shown that large numbers of patients suffer from moderate to severe pain during the first 24-48 hr. The success of fast-tracking depends to a considerable extent on effective postoperative pain management routines and the cost saving of outpatient surgery may be negated by unanticipated hospital admission for poorly treated pain. Depending on the intensity of postoperative pain current management includes the use of analgesics such as paracetamol, NSAIDs including coxibs and tramadol as single drugs or in combination as part of balanced (multimodal) analgesia. However, in the ambulatory setting many patients suffer from pain at home in spite of multimodal analgesic regimens. Sending patients home with perineural, incisional, and intra-articular catheters is a new and evolving area of postoperative pain management. Current evidence suggests that these techniques are effective, feasible and safe in the home environment if appropriate patient selection routines and organization for follow-up are in place.

  18. Ranitidine improves postoperative monocyte and neutrophil function

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Nielsen, H; Jensen, S;

    1994-01-01

    BACKGROUND: The histamine H2-receptor antagonist ranitidine hydrochloride has been shown to improve trauma-, blood transfusion-, and sepsis-induced immunosuppression. OBJECTIVE: To evaluate the effect of ranitidine on postoperative impairment in monocyte and neutrophil function. METHODS: Twenty...... difference (P detected. There were no infectious complications in ranitidine-treated patients. CONCLUSION: These results support previous studies...

  19. Characterizing postoperative cognitive dysfunction in the elderly

    NARCIS (Netherlands)

    Hovens, Iris Bertha

    2015-01-01

    In the Netherlands, yearly more than 400.000 elderly patients undergo surgery. An estimated ten percent of these patients develops long-lasting postoperative cognitive dysfunction (POCD), associated with a reduced quality of life, increased dependency and worse prognosis. Currently, there is no

  20. Prevention of postoperative pain by balanced analgesia

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Dirkes, W E;

    1990-01-01

    Fourteen patients undergoing colorectal surgery received an intraoperative afferent neural block with combined intrathecal and extradural local anaesthetics plus a balanced postoperative low-dose regimen of extradural bupivacaine 10 mg h-1-morphine 0.2 mg h-1 and systemic piroxicam 20 mg/24 h...

  1. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  2. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain...

  3. Management of pain in the postoperative neonate.

    Science.gov (United States)

    Truog, R; Anand, K J

    1989-03-01

    Only recently has the use of anesthesia and analgesia become widely accepted in the newborn infant. This is largely a result of the overwhelming evidence that neonates have the neurologic substrate for the perception of pain and display characteristic behavioral, physiologic, metabolic, and hormonal responses to noxious stimuli. The management of postoperative pain in the surgical neonate begins in the operating room, where techniques can be chosen that will ease the transition into the postoperative period. For postoperative analgesia, the most widely used and effective agents are the narcotics morphine and fentanyl. They may be administered either intermittently or continuously, and with proper precautions may be given to both intubated and nonintubated newborns. Other medications for analgesia and sedation are not as well studied in the newborn, but chloral hydrate and the benzodiazepines are useful for sedation, and acetaminophen may be used for analgesia alone or for potentiating the effect of narcotics. In addition, a number of creative nonpharmacologic techniques are being developed and promise to further decrease the discomfort experienced by postoperative neonates.

  4. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT ima